Gender Differences in the Use of Health Care Services Among Individuals with Mental Health Problems

Background

Research suggests an increased rate of medical problems in individuals with mental health disorders than in the general population, resulting in a shortened life span. Studies have found this to be attributable to gender, health beliefs, mental health diagnosis, particular antipsychotic medication, decreased self-care, and inadequate medical care. While studies have increasingly focused on determinants of health care use in mental health populations, few have examined how these factors differ between women and men. This study explores factors associated with gender differences in the use of outpatient and emergency health care services in a community sample of individuals with mental health problems.

Methods

Data on 5,798 individuals with mental health problems come from the Community Tracking Study (CTS; 2000-2001), the third round of the CTS Household Survey. The survey was administered in 60 randomly selected areas using random-digit dialing. Area probability sampling was used to cover households without a telephone or with intermittent telephone coverage. Descriptive statistics were used to describe demographic, clinical need, and service use barriers in a population with moderate to severe mental health need, as defined by the Medical Outcomes Study 12-item Short Form-12. Logistic regression analyses and predicted probabilities describe gender differences in the use of outpatient primary care and emergency services, including emergency room care and hospitalization, after controlling for sociodemographic, clinical need factors, and barriers to care.

Results

Among the sample who reported having moderate or severe mental health problems, the mean age was 44 years (SD=16), with 14% identifying as African American, 15% as Hispanic, and 66% as White. Most respondents were married (64%), 48% had at least a high school degree, and 36% had a moderate to severe physical health problem. Women had significantly lower health status and were more likely to use primary care and emergency room (ER) services than men. Logistic regression analyses showed significant gender differences in primary care use, with a greater likelihood of women using primary care than men. Factors explaining these differences appear to be related to physical health, income, and satisfaction of services. No significant gender differences were found in the likelihood of receiving emergency room services or being hospitalized, after controlling for sociodemographic and clinical risk factors.

Conclusion and Implications

Physical health is a major concern among individuals with mental health problems. This study found gender differences in using outpatient primary care. Evidence of clinical risk factors that appear to explain these differences highlight the importance of understanding and assessing contextual factors that affect women and men differently in accessing services. Further research is warranted to explore gender-specific experiences and pathways to care.