The Relationship Between Residential Stability and Service Use in a National Sample of Adults with Mental Health or Substance Abuse Problems

Background and Purpose:

Individuals with mental health or substance abuse problems experience disparities in health care utilization. While studies have focused on individual and social determinants of health care use in these populations, few have investigated the role of residential stability, especially in relation to using different types of services (i.e. inpatient vs outpatient treatment). The purpose of this study is to examine the relationship between residential stability and mental health and substance abuse service utilization among a national sample of adults with mental health or substance abuse problems. Based on theory and prior literature, we hypothesized that individuals who frequently relocate are more likely to use inpatient services and self-help groups, and less likely to use outpatient services.

Methods:

A sample of 43,411 individuals with mental health or substance abuse problems was drawn from the 2011 – 2014 National Survey of Drug Use and Health (NSDUH), which is administered annually with a civilian, non-institutionalized population in the United States using a multistage area probability sampling design. Logistic regression analyses were used to examine the association between residential stability, defined as the number of times moved in the past year, and past year use of mental health and substance abuse services delivered in different treatment contexts (e.g., inpatient, outpatient, self-help). All models adjusted for predisposing, need, and enabling factors. Estimates used population weights.  

Results:

Among the sample who reported having mental health problems or substance abuse problems in the past year, the largest age group is 35-49 years (27%), with 55% female, 69% identifying as white, 11% as black, and 14% as Hispanic. Thirty seven percent of respondents were never married, 29% had high school degree or GED, 19% were uninsured, 21% lived in poverty, and 5% reported moving 3 or more times in the past year. Sixty four percent of respondents reported having mental health problems, 22% having substance abuse problems, and 14% having co-occurring mental health and substance abuse problems. Multiple logistic regression analyses showed significant increase in utilization of inpatient mental health treatment, inpatient substance abuse treatment, and substance abuse self-help groups among people who moved 3 or more times in the past year compared to those who did not move. Factors explaining these differences appear to be related to age, education, marital status, and service needs. No significant changes in service utilization were found in mental health and substance outpatient.

Conclusions and Implications:

Frequent residential relocation is significantly associated with increased utilization of inpatient service and self-help groups. These findings highlight the importance of understanding housing stability as a predictor factor of service use and access. Monitoring the health care use history of highly mobile individuals with mental health and/or substance abuse problems is a critical strategy for facilitating access to resources necessary to improve and maintain recovery outcomes.