Socioeconomic Status and Mental Health Service Use Among National Guard Soldiers.
OBJECTIVE
Convergent evidence suggests that low socioeconomic status (SES) may be related to reduced mental health service use. However, this relationship has not been tested in the National Guard (NG) population, in which the prevalence of mental health symptoms is high.


METHODS
Surveys were completed by 1,262 NG soldiers. SES was measured by education and income. Adjusted multivariable regression models assessed associations between SES, overall service use, and use of specific types of services.


RESULTS
SES was not associated with overall use but was associated with use of certain types of services. Higher SES was associated with lower likelihood of psychotropic medication use (odds ratio=.83, 95% confidence interval=.72-.96), and higher SES strengthened the positive relationship between PTSD and use of individual therapy.


CONCLUSIONS
Higher SES may increase the use of individual therapy among soldiers with PTSD. Barriers to care among individuals with low SES merit continued attention and outreach efforts.
Dr. Sripada, Ms. Walters, Ms. Ganoczy, Dr. Bohnert, and Dr. Valenstein are with the Serious Mental Illness Treatment Resource and Evaluation Center, Center for Clinical Management Research, and Ms. Richards and Dr. Rauch are with the Mental Health Service, all at the U.S. Department of Veterans Affairs Ann Arbor Health Care System, Ann Arbor, Michigan. Dr. Sripada, Ms. Walters, Dr. Bohnert, Dr. Kees, and Dr. Valenstein are also with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor (e-mail: rekaufma@umich.edu ). Dr. Gorman is with the Michigan Public Health Institute, Okemos. Dr. Blow is with the Department of Family and Child Ecology, Michigan State University, East Lansing.
Rebecca K
RK
Sripada
Dr. Sripada, Ms. Walters, Ms. Ganoczy, Dr. Bohnert, and Dr. Valenstein are with the Serious Mental Illness Treatment Resource and Evaluation Center, Center for Clinical Management Research, and Ms. Richards and Dr. Rauch are with the Mental Health Service, all at the U.S. Department of Veterans Affairs Ann Arbor Health Care System, Ann Arbor, Michigan. Dr. Sripada, Ms. Walters, Dr. Bohnert, Dr. Kees, and Dr. Valenstein are also with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor (e-mail: rekaufma@umich.edu ). Dr. Gorman is with the Michigan Public Health Institute, Okemos. Dr. Blow is with the Department of Family and Child Ecology, Michigan State University, East Lansing.
Sarah K H
SK
Richards
Dr. Sripada, Ms. Walters, Ms. Ganoczy, Dr. Bohnert, and Dr. Valenstein are with the Serious Mental Illness Treatment Resource and Evaluation Center, Center for Clinical Management Research, and Ms. Richards and Dr. Rauch are with the Mental Health Service, all at the U.S. Department of Veterans Affairs Ann Arbor Health Care System, Ann Arbor, Michigan. Dr. Sripada, Ms. Walters, Dr. Bohnert, Dr. Kees, and Dr. Valenstein are also with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor (e-mail: rekaufma@umich.edu ). Dr. Gorman is with the Michigan Public Health Institute, Okemos. Dr. Blow is with the Department of Family and Child Ecology, Michigan State University, East Lansing.
Sheila A M
SA
Rauch
Dr. Sripada, Ms. Walters, Ms. Ganoczy, Dr. Bohnert, and Dr. Valenstein are with the Serious Mental Illness Treatment Resource and Evaluation Center, Center for Clinical Management Research, and Ms. Richards and Dr. Rauch are with the Mental Health Service, all at the U.S. Department of Veterans Affairs Ann Arbor Health Care System, Ann Arbor, Michigan. Dr. Sripada, Ms. Walters, Dr. Bohnert, Dr. Kees, and Dr. Valenstein are also with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor (e-mail: rekaufma@umich.edu ). Dr. Gorman is with the Michigan Public Health Institute, Okemos. Dr. Blow is with the Department of Family and Child Ecology, Michigan State University, East Lansing.
Heather M
HM
Walters
Dr. Sripada, Ms. Walters, Ms. Ganoczy, Dr. Bohnert, and Dr. Valenstein are with the Serious Mental Illness Treatment Resource and Evaluation Center, Center for Clinical Management Research, and Ms. Richards and Dr. Rauch are with the Mental Health Service, all at the U.S. Department of Veterans Affairs Ann Arbor Health Care System, Ann Arbor, Michigan. Dr. Sripada, Ms. Walters, Dr. Bohnert, Dr. Kees, and Dr. Valenstein are also with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor (e-mail: rekaufma@umich.edu ). Dr. Gorman is with the Michigan Public Health Institute, Okemos. Dr. Blow is with the Department of Family and Child Ecology, Michigan State University, East Lansing.
Dara
D
Ganoczy
Dr. Sripada, Ms. Walters, Ms. Ganoczy, Dr. Bohnert, and Dr. Valenstein are with the Serious Mental Illness Treatment Resource and Evaluation Center, Center for Clinical Management Research, and Ms. Richards and Dr. Rauch are with the Mental Health Service, all at the U.S. Department of Veterans Affairs Ann Arbor Health Care System, Ann Arbor, Michigan. Dr. Sripada, Ms. Walters, Dr. Bohnert, Dr. Kees, and Dr. Valenstein are also with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor (e-mail: rekaufma@umich.edu ). Dr. Gorman is with the Michigan Public Health Institute, Okemos. Dr. Blow is with the Department of Family and Child Ecology, Michigan State University, East Lansing.
Kipling M
KM
Bohnert
Dr. Sripada, Ms. Walters, Ms. Ganoczy, Dr. Bohnert, and Dr. Valenstein are with the Serious Mental Illness Treatment Resource and Evaluation Center, Center for Clinical Management Research, and Ms. Richards and Dr. Rauch are with the Mental Health Service, all at the U.S. Department of Veterans Affairs Ann Arbor Health Care System, Ann Arbor, Michigan. Dr. Sripada, Ms. Walters, Dr. Bohnert, Dr. Kees, and Dr. Valenstein are also with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor (e-mail: rekaufma@umich.edu ). Dr. Gorman is with the Michigan Public Health Institute, Okemos. Dr. Blow is with the Department of Family and Child Ecology, Michigan State University, East Lansing.
Lisa A
LA
Gorman
Dr. Sripada, Ms. Walters, Ms. Ganoczy, Dr. Bohnert, and Dr. Valenstein are with the Serious Mental Illness Treatment Resource and Evaluation Center, Center for Clinical Management Research, and Ms. Richards and Dr. Rauch are with the Mental Health Service, all at the U.S. Department of Veterans Affairs Ann Arbor Health Care System, Ann Arbor, Michigan. Dr. Sripada, Ms. Walters, Dr. Bohnert, Dr. Kees, and Dr. Valenstein are also with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor (e-mail: rekaufma@umich.edu ). Dr. Gorman is with the Michigan Public Health Institute, Okemos. Dr. Blow is with the Department of Family and Child Ecology, Michigan State University, East Lansing.
Michelle
M
Kees
Dr. Sripada, Ms. Walters, Ms. Ganoczy, Dr. Bohnert, and Dr. Valenstein are with the Serious Mental Illness Treatment Resource and Evaluation Center, Center for Clinical Management Research, and Ms. Richards and Dr. Rauch are with the Mental Health Service, all at the U.S. Department of Veterans Affairs Ann Arbor Health Care System, Ann Arbor, Michigan. Dr. Sripada, Ms. Walters, Dr. Bohnert, Dr. Kees, and Dr. Valenstein are also with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor (e-mail: rekaufma@umich.edu ). Dr. Gorman is with the Michigan Public Health Institute, Okemos. Dr. Blow is with the Department of Family and Child Ecology, Michigan State University, East Lansing.
Adrian J
AJ
Blow
Dr. Sripada, Ms. Walters, Ms. Ganoczy, Dr. Bohnert, and Dr. Valenstein are with the Serious Mental Illness Treatment Resource and Evaluation Center, Center for Clinical Management Research, and Ms. Richards and Dr. Rauch are with the Mental Health Service, all at the U.S. Department of Veterans Affairs Ann Arbor Health Care System, Ann Arbor, Michigan. Dr. Sripada, Ms. Walters, Dr. Bohnert, Dr. Kees, and Dr. Valenstein are also with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor (e-mail: rekaufma@umich.edu ). Dr. Gorman is with the Michigan Public Health Institute, Okemos. Dr. Blow is with the Department of Family and Child Ecology, Michigan State University, East Lansing.
Marcia
M
Valenstein
D000328:Adult; D004522:Educational Status; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology* / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult