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Differences in Use of Government Subsidised Mental Health Services by Men and Women with Psychological Distress: A Study of 229,628 Australians Aged 45 Years and Over

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Abstract

This study examined factors associated with use of government subsidised mental health services by 229,628 men and women from the Sax Institute’s 45 and Up Study. Logistical regression models assessed use of mental health services by gender and according to level of psychological distress. Approximately equal proportion of men and women had high psychological distress scores (approximately 7%) but only 7% of these men and 11% of these women used services. Use was associated with predisposing (younger age and higher education), enabling (private health insurance) and need factors (higher psychological distress scores). Associations were similar for men and women except urban area of residence, separated/divorced marital status, and smoking were associated with service use for women but not men. Results suggest some inequity in the use of services by those with higher levels of need and further efforts may be required to reach people with higher need but lower service use.

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Notes

  1. Treatment gap represented by the absolute difference between the true prevalence of the illness and the proportion of individuals treated for the illness.

References

  • Aday, L. A., & Andersen, R. M. (2005). Models of Health Care Utilization and Behavior. Encyclopedia of Biostatistics. https://doi.org/10.1002/0470011815.b2a4a010.

    Article  Google Scholar 

  • Al-Windi, A. (2005). The relations between symptoms, somatic and psychiatric conditions, life satisfaction and perceived health: A primary care based study. Health & Quality of Life Outcomes, 3, 28.

    Article  Google Scholar 

  • Andersen, R., & Newman, J. F. (1973). Societal and individual determinants of medical care utilization in United-States. Milbank Memorial Fund Quarterly-Health and Society, 51(1), 95–124. https://doi.org/10.2307/3349613.

    Article  CAS  PubMed  Google Scholar 

  • Andersen, R. M. (1995). Revisiting the behavioral-model and access to medical-care: Does it matter. Journal of Health and Social Behavior, 36(1), 1–10. https://doi.org/10.2307/2137284.

    Article  CAS  PubMed  Google Scholar 

  • Andersen, R. M. (2008). National health surveys and the behavioral model of health services use. Medical Care, 46(7), 647–653. https://doi.org/10.1097/MLR.0b013e31817a835d.

    Article  PubMed  Google Scholar 

  • Australian Bureua of Statistics. (2007). 432.6 National Survey of Mental Health and Wellbeing: Summmary of results 2007. In A. B. O. Statistics (Ed.) Australian Bureau of Statistics.

  • Australian Institute of Health and Welfare. (2010). Australia’s health 2010 In H. A. T. L. stages (Ed.), Health and welfare expenditure series (Vol. 36). Canberra: Australian Institute of Health and Welfare.

  • Banks, E., Redman, S., Jorm, L., Armstrong, B., Bauman, A., Beard, J., et al. (2008). Cohort profile: The 45 and up study. International Journal of Epidemiology, 37(5), 941–947. https://doi.org/10.1093/ije/dym184.

    Article  PubMed  Google Scholar 

  • Barney, L. J., Griffiths, K. M., Jorm, A. F., & Christensen, H. (2006). Stigma about depression and its impact on help-seeking intentions. Australian and New Zealand Journal of Psychiatry, 40(1), 51–54. https://doi.org/10.1080/j.1440-1614.2006.01741.x.

    Article  PubMed  Google Scholar 

  • Blumenthal, R., & Endicott, J. (1996). Barriers to seeking treatment for major depression. Depression & Anxiety, 4(6), 273–278.

    Article  PubMed  Google Scholar 

  • Bower, P., Hardy, R. N. R (2003). The clinical effectiveness of counselling in primary care: A systematic review and meta-analysis. Psychological Medicine, 33, 203–213. https://doi.org/10.1017/S0033291702006979.

    Article  CAS  PubMed  Google Scholar 

  • Brettle, A., Hill, A., & Jenkins, P. (2008). Counselling in primary care: A systematic review of the evidence. Counselling & Psychotherapy Research, 8(4), 207–214.

    Article  Google Scholar 

  • Byles, J. E., Dolja-Gore, X., Loxton, D. J., Parkinson, L., & Williams, J. A. S. (2011). Women’s uptake of medicare benefits schedule mental health items for general practitioners, psychologists and other allied mental health professionals. Medical Journal of Australia, 194(4), 175–179.

    PubMed  Google Scholar 

  • Byles, J. E., Gallienne, L., Blyth, F. M., & Banks, E. (2012). Relationship of age and gender to the prevalence and correlates of psychological distress in later life. International Psychogeriatrics, 24(06), 1009–1018. https://doi.org/10.1017/S1041610211002602.

    Article  PubMed  Google Scholar 

  • Caldwell, T. M., Jorm, A. F., Knox, S., Braddock, D., Dear, K. B., & Britt, H. (2004a). General practice encounters for psychological problems in rural, remote and metropolitan areas in Australia. Australian & New Zealand Journal of Psychiatry, 38(10), 774–780.

    Article  CAS  Google Scholar 

  • Caldwell, T. M., Jorm, A. F., Knox, S., Braddock, D., Dear, K. B. G., & Britt, H. (2004b). General practice encounters for psychological problems in rural, remote and metropolitan areas in Australia. Australian and New Zealand Journal of Psychiatry, 38(10), 774–780. https://doi.org/10.1111/j.1440-1614.2004.01461.x.

    Article  CAS  PubMed  Google Scholar 

  • Cuijpers, P., Huibers, M., Daniel Ebert, D., Koole, S. L., & Andersson, G. (2013). Review: How much psychotherapy is needed to treat depression? A metaregression analysis. Journal of Affective Disorders, 149, 1–13. https://doi.org/10.1016/j.jad.2013.02.030.

    Article  PubMed  Google Scholar 

  • Department of Health and Aged Care. (2001). Measuring remoteness: Accessibility/remoteness index of Australia (ARIA). Revised Ed. In (GISCA) (Ed.), Occasional Paper (Vol. Series No. 14).

  • Department of Health and Ageing. (2008). Impact of the Collection and Recording of PBS Under Copayment Prescription Data. Canberra: Department of Health and Ageing. Retrieved 8 August, 2015 from http://www.health.gov.au/internet/main/publishing.nsf/content/3AFDB28CDC5C43A5CA25751400032D03/$File/PBS%20Under%20Co-Pay%20Report.pdf.

  • Dhingra, S. S., Zack, M., Strine, T., Pearson, W. S., & Balluz, L. (2010). Determining prevalence and correlates of psychiatric treatment with Andersen’s behavioral model of health services use. Psychiatric Services, 61(5), 524–528.

    Article  PubMed  Google Scholar 

  • Donoghue, J. M., & Tylee, A. (1996). The treatment of depression: Prescribing patterns of antidepressants in primary care in the UK. British Journal of Psychiatry, 168(2), 164–168. https://doi.org/10.1192/bjp.168.2.164.

    Article  CAS  Google Scholar 

  • Drapalski, A. L., Milford, J., Goldberg, R. W., Brown, C. H., & Dixon, L. B. (2008). Perceived barriers to medical care and mental health care among veterans with serious mental illness. Psychiatric Services, 59(8), 921–924.

    Article  PubMed  Google Scholar 

  • Flint, J., Cuijpers, P., Horder, J., Koole, S. L., & Munafò, M. R. (2015). Is there an excess of significant findings in published studies of psychotherapy for depression? Psychological Medicine, 45(2), 439–446. https://doi.org/10.1017/S0033291714001421.

    Article  CAS  PubMed  Google Scholar 

  • Gelberg, L., Andersen, R. M., & Leake, B. D. (2000). The behavioral model for vulnerable populations: Application to medical care use and outcomes for homeless people. Health Services Research, 34(6), 1273–1302.

    CAS  PubMed Central  PubMed  Google Scholar 

  • Goldney, R., Fisher, L. J., Wilson, D. H., & Cheok, F. (2000). Major depression and its associated morbidity and quality of life in a random, repesentative Australian community sample. Australian and New Zealand Journal of Psychiatry, 34, 1022–1029.

    Article  CAS  PubMed  Google Scholar 

  • Goldney, R. D., Eckert, K. A., Hawthorne, G., & Taylor, A. W. (2010). Changes in the prevalence of major depression in an Australian community sample between 1998 and 2008. Australian & New Zealand Journal of Psychiatry, 44(10), 901–910. https://doi.org/10.3109/00048674.2010.490520.

    Article  Google Scholar 

  • Harris, M. (2011). A tale of two studies: Separate evaluations of Better Access yield similar findings. The British Journal of Psychiatry (online). (in response to vol 198)

  • Harris, M. G., Burgess, P. M., Pirkis, J. E., Slade, T. N., & Whiteford, H. A. (2011). Policy initiative to improve access to psychological services for people with affective and anxiety disorders: population-level analysis. British Journal of Psychiatry, 198, 99–108.

    Article  Google Scholar 

  • Harris, M. G., Diminic, S., Burgess, P. M., Carstensen, G., Stewart, G., Pirkis, J., et al. (2014). Understanding service demand for mental health among Australians aged 16 to 64 years according to their possible need for treatment. Australian and New Zealand Journal of Psychiatry, 48(9), 838–851. https://doi.org/10.1177/0004867414531459.

    Article  PubMed  Google Scholar 

  • Harris, M. G., Philip, M. J. H., Burgess, M., Pirkis, J. E., Diminic, S., Siskind, D. J., Andrews, G., & Whiteford, H. A. (2015). Frequency and quality of mental health treatment for affective and anxiety disorders among Australian adults. Medical Journal of Australia, 202(4), 185–189. https://doi.org/10.5694/mja14.00297.

    Article  PubMed  Google Scholar 

  • Harrison, C. M., Charles, B. H. C. J (2012). Better outcomes or better access: Which was better for mental health care? The Medical Journal of Australia, 197(3), 170–172.

    Article  PubMed  Google Scholar 

  • Hawthorne, G., Goldney, R., & Taylor, A. W. (2008). Depression prevalence: is it really increasing? Australian and New Zealand Journal of Psychiatry, 42(7), 606–616. https://doi.org/10.1080/00048670802119788.

    Article  PubMed  Google Scholar 

  • Hunsley, J., Elliott, K., & Therrien, Z. (2014). The efficacy and effectiveness of psychological treatments for mood, anxiety, and related disorders. Canadian Psychology, 55(3), 161–176. https://doi.org/10.1037/a0036933.

    Article  Google Scholar 

  • Isaacs, A. N., Pyett, P., Oakley-Browne, M. A., Gruis, H., & Waples-Crowe, P. (2010). Barriers and facilitators to the utilization of adult mental health services by Australia’s Indigenous people: Seeking a way forward. International Journal of Mental Health Nursing, 19(2), 75–82.

    Article  PubMed  Google Scholar 

  • Jayasekara, R., Procter, N., Harrison, J., Skelton, K., Hampel, S., Draper, R., et al. (2015). Cognitive behavioural therapy for older adults with depression: A review. Journal of Mental Health, 24(3), 168–171. https://doi.org/10.3109/09638237.2014.971143.

    Article  PubMed  Google Scholar 

  • Jorm, A. F., & Reavley, N. J. (2012). Changes in psychological distress in Australian adults between 1995 and 2011. Australian and New Zealand Journal of Psychiatry, 46(4), 352–356. https://doi.org/10.1177/0004867411428017.

    Article  PubMed  Google Scholar 

  • Katon, W. J., Unutzer, A., & Simon, G. (2004). Treatment of depression in primary care: Where we are, where we can go. Medical Care, 42(12), 1153–1157. https://doi.org/10.1097/00005650-200412000-00001.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., Andrews, G., Colpe, L. J., & Hiripi, E. (2002). Short screening scales to monitor population prevalences and trends in nonspecific psychological distress. Psychological Medicine, 32, 959–976.

    Article  CAS  PubMed  Google Scholar 

  • Kessler, R. C., Demler, O., Frank, R. G., Olfson, M., Pincus, H. A., Walters, E. E., et al. (2005). US prevalence and treatment of mental disorders: 1990–2003. The New England Journal of Medicine, 352(24), 2515–2523. https://doi.org/10.1056/NEJMsa043266.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Kessler, R. C., & Ustun, B. (2008). The WHO world mental health surveys: Global perspectives of meantl health surveys (1 st ed.). New York: Cambridge University Press.

    Google Scholar 

  • Khlat, M., Legleye, S., & Sermet, C. (2014). Factors influencing report of common mental health problems among psychologically distressed adults. Community Mental Health Journal, 50(5), 597–603. https://doi.org/10.1007/s10597-013-9680-9.

    Article  PubMed  Google Scholar 

  • Kohn, M., Hitch, D., & Stagnitti, K. (2012). Better access to mental health program: Influence of mental health occupational therapy. Australian Occupational Therapy Journal, 59(6), 437–444. https://doi.org/10.1111/1440-1630.12005.

    Article  PubMed  Google Scholar 

  • Kohn, R., Saxena, S., Levav, I., & Saraceno, B. (2004). The treatment gap in mental health care. Bulletin of World Health Organization, 82(11), 858–866.

    Google Scholar 

  • Lindamer, L. A., Liu, L., Sommerfeld, D. H., Folsom, D. P., Hawthorne, W., Garcia, P., et al. (2012). Predisposing, enabling, and need factors associated with high service use in a public mental health system. Administration & Policy in Mental Health, 39(3), 200–209. https://doi.org/10.1007/s10488-011-0350-3.

    Article  Google Scholar 

  • Littlefield, L. (2014). Seven years of Better Access. Consumers show benefits from an effective, affordable and destigmatising mental health reform. Retrieved 14 June, 2017 from http://www.psychology.org.au/Assets/Files/2013-Better-Access-APS-report.pdf.

  • Marcus, S. C., & Olfson, M. (2010). National trends in the treatment for depression from 1998 to 2007. Archives of General Psychiatry, 67(12), 1265–1273. https://doi.org/10.1001/archgenpsychiatry.2010.151.

    Article  PubMed  Google Scholar 

  • Marques, L., LeBlanc, N. J., Weingarden, H. M., Timpano, K. R., Jenike, M., & Wilhelm, S. (2010). Barriers to treatment and service utilization in an internet sample of individuals with obsessive-compulsive symptoms. Depression and Anxiety, 27(5), 470–475. https://doi.org/10.1002/da.20694.

    Article  PubMed  Google Scholar 

  • McGarry, H., Hegarty, K., Johnson, C., Gunn, J., & Blashki, G. (2009). Managing depression in a changing primary mental healthcare system: comparison of two snapshots of Australian GPs’ treatment and referral patterns. Mental Health in Family Medicine, 6(2), 75–83.

    PubMed Central  PubMed  Google Scholar 

  • Mohr, D. C., Ho, J., Duffecy, J., Baron, K. G., Lehman, K. A., Jin, L., et al. (2010). Perceived barriers to psychological treatments and their relationship to depression. Journal of Clinical Psychology, 66(4), 394–409.

    PubMed Central  PubMed  Google Scholar 

  • O’Sullivan, C. (2004). The psychosocial determinants of depression: A lifespan perspective. Journal of Nervous and Mental Disease, 192(9), 585–594. https://doi.org/10.1097/01.nmd.0000138225.19549.dd.

    Article  PubMed  Google Scholar 

  • Parslow, R. A., & Jorm, A. F. (2000). Who uses mental health services in Australia? An analysis of data from the national survey of mental health and wellbeing. Australian and New Zealand Journal of Psychiatry, 34(6), 997–1008. https://doi.org/10.1046/j.1440-1614.2000.00839.x.

    Article  CAS  PubMed  Google Scholar 

  • Pirkis, J., Burgess, P., Olesen, S., Bassilios, B., Fletcher, J., & Harris, M. (2010). Evaluation of the better access to psychiatrists, psychologists and GPs throught the medicare benefits schedule initiative. Melbourne: Centre For Health Policy, Programs and Economics. Retrieved 31 August, 2015 from http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-ba-eval.

  • Pirkis, J., Ftanou, M., Williamson, M., Machlin, A., Spittal, M. J., Bassilios, B., et al. (2011). Australia’s better access initiative: An evaluation. Australian & New Zealand Journal of Psychiatry, 45(9), 726–739. https://doi.org/10.3109/00048674.2011.594948.

    Article  Google Scholar 

  • Raue, P. J., Schulberg, H. C., Heo, M., Klimstra, S., & Bruce, M. L. (2009). Patients’ depression treatment preferences and initiation, adherence, and outcome: A randomized primary care study. Psychiatric Services, 60(3), 337–343.

    Article  PubMed  Google Scholar 

  • Richards, D. A., & Borglin, G. (2011). Implementation of psychological therapies for anxiety and depression in routine practice: Two year prospective cohort study. Journal of Affective Disorders, 133, 51–60. https://doi.org/10.1016/j.jad.2011.03.024.

    Article  PubMed  Google Scholar 

  • Richards, D. A., & Bower, P. (2011). Equity of access to psychological therapies. The British Journal of Psychiatry: The Journal of Mental Science, 198(2), 91–92.

    Article  Google Scholar 

  • Rocha, K., Rodríguez-Sanz, M., Pérez, K., Obiols, J., & Borrell, C. (2013). Inequalities in the utilization of psychiatric and psychological services in Catalonia: A multilevel approach. Administration and Policy in Mental Health and Mental Health Services Research, 40(5), 355–363. https://doi.org/10.1007/s10488-012-0426-8.

    Article  PubMed  Google Scholar 

  • Schomerus, G., Appel, K., Meffert, P., Luppa, M., Andersen, R., Grabe, H., et al. (2013). Personality-related factors as predictors of help-seeking for depression: A population-based study applying the behavioral model of health services use. Social Psychiatry & Psychiatric Epidemiology, 48(11), 1809–1817.

    Article  Google Scholar 

  • Shellman, J., Granara, C., & Rosengarten, G. (2011). Barriers to depression care for black older adults: Practice and policy implication. Journal of Gerontological Nursing, 37(6), 13–17. https://doi.org/10.3928/00989134-20110503-05.

    Article  PubMed  Google Scholar 

  • Shippee, N. D., Call, K. T., Weber, W., & Beebe, T. J. (2012). Depression, access barriers, and their combined associations with unmet health needs among publicly insured individuals in Minnesota. Society and Mental Health, 2(2), 85–98. https://doi.org/10.1177/2156869312448081.

    Article  Google Scholar 

  • Stein, J. A., Andersen, R., & Gelberg, L. (2007). Applying the Gelberg-Andersen behavioral model for vulnerable populations to health services utilization in homeless women. Journal of Health Psychology, 12(5), 791–804. https://doi.org/10.1177/1359105307080612.

    Article  PubMed  Google Scholar 

  • Whiteford, H. A., Buckingham, W. J., Harris, M. G., Burgess, P. M., Pirkis, J. E., Barendregt, J. J., et al. (2014). Estimating treatment rates for mental disorders in Australia. Australian Health Review, 38(1), 80–85. https://doi.org/10.1071/AH13142.

    Article  PubMed  Google Scholar 

  • World Health Organization. (2001). WHO: The World health report 2001: Mental health: new understanding, new hope. Geneva: Office of Publications, World Health Organization. Retrieved 20 May, 2014 from http://www.who.int/whr/2001/media_centre/en/index.html.

  • World Health Organization. (2003). Investing in mental health. Geneva: Department of Mental Health and Substance Dependence, Noncommunicable Diseases and Mental Health, World Health Organization.

    Google Scholar 

  • World Health Organization. (2007). WHO collaborating centre for drug statistics methodology: Complete ATC index 2007. Geneva: World Health Organization. Retrieved 20 May, 2014 from http://www.whocc.no/atc_ddd_index/.

  • World Health Organization. (2010). Fact sheet: Obesity and overweight. Geneva: World Health Organization. Retrieved 20 May, 2014 from http://www.who.int/mediacentre/factsheets/fs311/en/#.

  • Ziller, E. C., Anderson, N. J., & Coburn, A. F. (2010). Access to rural mental health services: Service use and out-of-pocket costs. Journal of Rural Health, 26(3), 214–224. https://doi.org/10.1111/j.1748-0361.2010.00291.x.

    Article  Google Scholar 

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Acknowledgements

This research was completed using data collected through the 45 and Up Study (http://www.saxinstitute.org.au). The 45 and Up Study is managed by the Sax Institute in collaboration with major partner Cancer Council NSW; and partners: the National Heart Foundation of Australia (NSW Division); NSW Ministry of Health; NSW Government Family & Community Services – Carers, Ageing and Disability Inclusion; and the Australian Red Cross Blood Service. We thank the many thousands of people participating in the 45 and Up Study. This specific project was conducted by the University of Newcastle and the Sax Institute. We acknowledge the Australian Government Department of Human Services for providing the Pharmaceutical Benefits Scheme and Medical Benefits Schedule data.

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Authors and Affiliations

  1. Research Centre for Generational Health and Ageing, The University of Newcastle, Callaghan Dr, Callaghan, NSW, 2308, Australia

    Xenia Dolja-Gore, Deborah Loxton & Julie Byles

  2. The Australian Longitudinal study on Women’s Health, The University of Newcastle, Callaghan Dr, Callaghan, NSW, 2308, Australia

    Xenia Dolja-Gore, Deborah Loxton & Julie Byles

  3. National Centre for Epidemiology and Population Health (NCEPH) Research School of Population Health, ANU College of Medicine, Biology and Environment, The Australian National University Building, 62 Mills Road, Canberra, ACT, 0200, Australia

    Catherine D’Este

  4. CHAMP Study Centre for Education and Research on Ageing Concord Hospital, Concord Clinical School, University of Sydney, Sydney, NSW, 2300, Australia

    Fiona Blyth

  5. Faculty of Health and Medicine, The University of Newcastle, Callaghan Dr, Callaghan, NSW, 2308, Australia

    Julie Byles

  6. University of Newcastle, HMRI Building L4W, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia

    Xenia Dolja-Gore

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  1. Xenia Dolja-Gore
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Correspondence to Xenia Dolja-Gore.

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Conflict of interest

All authors have read and understood the Community Mental Health Journal policy on declaration of interests and all authors declare: JB was funded by Beyondblue through the SAX institute to carry out the research for the submitted work but this does not represent a conflict of interest; both JB and DL from ‘The Priority Research Centre for Generational Health and Ageing’ research centre have a financial relationships with the Department of Health and Ageing who fund the Australian Longitudinal Study on Women’s Health study this dataset was not used in the current study and is not a conflict of interest in this research; no other relationships or activities exist that could appear to have influenced the submitted work.

Ethics Approval

The 45 and Up study is bound by the Australian Commonwealth and State privacy legislation, including the Health Records and Information Privacy Act and the NSW Health Privacy Manual. In addition, ethical approval for the 45 and Up Study as a whole was obtained from the University of New South Wales Human Research Ethics Committee. Participants are non-identifiable and personal information is not disclosed to the researcher. For this project privacy protocols were signed and the project specifications were approved by the Sax Institute for use of the 45 and Up Study data. This study was approved by the University of New South Wales and University of Newcastle Human Research Ethics Committees.

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Dolja-Gore, X., Loxton, D., D’Este, C. et al. Differences in Use of Government Subsidised Mental Health Services by Men and Women with Psychological Distress: A Study of 229,628 Australians Aged 45 Years and Over. Community Ment Health J 54, 1008–1018 (2018). https://doi.org/10.1007/s10597-018-0262-8

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