Uses of Andersen health services utilization framework to determine healthcare utilization for mental health among migrants-a scoping review

Background

Migration is a worldwide occurrence that carries significant implications for healthcare systems, and it entails challenges to mental healthcare. The Andersen Behavioral Model is widely used by researchers to determine healthcare service utilization among many populations, including migrants. Our study aimed to explore the ways of using the Andersen Health System Utilization Framework in the literature to discover the utilization of mental healthcare by migrants.

Methods

This scoping review was based on Arksey and O'Malley's framework. A comprehensive search was performed across five electronic databases.

Results

A total of 12 articles from January 1992 to July 2023 identified various versions of the Andersen Behavioral Model to provide an overview of mental health services utilization among migrants. The analysis identified four significant trends in the literature. First, there is a predominant focus on individual characteristics over contextual factors. Second, researchers tend to integrate multiple versions of the Andersen Behavioral Model, and the most is the version from 1995. Third, additional factors specific to migrant populations are incorporated into the model, but the categorization is sometimes unclear. Finally, the majority of studies have used a quantitative approach and are based in North America, suggesting a focus on the significance of mental health in migrant communities in that context.

Conclusion

In summary, our scoping review calls for further research using the Andersen Behavioral Model to study mental healthcare utilization among migrants. Notable findings include the adaptation of the model to migrant populations, a focus on individual characteristics, a need for more diverse research methods, and the proposal of a new conceptual model to guide research and policy development in this field.

Differences in internalized stigma of mental illness among college students based on demographic characteristics

Objective: To assess differences in internalized stigma of mental illness based on demographic characteristics and mental healthcare utilization among college students. Participants: Students with self-reported mental illness (n = 128) were recruited via random sampling. Methods: Participants completed an online survey, including questions related to demographic characteristics and mental healthcare utilization. The survey also included the Internalized Stigma of Mental Illness (ISMI) scale. Data were analyzed using descriptive and inferential statistics. Results: Students accessing mental healthcare (pharmacological and/or psychotherapeutic) reported higher ISMI scores than students who did not access services during past year. Students with sexual minority statuses also reported higher ISMI scores than their heterosexual counterparts. Conclusions: Results highlight differences in internalized stigma based on demographics characteristics and mental healthcare utilization among college students. More research is needed to better understand intersectional stigma. Further, universities need tailored and specific interventions to address internalized stigma among students with diverse backgrounds and needs.

Disruptive office behaviors in the medical setting: associations with other clinical phenomena

Aggression and violence in the medical setting appear to be on the increase. In support of this impression, a number of studies have documented surprising rates of such behavior toward trainees as well as physicians-in-practice. However, to date, these studies have focused on the experiences and reports of professionals, not patient offenders. In a series of investigations, we examined aggressive and disruptive office behaviors from the perspective of the perpetrators-the patients. Findings from these studies indicate that disruptive office behaviors by patients appear to be related to borderline personality symptomatology, alcohol/drug misuse, prescription medication abuse, and higher rates of past mental healthcare utilization. The results of these studies suggest a rudimentary psychological profile for the aggressive patient in the primary care setting.

The relationship between mental healthcare utilization and criminal behaviors among internal medicine outpatients

BACKGROUND

According to the scant empirical literature, largely in studies of offenders, there appears to be a general but diffuse relationship between various psychiatric disorders and criminal behavior. In this study, we examined mental healthcare utilization, a general measure of psychiatric dysfunction, in relationship to a history of criminal behavior in a sample of internal medicine outpatients.

METHOD

In a consecutive sample of 376 internal medicine outpatients being seen predominantly by resident providers, we examined the relationship between 27 illegal behaviors (charges, not convictions) as delineated by the Federal Bureau of Investigation's crime cataloguing schema and four items related to mental healthcare utilization (i.e., ever been seen by a psychiatrist, ever been hospitalized in a psychiatric hospital, ever been in counseling, ever been on medication for your "nerves").

RESULTS

Twenty-two percent of the sample reported a history of having been charged with at least one criminal behavior. With the exception of ever having been on "nerve" medication, the remaining mental-healthcare-utilization variables demonstrated statistically significant relationships with the number of illegal behaviors reported. However, overall correlations were relatively weak.

CONCLUSIONS

Using both a sample and methodology that is unique to the current literature, we found relationships between past mental health treatment and history of criminal behavior.

Mental healthcare utilization and sleep disturbance: a pilot study

Disturbances in sleep are empirically associated with a number of different psychiatric disorders. In this pilot study, we examined whether four general queries about mental healthcare utilization ("Have you ever been seen by a psychiatrist?," "Have you ever been hospitalized in a psychiatric hospital?," "Have you ever been in counseling?," and "Have you ever been on medication for your nerves?") would evidence correlations with various aspects of sleep disturbance as measured by the Pittsburgh Sleep Quality Index. In a cross-sectional sample of convenience, we surveyed 75 internal medicine outpatients. We asked participants about the four preceding mental healthcare variables as well as sleep experiences using the Pittsburgh Sleep Quality Index. Prior to statistical analyses, we assigned one point to each mental healthcare utilization variable endorsed and developed a composite score (0-4). In analyses, while the mental-healthcare-utilization composite score was not related to overall sleep quality (i.e., the Global Pittsburgh Sleep Quality Index Score), it was statistically significantly related to the Pittsburgh Sleep Quality Index component of Sleep Disturbance (p<.01). This suggests that while individuals with greater mental healthcare utilization do not evidence differences in overall sleep quality compared to those with low utilization, they do report more disturbances in sleep.

Mental health services utilization and driving violations

Abstract Objective. The objective of this study was to determine whether there is a relationship between the past utilization of four mental health services (i.e. ever been seen by a psychiatrist, ever been in a psychiatric hospital, ever been in counseling, ever been on psychotropic medication) and different types of driving citations during one's lifetime. Methods. Using a consecutive, cross-sectional, primary care sample, we surveyed participants about their past use of four mental health services and lifetime incidence of 29 different types of driving citations (charges, not convictions). Results. The total number of different types of moving violations was statistically significantly related to a history of psychiatric hospitalization. The total number of different types of non-moving violations was statistically significantly related to all mental health services variables. Conclusions. In this study, general non-specific queries about the past utilization of mental health services were correlated with both moving violations (past psychiatric hospitalization) and non-moving violations (all mental health services variables). These findings suggest that patients who have received mental health treatment are at a higher risk for being cited for driving violations than those who have not received mental health treatment. However, among the mental health variables under study, only past psychiatric hospitalization was associated with moving violations.