title: Health service utilization for mental, behavioural and emotional problems among conflict-affected population in Georgia: a cross-sectional study.
abstract: BACKGROUND
  There is large gap in mental illness treatment globally and potentially especially so in war-affected populations. The study aim was to examine health care utilization patterns for mental, behavioural and emotional problems among the war-affected adult population in the Republic of Georgia.
  
  
  METHODS
  A cross-sectional household survey was conducted among 3600 adults affected by 1990s and 2008 armed conflicts in Georgia. Service use was measured for the last 12 months for any mental, emotional or behavioural problems. TSQ, PHQ-9 and GAD-7 were used to measure current symptoms of PTSD, depression and anxiety. Descriptive and regression analyses were used.
  
  
  RESULTS
  Respondents were predominantly female (65.0%), 35.8% were unemployed, and 56.0% covered by the government insurance scheme. From the total sample, 30.5% had symptoms of at least one current mental disorder. Among them, 39.0% sought care for mental problems, while 33.1% expressed facing barriers to accessing care and so did not seek care. General practitioners (29%) and neurologists (26%) were consulted by the majority of those with a current mental disorder who accessed services, while use of psychiatric services was far more limited. Pharmacotherapy was the predominant type of care (90%). Female gender (OR 1.50, 95% CI: 1.25, 1.80), middle-age (OR 1.83, 95% CI: 1.48, 2.26) and older-age (OR 1.62, 95% CI: 1.19, 2.21), possession of the state insurance coverage (OR 1.55, 95% CI: 1.30, 1.86), current PTSD symptoms (OR 1.56, 95% CI: 1.29, 1.90) and depression (OR 2.12, 95% CI: 1.70, 2.65) were associated with higher rates of health service utilization, while employed were less likely to use services (OR 0.71, 95% CI: 0.55, 0.89).
  
  
  CONCLUSIONS
  Reducing financial access barriers and increasing awareness and access to local care required to help reduce the burden of mental disorders among conflict-affected persons in Georgia.
authors: Curatio International Foundation, Tbilisi, Georgia.
authors: Ivdity
authors: I
authors: Chikovani
authors: Global Initiative on Psychiatry, Tbilisi, Georgia and Ilia State University, Tbilisi, Georgia.
authors: Nino
authors: N
authors: Makhashvili
authors: Curatio International Foundation, Tbilisi, Georgia.
authors: George
authors: G
authors: Gotsadze
authors: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors: Vikram
authors: V
authors: Patel
authors: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors: Martin
authors: M
authors: McKee
authors: Curatio International Foundation, Tbilisi, Georgia.
authors: Maia
authors: M
authors: Uchaneishvili
authors: Curatio International Foundation, Tbilisi, Georgia.
authors: Natia
authors: N
authors: Rukhadze
authors: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors: Bayard
authors: B
authors: Roberts
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology*; D003866:Depressive Disorder / Q000453:epidemiology; D005260:Female; D005846:Georgia (Republic); D006296:Health Services; D006801:Humans; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D000067453:War Exposure