The role of adverse physical health events on the utilization of mental health services.

When individuals are confronted with a new diagnosis, unexpected hospitalization, major surgery, or other physical health events, a change to their mental health state, either development of new symptoms or worsening of existing conditions, such as feeling anxious or being depressed, may arise for some individuals. These emotional distress or psychiatric disorders may be linked to the uncertainty of health outcomes associated with the new medical event or may be a result of financial strain such as medical bankruptcy, the inability to do everyday tasks without becoming overly tired, or something else related to the health event such as mediation side effects. It is also possible that with a new health event, untreated mental health problems are simply identified via contacts with the health care system. To put this association in perspective, a prospective study of 285 patients hospitalized for acute myocardial infarction reports that approximately one-fifth of the patients have major depression, most of whom continue to have depression several months after their initial hospital discharge (Bush et al. 1998). A recent review of psycho-oncology literature finds that about half of all patients with advanced cancer suffer from serious mental health problems, such as depression, anxiety, and adjustment disorders (Miovic and Block 2001). Likewise, co-morbid mental health problems are widespread among HIV-positive patients (Ellis, Collis, and King 2002), and clinical depression is more prevalent among diabetes patient compared with the general population (Egede, Zheng, and Simpson 2003). Despite the frequent association between physical and mental health in the literature, the extent to which an individual's adverse physical health event actually influences the utilization of mental health services remains unanswered. Understanding this association has implications for patients, acute care physicians, mental health providers, and the health care system as a whole. Adverse physical health events do not always affect demand for mental health services. Some individuals may not seek out mental health treatment due to stigma (Sussman, Robins, and Earls 2001; Cooper-Patrick et al. 2001; Department of Health, Human Services [DHHS] 1997; Sirey et al. 2000), financial constraints (Wang et al. 2001), and lack of coordination between the physical health and mental health system (Institute of Medicine [IOM] 1997). In addition, the link between physical health events and mental health service use may differ by the severity of the events. For example, Kokkonen, Kokkonen, and Moilanen (2002) report the same prevalence of depressive symptoms in Finnish young adults ages 19–25 who have had chronic health conditions since their childhood and their counterparts who did not, but they also document more serious psychiatric problems for those with more severely disabling conditions. The primary purpose of this research is to explore the relationship between adverse physical health events and subsequent utilization of mental health services. Specifically, using a nationally representative sample of adults from the Medical Expenditure Panel Survey for years 2004 and 2005, we empirically examined whether, and to what extent, physical health events would alter use of provider visits and prescription medication for the treatment of mental health problems. Given that such relationship might vary by an individual's heterogeneous experience with physical health events, we also tested the extent to which an individual's perception of severity related to the variation in the use of the mental health services.