title: Relationships between adult emotional states and indicators of health care utilization: Findings from the National Health Interview Survey 2006-2014.
abstract: Adults with serious psychological distress have a high likelihood of mental health problems severe enough to cause serious impairment in social and occupational functioning requiring treatment. These adults visit doctors frequently yet have poor health compared to adults without serious psychological distress. This study examined associations between emotional states of serious psychological distress in relationship to healthcare utilization indicators. A guiding hypothesis was that somatization underlying emotional states contributes to excessive healthcare seeking among adults with serious psychological distress.
  
  
  
  Using 2006-2014 National Health Interview Survey, in adults with serious psychological distress (n=9271), the six states: unable to make efforts, nervousness, hopelessness, sadness, worthlessness and restlessness were assessed in multivariate models in relation to four healthcare utilization indicators: change in the usual place of healthcare, change due to insurance, having seen a healthcare provider in the last 6months and having 10 or more doctor visits in the last 12months. Models were adjusted for sociodemographic variables, having seen a mental health provider, and health conditions.
  
  
  
  Adults feeling unable to make efforts were more likely to seek healthcare in the last 6months and at least ten times in the last twelve months. Adults feeling hopeless were less likely to be heavy healthcare utilizers.
  
  
  
  Predisposing medical conditions do not fully explain healthcare utilization in adults with serious psychological distress. Educating healthcare providers about the emotional states motivating healthcare seeking, and integrating mental healthcare into primary care, may improve the health of adults with serious psychological distress.
authors.affiliation: New York University School of Medicine, Department of General Internal Medicine and Clinical Innovation, United States. Electronic address: Judith.weissman@nyumc.org.
authors.forename: Judith D
authors.initials: JD
authors.lastname: Weissman
authors.affiliation: Center for Home Care Policy & Research, Visiting Nurse Service of New York, United States.
authors.forename: David
authors.initials: D
authors.lastname: Russell
authors.affiliation: New York University School of Medicine, Department of General Internal Medicine and Clinical Innovation, United States.
authors.forename: Jeannette
authors.initials: J
authors.lastname: Beasley
authors.affiliation: New York University School of Medicine, Department of General Internal Medicine and Clinical Innovation, United States.
authors.forename: Melanie
authors.initials: M
authors.lastname: Jay
authors.affiliation: New York University School of Medicine, Department of Psychiatry and Child Psychiatry, United States.
authors.forename: Dolores
authors.initials: D
authors.lastname: Malaspina
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015897:Comorbidity; D004644:Emotions; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data*; D013315:Stress, Psychological / Q000150:complications* / Q000523:psychology*; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult
keywords: Access to care; Integration of healthcare; Kessler K6; Serious psychological distress