Re-Engagement Into Mental Health Care: The Role of Treatment Satisfaction On Service Use for Managing Depressive Episodes in Primary Care Settings

Purpose: Research is needed to understand the mechanisms of care relevant to service use behavior after active depression treatment in order to address the high rate of relapse among those who experience depression and the persistent underuse of mental health care.  Little is known about how populations use previous treatment experiences to address future mental health treatment needs.  Within services research, treatment satisfaction is reported as varying greatly depending on individual morbidity rates and by level of access to appropriate care. To account for these variations, it is important to assure both interpersonal aspects of care and technical quality are accounted for in the provider-patient dynamic. The study examines these elements through assessing treatment satisfaction and the interaction with the relationship between evaluated need for care and service use over a five-year period, hypothesizing a positive effect.  Methods: Using data from the 12-month and 57-month follow-up study of the randomized control trial Partners in Care (PIC), we assessed direct and moderating effects of reported 12-month treatment satisfaction with the PIC trial on service use for depression at 57-months in an adult sample, minorities and non-Hispanic Whites (n=991).  Treatment satisfaction was measured using an adapted version of the Consumer Assessment of Healthcare Plans and Systems (CAHPS) scale at the 12-month time point, reflecting evaluation of care received during the PIC intervention.  The scale presented strong internal consistency with the sample (alpha=0.91).  Results: Direct effects with service use were positively supported for females, higher education level, minority status (non-Hispanic Whites), and expressed health and mental health need.  In reviewing moderation effects, treatment satisfaction at 12-months significantly moderated the relationship between health need and service use at 57-months. In post hoc analysis of those with high health need, individuals reporting high and medium levels of satisfaction at 12-months had increased service use at 57-months compared to those with low levels of satisfaction with the PIC trial.  Implications:  Findings empirically support the significance of previous treatment experiences as a relevant component of decision making about seeking care for mental health needs. Profiling risk factors for under use such as tracking previous experience with mental health care and high health needs assists practitioners in outreaching to those least likely to seek mental health care independently as episodes reoccur.  Further, the study brings forth the importance of maintaining a patient centered approach to care in order to optimize the treatment experience and long term outcomes. Suggestions for enhancing current treatment models through ongoing monitoring of patient engagement and satisfaction are discussed.