title: Triple jeopardy: impact of partner violence perpetration, mental health and substance use on perceived unmet need for mental health care among men.
abstract: OBJECTIVE
  To examine the relationship between intimate partner violence (IPV) perpetration, serious mental illness, and substance use and perceived unmet need for mental health treatment in the past year among men in the general population using the behavioral model for health-care use (Aday and Anderson in Health Serv Res 9:208-220, 1974; Andersen in A behavioral model of families' use of health services, 1968; Andersen in Med Care 46:647-653, 2008).
  
  
  METHODS
  Non-Hispanic black, Hispanic, and non-Hispanic white males aged 18-49 years and cohabiting with a spouse/partner were included in this analysis of the 2002 National Survey on Drug Use and Health. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated using logistic regression.
  
  
  RESULTS
  The proportion of men reporting unmet treatment need was greater among IPV perpetrators than nonperpetrators (12.1 vs. 3.4%, respectively). Hazardous drinking, illicit drug use, alcohol and drug abuse/dependence, and SMI were also more common among perpetrators. Perpetrators were twice as likely to report unmet need for treatment after taking predisposing, enabling, and need factors into account (AOR 2.00, CI 1.13-3.55). Alcohol abuse/dependence (AOR 2.96, CI 1.79-4.90), drug abuse/dependence (AOR, 1.79, CI 1.01-3.17), substance abuse treatment (AOR 3.09, CI 1.18-8.09), and SMI (AOR 8.46, CI 5.53-12.94) were independently associated with perceived unmet need for treatment.
  
  
  CONCLUSIONS
  These findings suggest that men who perpetrate IPV are at increased risk of perceived unmet need for mental health care. This study also emphasizes the need to identify substance use disorders and mental health problems among IPV perpetrators identified in health, social service, or criminal justice settings. Further research should address barriers to care specific to men who perpetrate IPV beyond economic factors.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA. Lipsky@u.washington.edu
authors.forename: Sherry
authors.initials: S
authors.lastname: Lipsky
authors.forename: Raul
authors.initials: R
authors.lastname: Caetano
authors.forename: Peter
authors.initials: P
authors.lastname: Roy-Byrne
mesh_terms: D000293:Adolescent; D000328:Adult; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D012307:Risk Factors; D013179:Spouse Abuse / Q000523:psychology*; D019966:Substance-Related Disorders / Q000523:psychology*; D055815:Young Adult