Top

BMC Psychiatry

Published in:

Open Access 01-12-2021 | Mood Disorders | Study protocol

Influence of established and subjectively perceived as well as evaluated individual characteristics on the utilization of mental health services among individuals with depressive disorders: protocol of a longitudinal study examining how to supplement the “behavioral model of health services use” and on need-congruent use of mental health services

Authors: Anna Katharina Reinhold, Julia Louise Magaard, Anna Levke Brütt

Published in: BMC Psychiatry | Issue 1/2021

Abstract

Background

Approximately one out of every three people in Germany who meets the diagnostic criteria for major depression has contact with mental health services. Therefore, according to treatment guidelines, two thirds of all individuals with depression are insufficiently treated. In the past, the subjective perspective of people who (do not) make use of mental health services has been neglected. Factors related to the use of health services are described in Andersen’s Behavioral Model of Health Services Use (ABM). The aim of this study is to supplement operationalizations of subjectively perceived and evaluated individual characteristics in the ABM and to evaluate whether the supplemented model can better explain mental health services use in individuals with depression than established operationalizations.

Methods

A representative telephone study with two measurement points will be conducted. In an explanatory mixed-methods design, qualitative interviews will be added to further interpret the quantitative data. A nationwide sample scoring 5 or more on the Patient Health Questionnaire (PHQ-9) will be recruited and interviewed via telephone at T0 and 12 months later (T1). Data on established and subjective characteristics as well as mental health service use will be collected. At T1, conducting a diagnostic interview (Composite International Diagnostic Interview, DIA-X-12/M-CIDI) enables the recording of 12-month diagnoses according to DSM-IV-TR criteria. Ideally, n = 768 datasets will be available and analyzed descriptively by means of regression analysis. Up to n = 32 persons who use or do not use depression-specific health services incongruent with their objective or subjective needs will be interviewed (face-to-face) to better explain their behavior. In addition, theories of non-need-based mental health service use are developed within the framework of the grounded theory-based analysis of the qualitative interviews.

Discussion

The study intends to contribute to the theoretical foundation of health services research and to specify the characteristics described in the ABM. Thus, after completion of the study, a further sophisticated and empirically tested model will be available to explain mental health services. The identified modifiable influencing factors are relevant for the development of strategies to increase mental health service use in line with the objective and subjective needs of individuals with depression.

Available only for authorised users

Jacobi F, Höfler M, Strehle J, Mack S, Gerschler A, Scholl L, et al. Mental disorders in the general population. Study on the health of adults in Germany and the additional module mental health (DEGS1-MH). Nervenarzt. 2014;85(1):77–87 https://doi.org/10.1007/s00115-013-3961-y.CrossRefPubMed

Cabello M, Mellor-Marsá B, Sabariego C, Cieza A, Bickenbach J, Ayuso-Mateos JL. Psychosocial features of depression: a systematic literature review. J Affect Disord. 2012;141(1):22–33 https://doi.org/10.1016/j.jad.2011.12.009.PubMedCrossRef

Ferrari AJ, Charlson FJ, Norman RE, Patten SB, Freedman G, Murray CJ, et al. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Med. 2013;10(11):e1001547 https://doi.org/10.1371/journal.pmed.1001547.PubMedPubMedCentralCrossRef

Schulz H, Barghaan D, Harfst T, Koch U. Gesundheitsberichterstattung des Bundes: Psychotherapeutische Versorgung. Berlin: Robert-Koch-Institut; 2008. Available from: https://www.rki.de/DE/Content/Gesundheitsmonitoring/Gesundheitsberichterstattung/GBEDownloadsT/Psychotherapeutische_Versorgung.pdf;jsessionid=46DBE9C0FE8A374902F53923D2185C25.internet052?__blob=publicationFile. Accessed 27 Nov 2020.

DGPPN B, KBV, AWMF, AkdÄ, BPtK, BApK, DAGSHG, DEGAM, DGPM, DGPs, DGRW (Hrsg.) für die Leitlinienversion Unipolare Depression. S3-Leitlinie/Nationale VersorgungsLeitlinie Unipolare Depression-Langfassung 2015. Available from: https://www.leitlinien.de/mdb/downloads/nvl/depression/depression-2aufl-vers5-lang.pdf. Accessed 27 Nov 2020.

Mack S, Jacobi F, Gerschler A, Strehle J, Höfler M, Busch MA, et al. Self-reported utilization of mental health services in the adult German population–evidence for unmet needs? Results of the DEGS1-mental health module (DEGS1-MH). Int J Methods Psychiatr Res. 2014;23(3):289–303.PubMedPubMedCentralCrossRef

Andersen RM. National health surveys and the behavioral model of health services use. Med Care. 2008;46(7):647–53 https://doi.org/10.1097/MLR.0b013e31817a835d.PubMedCrossRef

Janßen C, Swart E, Von Lengerke T. Health care utilization in Germany: theory, methodology, and results: Springer Science & Business Media; 2014.CrossRef

Babitsch B, Gohl D, von Lengerke T. Re-revisiting Andersen’s behavioral model of health services use: a systematic review of studies from 1998–2011. Psychosoc Med. 2012;9 https://doi.org/10.3205/psm000089.

10.

Magaard JL, Seeralan T, Schulz H, Brütt AL. Factors associated with help-seeking behaviour among individuals with major depression: a systematic review. PLoS One. 2017;12(5):e0176730 https://doi.org/10.1371/journal.pone.0176730.PubMedPubMedCentralCrossRef

11.

Aromaa E, Tolvanen A, Tuulari J, Wahlbeck K. Personal stigma and use of mental health services among people with depression in a general population in Finland. BMC Psychiatry. 2011;11(1):52 https://doi.org/10.1186/1471-244X-11-52.PubMedPubMedCentralCrossRef

12.

Gabilondo A, Rojas-Farreras S, Rodráguez A, Ferníndez A, Pinto-Meza A, Vilagut G, et al. Use of primary and specialized mental health care for a major depressive episode in Spain by ESEMeD respondents. Psychiatr Serv. 2011;62(2):152–61 https://doi.org/10.1176/ps.62.2.pss6202_0152.PubMedCrossRef

13.

Chartrand H, Robinson J, Bolton JM. A longitudinal population-based study exploring treatment utilization and suicidal ideation and behavior in major depressive disorder. J Affect Disord. 2012;141(2):237–45 https://doi.org/10.1016/j.jad.2012.03.040.PubMedCrossRef

14.

Mojtabai R, Olfson M. Treatment seeking for depression in Canada and the United States. Psychiatr Serv. 2006;57(5):631–9 https://doi.org/10.1176/ps.2006.57.5.631.PubMedCrossRef

15.

Gagné S, Vasiliadis H-M, Préville M. Gender differences in general and specialty outpatient mental health service use for depression. BMC Psychiatry. 2014;14(1):135 https://doi.org/10.1186/1471-244X-14-135.PubMedPubMedCentralCrossRef

16.

Roberts T, Miguel Esponda G, Krupchanka D, Shidhaye R, Patel V, Rathod S. Factors associated with health service utilisation for common mental disorders: a systematic review. BMC Psychiatry. 2018;18(1):262 https://doi.org/10.1186/s12888-018-1837-1.PubMedPubMedCentralCrossRef

17.

Stolzenburg S, Freitag S, Evans-Lacko S, Speerforck S, Schmidt S, Schomerus G. Individuals with currently untreated mental illness: causal beliefs and readiness to seek help. Epidemiol Psychiatric Sciences. 2019;28(4):446–57 https://doi.org/10.1017/S2045796017000828.CrossRef

18.

Doblyte S, Jiménez-Mejías E. Understanding help-seeking behavior in depression:a qualitative synthesis of patients’ experiences. Qual Health Res. 2017;27(1):100–13 https://doi.org/10.1177/1049732316681282.PubMedCrossRef

19.

Creswell JW. Research design: qualitative, quantitative, and mixed methods approaches. Thousand Oaks, California: Sage; 2003.

20.

Arbeitskreis Deutscher Markt- und Sozialforschungsinstitute e.V. (ADM). Forschungsbericht - ADM-Forschungsprojekt "Dual-Frame-Ansätze" 2011/2012. 2012 03.12.2019. Available from: https://www.adm-ev.de/wp-content/uploads/2018/07/Forschungsbericht-Dual-Frame-Ans%C3%A4tze.pdf.

21.

Gabler S, Häder S. Ein neues Stichprobendesign für telefonische Umfragen in Deutschland. In: Gabler S, Häder S, Hoffmeyer-Zlotnik JHP, editors. Telefonstichproben in Deutschland: VS Verlag für Sozialwissenschaften; 1998. p. 69–88.

22.

Kish L. A procedure for objective respondent selection within the household. J Am Stat Assoc. 1949;44(247):380–7 https://amstat.tandfonline.com/doi/abs/10.1080/01621459.1949.10483314.CrossRef

23.

Gräfe K, Zipfel S, Herzog W, Löwe B. Screening for psychiatric disorders with the patient health questionnaire (PHQ). Results from the German validation study. Diagnostica. 2004;50(4):171–81 https://doi.org/10.1026/0012-1924.50.4.171.CrossRef

24.

Wittchen H-U. Reliability and validity studies of the WHO-composite international diagnostic interview (CIDI): a critical review. J Psychiatr Res 1994;28(1):57–84 https://doi.org/10.1016/0022-3956(94)90036-1.

25.

Wittchen H-U, Pfister H. DIA-X-interviews: manual für screening-Verfahren und interview; Interviewheft. Frankfurt: Swets & Zeitlinger; 1997.

26.

Flick U. Qualitative Sozialforschung. Eine Einführung Reinbek bei Hamburg: Rowohlt-Taschenbuch-Verlag. 2005.

27.

Kroenke K, Spitzer RL, Williams JBW. The PHQ-9. Validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13 https://doi.org/10.1046/j.1525-1497.2001.016009606.x.PubMedPubMedCentralCrossRef

28.

Lampert T, Kroll L, Müters S, Stolzenberg H. Measurement of socioeconomic status in the German health interview and examination survey for adults (DEGS1). Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz. 2013;56(5–6):631–6 https://doi.org/10.1007/s00103-012-1663-4.PubMedCrossRef

29.

Schulz H, Harfst T, Andreas S, Kawski S, Koch U, Rabung S. Can quality of life in psychotherapy be measured with clinician-ratings? A comparison of patient- and clinician-ratings using the SF-8. Rehabilitation (Stuttg). 2009;48(05):270–6 https://doi.org/10.1055/s-0029-1239549.CrossRef

30.

Ellert U, Lampert T, Ravens-Sieberer U. Measuring health-related quality of life with the SF-8. Normal sample of the German population. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz. 2005;48(12):1330–7 https://doi.org/10.1007/s00103-005-1168-5.CrossRef

31.

Ware JE, Kosinski M, Dewey JE, Gandek B. How to score and interpret single-item health status measures: a manual for users of the SF-8 health survey. Boston: QualityMetric; 2001.

32.

Bullinger M, Kirchberger I. SF-36: Fragebogen zum Gesundheitszustand. Handanweisung. Göttingen: Hogrefe, Verlag für Psychologie; 1998.

33.

Ware J. SF-36 health survey: manual and interpretation guide. Boston, Mass: The Health Inst., New England Med. Center; 1997.

34.

Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7 https://doi.org/10.1001/archinte.166.10.1092.PubMedCrossRef

35.

Löwe B, Decker O, Müller S, Brähler E, Schellberg D, Herzog W, et al. Validation and standardization of the generalized anxiety disorder screener (GAD-7) in the general population. Med Care. 2008;46(3):266–74.PubMedCrossRef

36.

Saunders JB, Aasland OG, Babor TF, De La Fuente JR, Grant M. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction. 1993;88(6):791–804 https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.1993.tb02093.x.PubMedCrossRef

37.

Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. For the ambulatory care quality improvement project (ACQUIP). The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Arch Intern Med. 1998;158(16):1789–95 https://doi.org/10.1001/archinte.158.16.1789.PubMedCrossRef

38.

Moehring A, Rumpf H-J, Hapke U, Bischof G, John U, Meyer C. Diagnostic performance of the alcohol use disorders identification test (AUDIT) in detecting DSM-5 alcohol use disorders in the general population. Drug Alcohol Depend. 2019;204:107530 https://doi.org/10.1016/j.drugalcdep.2019.06.032.PubMedCrossRef

39.

Kroenke K, Spitzer RL, Williams JBW. The PHQ-15: Validity of a New Measure for Evaluating the Severity of Somatic Symptoms. Psychosom Med. 2002;64(2):258-66.

40.

Toussaint A, Murray AM, Voigt K, Herzog A, Gierk B, Kroenke K, et al. Development and validation of the somatic symptom disorder–B criteria scale (SSD-12). Psychosom Med. 2016;78(1):5–12 https://doi.org/10.1097/psy.0000000000000240.PubMedCrossRef

41.

Toussaint A, Löwe B, Brähler E, Jordan P. The somatic symptom disorder - B criteria scale (SSD-12): factorial structure, validity and population-based norms. J Psychosom Res. 2017;97:9–17 https://doi.org/10.1016/j.jpsychores.2017.03.017.PubMedCrossRef

42.

Broadbent E, Petrie KJ, Main J, Weinman J. The brief illness perception questionnaire. J Psychosom Res. 2006;60(6):631–7 https://doi.org/10.1016/j.jpsychores.2005.10.020.PubMedCrossRef

43.

Moss-Morris R, Weinman J, Petrie K, Horne R, Cameron L, Buick D. The revised illness perception questionnaire (IPQ-R). Psychol Health. 2002;17(1):1–16 https://doi.org/10.1080/08870440290001494.CrossRef

44.

Glattacker M, Bengel J, Jäckel WH. German version of the illness perception questionnaire-revised (IPQ-R): psychometric evaluation in patients with chronic somatic illness. Zeitschrift für Gesundheitspsychologie. 2009;17(4):158–69 https://doi.org/10.1026/0943-8149.17.4.158.CrossRef

45.

Andrade LH, Alonso J, Mneimneh Z, Wells JE, Al-Hamzawi A, Borges G, et al. Barriers to mental health treatment: results from the WHO world mental health surveys. Psychol Med. 2014;44(6):1303–17 https://doi.org/10.1017/S0033291713001943.PubMedCrossRef

46.

Vogel DL, Wade NG, Haake S. Measuring the self-stigma associated with seeking psychological help. J Couns Psychol. 2006;53(3):325–37 https://doi.org/10.1037/0022-0167.53.3.325.CrossRef

47.

Stolzenburg S, Freitag S, Evans-Lacko S, Muehlan H, Schmidt S, Schomerus G. The stigma of mental illness as a barrier to self labeling as having a mental illness. J Nerv Ment Dis. 2017;205(12):903–9 https://doi.org/10.1097/nmd.0000000000000756.PubMedCrossRef

48.

Schomerus G, Auer C, Rhode D, Luppa M, Freyberger HJ, Schmidt S. Personal stigma, problem appraisal and perceived need for professional help in currently untreated depressed persons. J Affect Disord. 2012;139(1):94–7 https://doi.org/10.1016/j.jad.2012.02.022.PubMedCrossRef

49.

Schomerus G, Muehlan H, Auer C, Horsfield P, Tomczyk S, Freitag S, et al. Validity and psychometric properties of the self-identification as having a mental illness scale (SELF-I) among currently untreated persons with mental health problems. Psychiatry Res. 2019;273:303–8 https://doi.org/10.1016/j.psychres.2019.01.054.PubMedCrossRef

50.

Evans-Lacko S, Stolzenburg S, Gronholm PC, Ribeiro W, York-Smith M, Schomerus G. Psychometric validation of the self-identification of having a mental illness (SELF-I) scale and the relationship with stigma and help-seeking among young people. Soc Psychiatry Psychiatr Epidemiol. 2019;54(1):59–67 https://doi.org/10.1007/s00127-018-1602-2.PubMedCrossRef

51.

McNab C, Meadows G. The general-practice Users' perceived-need inventory (GUPI'): a brief general practice tool to assist in bringing mental healthcare needs to professional attention. Primary Care Mental Health. 2005;3(2):93–101.

52.

Meadows G, Harvey C, Fossey E, Burgess P. Assessing perceived need for mental health care in a community survey: development of the perceived need for care questionnaire (PNCQ). Soc Psychiatry Psychiatr Epidemiol. 2000;35(9):427–35.PubMedCrossRef

53.

Jacobi F, Mack S, Gerschler A, Scholl L, Höfler M, Siegert J, et al. The design and methods of the mental health module in the German health interview and examination survey for adults (DEGS1-MH). Int J Methods Psychiatr Res. 2013;22(2):83–99.PubMedPubMedCentralCrossRef

54.

Bhandari A, Wagner T. Self-reported utilization of health care services: improving measurement and accuracy. Med Care Res Rev. 2006;63(2):217–35 https://doi.org/10.1177/1077558705285298.PubMedCrossRef

55.

Software VERBI. MAXQDA 2020. Berlin: VERBI Software; 2019.

56.

Harrell FE Jr. Regression modeling strategies: with applications to linear models, logistic and ordinal regression, and survival analysis: springer; 2015.

57.

Kocalevent R-D, Hinz A, Brähler E. Standardization of the depression screener patient health questionnaire (PHQ-9) in the general population. Gen Hosp Psychiatry 2013;35(5):551–5 https://doi.org/10.1016/j.genhosppsych.2013.04.006.

58.

Löwe B, Kroenke K, Herzog W, Gräfe K. Measuring depression outcome with a brief self-report instrument: sensitivity to change of the patient health questionnaire (PHQ-9). J Affect Disord. 2004;81(1):61–6 https://doi.org/10.1016/S0165-0327(03)00198-8.PubMedCrossRef

59.

Manea L, Gilbody S, McMillan D. Optimal cut-off score for diagnosing depression with the patient health questionnaire (PHQ-9): a meta-analysis. CMAJ. 2012;184(3):E191–E6 https://doi.org/10.1503/cmaj.110829.PubMedPubMedCentralCrossRef

Title: Influence of established and subjectively perceived as well as evaluated individual characteristics on the utilization of mental health services among individuals with depressive disorders: protocol of a longitudinal study examining how to supplement the “behavioral model of health services use” and on need-congruent use of mental health services
Authors: Anna Katharina Reinhold
Julia Louise Magaard
Anna Levke Brütt
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Mood Disorders
Affective Disorder
Published in: BMC Psychiatry / Issue 1/2021
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-021-03065-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Discussion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Discussion

Please log in to get access to this content

Other articles of this Issue 1/2021

A collaborative, computer-assisted, psycho-educational intervention for depressed patients with chronic disease at primary care: protocol for a cluster randomized controlled trial

Depression and HIV associated neurocognitive disorders among HIV infected adults in rural southwestern Uganda: a cross-sectional quantitative study

Development and psychometric testing of nursing students’ perceptions of clinical stressors scale: an instrument design study

A systematic review of the latent structure of the Center for Epidemiologic Studies Depression Scale (CES-D) amongst adolescents

Physical multimorbidity and lifetime suicidal ideation and plans among rural older adults: the mediating role of psychological distress

Prevalence and risk factors for non-suicidal self-injury among patients with depression or bipolar disorder in China