title: Social Support and Health Service Use in Depressed Adults: Findings From the National Health and Nutrition Examination Survey.
abstract: OBJECTIVE
  We investigated the relationship between social support and health service use among men and women with depression.
  
  
  METHODS
  Participants were 1379 adults with symptoms of depression (Patient Health Questionnaire-9 score ≥ 5) in the National Health and Nutrition Examination Survey. Using the framework of the Andersen Behavioral Model of Health Services Use, multivariable regression models used social support, stratified by depression severity, to estimate association with utilization of mental health and nonmental health services. Partial F-tests examined a priori interactions between social support and gender.
  
  
  RESULTS
  Among those with adequate social support, odds of seeing a nonmental health provider were much higher when depression was moderate [Odds Ratio (OR): 2.6 (1.3-5.3)] or severe [OR: 3.2 (1.2-8.7)], compared to those lacking social support. Conversely, odds of mental health service use were 60% lower among those with moderate depression [OR: 0.4 (0.2-1.0)] when social support was adequate as opposed to inadequate. Social support was unrelated to service use when depression was mild. Gender moderated the relationship between social support and health service use among individuals with severe depression.
  
  
  CONCLUSIONS
  Social support has opposite associations with mental and nonmental health service use among adults with clinically significant depression. This association is largely attributable to the effect of male gender on the relationship between social support and health service use.
authors.affiliation: VA Portland Health Care System and HSR&D Center to Improve Veteran Involvement in Care, Portland, OR, USA; OHSU-PSU School of Public Health, Portland, OR, USA.
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Andrea
authors.affiliation: OHSU-PSU School of Public Health, Portland, OR, USA.
authors.forename: Sarah A R
authors.initials: SA
authors.lastname: Siegel
authors.affiliation: VA Portland Health Care System and HSR&D Center to Improve Veteran Involvement in Care, Portland, OR, USA; OHSU-PSU School of Public Health, Portland, OR, USA. Electronic address: teoa@ohsu.edu.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Teo
mesh_terms: D000328:Adult; D000368:Aged; D003863:Depression / Q000453:epidemiology*; D003866:Depressive Disorder / Q000453:epidemiology*; D006306:Health Surveys / Q000706:statistics & numerical data; D006801:Humans; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D009749:Nutrition Surveys / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D012737:Sex Factors; D012944:Social Support
keywords: Depression; Gender; Health service use; NHANES; Social support