title: Configuration of services used by depressed older adults.
abstract: As a more comprehensive service use measure, this study identifies service use configurations based on the use of 17 services. Factors associated with service use configurations are examined guided by the Andersen and Network Episode models. Self-report data at admission and at six-month follow-up were collected, along with information from medical charts among 140 older adults hospitalized for major depression. The data document service access and levels of use in three sectors of care (psychiatric, medical, and psychosocial services) and assess need, predisposing, enabling, and social network factors associated with use. Three distinct service use configurations were identified with cluster analysis: (1) home care users; (2) moderate users of outpatient mental health services; and (3) heavy users of all formal services. Rather than psychiatric needs, post-acute service use was related to: (1) concurrent physical conditions; (2) the availability of formal and informal services; and (3) financial stability. No difference in psychiatric outcomes was found by service use configuration. It is important to understand service use patterns as a measure of service use, given the co-occurring medical, psychiatric, and psychosocial conditions of older adults and corresponding needs in multiple sectors of care.
authors.affiliation: Center for Mental Health Services Research, George Warren Brown School of Social Work, Washington University, St. Louis, Missouri 63130, USA. schoi@gwbmail.wustl.edu
authors.forename: S
authors.initials: S
authors.lastname: Choi
authors.forename: N
authors.initials: N
authors.lastname: Morrow-Howell
authors.forename: E
authors.initials: E
authors.lastname: Proctor
mesh_terms: D000359:Aftercare / Q000706:statistics & numerical data*; D000368:Aged; D000375:Aging / Q000523:psychology*; D000704:Analysis of Variance; D016000:Cluster Analysis; D003866:Depressive Disorder / Q000191:economics / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006699:Home Care Services / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D020380:Needs Assessment; D012944:Social Support