title: Factors associated with reported service use for mental health problems by residents of rural and remote communities: cross-sectional findings from a baseline survey.
abstract: BACKGROUND
  The patterns of health service use by rural and remote residents are poorly understood and under-represented in national surveys. This paper examines professional and non-professional service use for mental health problems in rural and remote communities in Australia.
  
  
  METHODS
  A stratified random sample of adults was drawn from non-metropolitan regions of New South Wales, Australia as part of a longitudinal population-based cohort. One-quarter (27.7%) of the respondents were from remote or very remote regions. The socio-demographic, health status and service utilization (professional and non-professional) characteristics of 2150 community dwelling residents are described. Hierarchical logistic regressions were used to identify cross-sectional associations between socio-demographic, health status and professional and non-professional health service utilization variables.
  
  
  RESULTS
  The overall rate of professional contacts for mental health problems during the previous 12 months (17%) in this rural population exceeded the national rate (11.9%). Rates for psychologists and psychiatrists were similar but rates for GPs were higher (12% vs. 8.1%). Non-professional contact rates were 12%. Higher levels of help seeking were associated with the absence of a partner, poorer finances, severity of mental health problems, and higher levels of adversity. Remoteness was associated with lower utilization of non-professional support. A Provisional Service Need Index was devised, and it demonstrated a broad dose-response relationship between severity of mental health problems and the likelihood of seeking any professional or non-professional help. Nevertheless, 47% of those with estimated high service need had no contact with professional services.
  
  
  CONCLUSIONS
  An examination of self-reported patterns of professional and non-professional service use for mental health problems in a rural community cohort revealed relatively higher rates of general practitioner attendance for such problems compared with data from metropolitan centres. Using a measure of Provisional Service Need those with greater needs were more likely to access specialist services, even in remote regions, although a substantial proportion of those with the highest service need sought no professional help. Geographic and financial barriers to service use were identified and perception of service adequacy was relatively low, especially among those with the highest levels of distress and greatest adversity.
authors: Centre of Research Excellence in Rural and Remote Primary Health Care and Department of Rural Health, University of Sydney, Broken Hill, NSW, Australia. DPerkins@gwahs.health.nsw.gov.au
authors: David
authors: D
authors: Perkins
authors: Jeffrey
authors: J
authors: Fuller
authors: Brian J
authors: BJ
authors: Kelly
authors: Terry J
authors: TJ
authors: Lewin
authors: Michael
authors: M
authors: Fitzgerald
authors: Clare
authors: C
authors: Coleman
authors: Kerry J
authors: KJ
authors: Inder
authors: John
authors: J
authors: Allan
authors: Dinesh
authors: D
authors: Arya
authors: Russell
authors: R
authors: Roberts
authors: Richard
authors: R
authors: Buss
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D001523:Mental Disorders / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D009517:New South Wales; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D012111:Residence Characteristics; D012424:Rural Population; D057566:Self Report; D012959:Socioeconomic Factors; D014505:Urban Population; D055815:Young Adult
references: Int J Epidemiol. 2008 Oct;37(5):941-7
references: 17881411
references: BMC Med Res Methodol. 2008 Nov 03;8:71
references: 18980694
references: Med J Aust. 1997 Jun 2;166(11):577-80
references: 9201176
references: Arch Gen Psychiatry. 2003 Feb;60(2):184-9
references: 12578436
references: J Rural Health. 2010 Summer;26(3):205-13
references: 20633088
references: Addiction. 1995 Oct;90(10):1349-56
references: 8616463
references: Aust J Rural Health. 2011 Feb;19(1):38-44
references: 21265924
references: J Rural Health. 2010 Summer;26(3):214-24
references: 20633089
references: Health Aff (Millwood). 2003 Sep-Oct;22(5):8-20
references: 14515877
references: Med J Aust. 2011 Aug 15;195(4):205-9
references: 21843126
references: Acta Psychiatr Scand. 1990 Jul;82(1):77-81
references: 2399824
references: Addiction. 1993 Jun;88(6):791-804
references: 8329970
references: BMC Health Serv Res. 2009 Jul 23;9:124
references: 19624859
references: Aust N Z J Public Health. 2010 Oct;34(5):458-65
references: 21040172
references: J Affect Disord. 2010 Dec;127(1-3):96-101
references: 20466432
references: J Rural Health. 2010 Summer;26(3):203-4
references: 20633087
references: Aust N Z J Psychiatry. 2009 Jul;43(7):594-605
references: 19530016
references: Aust N Z J Psychiatry. 2009 Jul;43(7):615-23
references: 19530018
references: Aust N Z J Psychiatry. 2009 Jul;43(7):624-34
references: 19530019
references: Int J Geriatr Psychiatry. 2003 Apr;18(4):318-24
references: 12673608
references: J Rural Health. 1993 Winter;9(1):57-62
references: 10124199
references: Aust N Z J Public Health. 2001 Dec;25(6):494-7
references: 11824981
references: Med J Aust. 2007 Nov 19;187(10):556-60
references: 18021042
references: Soc Psychiatry Psychiatr Epidemiol. 2010 Oct;45(10):989-98
references: 19798457
references: Aust N Z J Psychiatry. 2010 Sep;44(9):823-30
references: 20815669
references: Br J Psychiatry. 2011 Dec;199(6):479-84
references: 21984803
references: Aust J Rural Health. 2006 Jun;14(3):105-10
references: 16706878
references: Aust J Rural Health. 2010 Feb;18(1):16-24
references: 20136810
references: Soc Psychiatry Psychiatr Epidemiol. 2011 Dec;46(12):1267-74
references: 20978883
references: Soc Sci Med. 2011 Dec;73(11):1593-9
references: 22005316
references: Gen Hosp Psychiatry. 2009 Jan-Feb;31(1):46-55
references: 19134510
references: Aust J Rural Health. 2007 Oct;15(5):304-12
references: 17760914
references: Aust J Rural Health. 2008 Apr;16(2):56-66
references: 18318846
references: Soc Psychiatry Psychiatr Epidemiol. 2011 Oct;46(10):1033-44
references: 20686887
references: J Rural Health. 2010 Summer;26(3):225-33
references: 20633090
references: Can J Psychiatry. 2005 Sep;50(10):643-51
references: 16276856
references: Aust N Z J Psychiatry. 2010 May;44(5):475-81
references: 20397791
references: BMC Public Health. 2012 Aug 01;12:586
references: 22853803
references: Psychiatr Serv. 2010 Mar;61(3):250-7
references: 20194401
references: Can J Psychiatry. 2005 Sep;50(10):614-9
references: 16276852
references: J Rural Health. 2003 Summer;19(3):209-13
references: 12839126
references: Med Care Res Rev. 2002 Sep;59(3):231-65; discussion 266-71
references: 12205828
references: Aust J Rural Health. 2007 Jun;15(3):201-10
references: 17542794
references: Aust J Rural Health. 2010 Feb;18(1):25-31
references: 20136811
references: Soc Psychiatry Psychiatr Epidemiol. 2011 Dec;46(12):1331-42
references: 21046069
references: Soc Psychiatry Psychiatr Epidemiol. 2010 Feb;45(2):153-63
references: 19381427
references: Aust N Z J Psychiatry. 2006 Sep;40(9):769-76
references: 16911752
references: J Gen Intern Med. 2001 Sep;16(9):606-13
references: 11556941