title: Predisposing characteristics, enabling resources and need as predictors of utilization and clinical outcomes for veterans receiving mental health services.
abstract: BACKGROUND
  Though demand for mental health services (MHS) among US veterans is increasing, MHS utilization per veteran is decreasing. With health and social service needs competing for limited resources, it is important to understand the association between patient factors, MHS utilization, and clinical outcomes.
  
  
  OBJECTIVE
  We use a framework based on Andersen's behavioral model of health service utilization to examine predisposing characteristics, enabling resources, and clinical need as predictors of MHS utilization and clinical outcomes.
  
  
  METHODS
  This was a prospective observational study of veterans receiving inpatient or outpatient MHS through Veterans Administration programs. Clinician ratings (Global Assessment of Functioning [GAF]) and self-report assessments (Behavior and Symptom Identification Scale-24) were completed for 421 veterans at enrollment and 3 months later. Linear and logistic regression analyses were conducted to examine: (1) predisposing characteristics, enabling resources, and need as predictors of MHS inpatient, residential, and outpatient utilization and (2) the association between individual characteristics, utilization, and clinical outcomes.
  
  
  RESULTS
  Being older, female, having greater clinical need, lack of enabling resources (employment, stable housing, and social support), and easy access to treatment significantly predicted greater MHS utilization at 3-month follow-up. Less clinical need and no inpatient psychiatric hospitalization predicted better GAF and Behavior and Symptom Identification Scale-24 scores. White race and residential treatment also predicted better GAF scores. Neither enabling resources, nor number of outpatient mental health visits predicted clinical outcomes.
  
  
  CONCLUSIONS
  This application of Andersen's behavioral model of health service utilization confirmed associations between some predisposing characteristics, need, and enabling resources on MHS utilization but only predisposing characteristics, need, and utilization were associated with clinical outcomes.
authors.affiliation: Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA. dfasoli@bu.edu
authors.forename: DiJon R
authors.initials: DR
authors.lastname: Fasoli
authors.forename: Mark E
authors.initials: ME
authors.lastname: Glickman
authors.forename: Susan V
authors.initials: SV
authors.lastname: Eisen
mesh_terms: D000328:Adult; D001900:Boston; D005260:Female; D005544:Forecasting; D019538:Health Care Surveys; D006301:Health Services Needs and Demand; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D019370:Observation; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D014728:Veterans / Q000523:psychology*