Demographic Patterns of Preventive Service Use Among Seriously Mentally Ill Individuals Receiving Mental Health Treatment

Purpose and Background: This study examined the extent to which age, gender, race/ethnicity, and mental health diagnosis are associated with the use of routine preventive service among seriously mentally ill (SMI) individuals receiving [Recovery-oriented] mental health treatment. Age, gender, and race/ethnicity have been found to associate with preventive service use among those without mental illness (Collins, Hall, & Neuhaus, 1999; Musich, Ignaczak, McDonald, Hirschland, & Edington, 2001). However, these demographic patterns have not been explored specifically within the SMI population; this study contributes to this gap in the literature. Additionally, there is a lack of research exploring differences in preventive service use among SMI individuals by mental health diagnosis. Studies have found that individuals with psychotic disorders have poorer health outcomes than mentally ill individuals with other diagnoses (Osborne, et al., 2008). Furthermore, routine preventive care has been found to associate with improved health outcomes (USDHH, 2010). This study examined whether mental health diagnosis is associated with preventive service use, to determine if the diagnostic disparities in health outcomes might be attributed to differences in preventive service use.

Methods: This investigation is a secondary analysis of data originally collected for the New York State Office of Mental Health's Psychiatric Services and Clinical Knowledge Enhancement System (PSYCKES) 2008 Field Validation pilot. Hierarchical logistic regression analysis was used to predict the effects of age, gender, race/ethnicity, mental health diagnosis, and the presence of psychotic symptoms on the use of routine preventive service.

Results: The rate of preventive service use across the entire study population was considerably low (23%). Age and race/ethnicity were both predictive of preventive service use. Specifically, as a participant‘s age increased by one year, the odds of utilizing preventive service increased by about 5% (OR=1.053; 95% CI=1.028, 1.079; p<.01). Furthermore, the odds of Hispanic participants using preventive service were more than twice the odds of white participants (OR=2.565; 95% CI=1.283, 5.316; p<.05); there were no significant differences among any of the other ethnic groups. These findings differ from prior research involving non-mentally ill subjects, which found that older individuals and ethnic minorities were less likely to utilize preventive service (Collins et al., 1999; Musich et al., 2001). Gender, mental health diagnosis, and the presence of psychotic symptoms were not significant predictors of preventive service use.

Implications: The effects of age, gender, and race/ethnicity were all different from those found in previous literature, which might imply that involvement in Recovery-oriented mental health treatment influences the relationship between these demographics and preventive service use. That neither diagnosis nor the presence of psychotic symptoms were significantly predictive suggests that the poorer health outcomes for those with psychotic disorders cannot be explained by their preventive service use. The low rate of preventive service use across the entire study population suggests that helping professionals should focus on increasing service use among all SMI individuals, regardless of demography or diagnosis. Possible ways in which social work practitioners and researchers could help to improve service use are discussed.