Table 4 Synthesis of associations found between factors in Andersen socio-behavioural model of health service utilisation and treatment-seeking for CMD
From: Factors associated with health service utilisation for common mental disorders: a systematic review
Type | Factor | Summary of associations found | Evidence level | No. of studies | Relationship | No. of good quality studies | No. of longitudinal studies | Total sample size | Total number of studies from each region | No. of studies from LMIC | |
|---|---|---|---|---|---|---|---|---|---|---|---|
Predisposing factors | |||||||||||
Demographic | Age | Hill-shaped relationship commonly reported, with highest use by middle-aged individuals and lower use by the young and the elderly | Inconsistent | 25 | Hill-shaped | 9 | 3 | 33,779 | 10 1 1 | N. America Australasia L. America | 1 |
Positive/Consistent with hill-shape | 2 | 2 | 3162 | 1 1 2 | Africa L. America Europe | 2 | |||||
Mixed | 0 | 1 | 1926 | 2 | Europe | 0 | |||||
Null | 4 | 0 | 6501 | 2 2 2 | Africa N. America Europe | 2 | |||||
Age of onset | Older age of onset associated with service use in some studies | Inconsistent | 3 | Positive | 2 | 1 | 14,640 | 2 | N. America | 0 | |
Other | 0 | 1 | 1572 | 1 | Europe | 0 | |||||
Gender | Female gender generally associated with greater service utilisation | Inconsistent | 29 | Positive (women) | 9 | 5 | 28,201 | 10 1 1 1 | N. America L. America Africa Europe | 1 | |
Other/mixed | 4 | 2 | 29,838 | 3 2 1 | N. America Africa Europe | 2 | |||||
Null | 5 | 2 | 6380 | 1 1 2 1 4 | Africa Asia N. America Australasia Europe | 1 | |||||
Negative (women) | 1 | 0 | 531 | 1 | L. America | 1 | |||||
Social structure | Ethnicity | Caucasian ethnicity commonly associated with greater use than other ethnic groups | Inconsistent | 23 | Positive (white) | 7 | 2 | 60,534 | 11 1 | N. America L. America | 1 |
Positive compared to some ethnicities only | 2 | 0 | 17,299 | 3 | N. America | 0 | |||||
Mixed | 4 | 1 | 36,558 | 5 1 | N. America South Africa | 1 | |||||
Null | 2 | 1 | 2658 | 2 1 | N. America Australasia | 0 | |||||
Immigration status | No clear pattern found | Inconsistent | 6 | Negative (born abroad) | 0 | 1 | 2026 | 1 | Europe | 0 | |
Null | 2 | 1 | 15,056 | 2 1 | N. America Australasia | 0 | |||||
Mixed | 0 | 0 | 7687 | 2 | N. America | 0 | |||||
Marital Status | Being married associated with lower service use in some studies | Inconsistent | 18 | Negative (married) | 5 | 2 | 10,367 | 5 1 1 | N. America Europe Australasia | 0 | |
Null | 5 | 1 | 17,493 | 1 2 2 2 | L. America Africa N. America Europe | 3 | |||||
Positive (married) | 1 | 1 | 337 | 1 | N. America | 0 | |||||
Mixed | 2 | 1 | 13,590 | 1 1 | N. America Europe | 0 | |||||
Education | Higher levels of education associated with greater service use in some studies | Inconsistent | 20 | Positive (higher) | 6 | 4 | 31,441 | 6 1 1 1 | N. America Europe L. America Africa | 2 | |
Null | 7 | 1 | 11,377 | 5 2 1 1 | N. America Europe Australasia Africa | 1 | |||||
Mixed | 0 | 1 | 2130 | 1 1 | N. America Europe | 0 | |||||
Personality | Conscientiousness | No clear pattern found | Poor | 1 | Positive | 0 | 1 | 354 | 1 | Europe | 0 |
Mastery | No clear pattern found | Poor | 1 | Mixed | 0 | 1 | 903 | 1 | Europe | 0 | |
Neuroticism | Inconsistent | 2 | Positive | 1 | 1 | 2005 | 1 | Australasia | 0 | ||
Null | 1 | 1 | 102 | 2 | Europe | 0 | |||||
Health beliefs | Prior use of services | Prior use associated with greater use | Good | 3 | Positive | 2 | 2 | 13,672 | 4 | N. America | 0 |
Null | 0 | 0 | 0 | 0 | 0 | ||||||
Stigma | No clear pattern found | Poor | 2 | Null | 0 | 0 | 102 | 1 | Europe | 0 | |
Mixed | 1 | 0 | 56 | 1 | Asia | 1 | |||||
Mental Health Literacy | Not investigated | 0 | N/A | 0 | 0 | 0 | 0 | ||||
Enabling factors | |||||||||||
Assets | Income/ wealth | Most studies did not find any association | Good – no association | 11 | Null | 5 | 0 | 7623 | 3 3 1 | N. America Africa Europe | 3 |
Positive | 1 | 0 | 7209 | 1 1 | N. America Asia | 1 | |||||
Mixed | 1 | 0 | 2510 | 2 | N. America | 0 | |||||
Employment | Being employed associated with lower use in some studies | Inconsistent | 8 | Negative (being employed) | 2 | 2 | 3452 | 2 2 | N. America Europe | 0 | |
Null | 3 | 0 | 3059 | 2 1 1 | Africa Europe Australasia | 2 | |||||
Social support | Greater social support linked to use in some studies | Poor | 5 | Positive | 0 | 1 | 661 | 1 1 | Europe Africa | 1 | |
Null | 1 | 1 | 1275 | 2 1 | N. America Europe | 0 | |||||
Insurance | Having health insurance associated with use in some studies | Inconsistent | 7 | Positive | 2 | 1 | 10,393 | 4 | N. America | 0 | |
Null | 1 | 0 | 956 | 2 | N. America | 0 | |||||
Mixed | 0 | 0 | 558 | 1 | N. America | 0 | |||||
Need factors | |||||||||||
Perceived | Self-rated health/perceived need for care | Better self-rated health (/lower perceive need for care) associated with lower service use | Good | 8 | Negative | 2 | 2 | 2738 | 2 1 | N. America Europe | 0 |
Mixed or indirect | 2 | 0 | 2865 | 3 | N. America | 0 | |||||
Null | 0 | 1 | 491 | 1 1 | N. America Asia | 1 | |||||
Evaluated | Symptom severity | Greater severity commonly associated with service use | Inconsistent | 16 | Positive | 5 | 5 | 23,165 | 7 2 1 | N. America Europe Australasia | 0 |
Mixed | 1 | 0 | 298 | 1 | Europe | 0 | |||||
Null | 3 | 1 | 4052 | 2 2 1 | N. America Europe Asia | 1 | |||||
Chronicity/duration | Longer duration associated with service use | Good | 3 | Positive | 3 | 0 | 8603 | 2 1 | N. America Europe | 0 | |
Disability | Greater impairment associated with service use | Good | 8 | Positive | 3 | 1 | 4794 | 1 3 1 | N. America Europe Australasia | 0 | |
Mixed/borderline | 0 | 1 | 2199 | 2 1 | N. America Europe | 0 | |||||
Comorbid conditions – total | No clear pattern found | Poor | 4 | Null | 1 | 1 | 7565 | 1 1 1 | N. America Europe L. America | 1 | |
Non-psychiatric chronic conditions | No clear pattern found | Inconsistent | 14 | Positive | 3 | 2 | 17,455 | 3 1 1 | N. America Europe International | 1 (combined HIC/LMIC) | |
Negative | 1 | 0 | 220 | 1 | Europe | 0 | |||||
Mixed | 1 | 0 | 7460 | 1 1 | N. America Africa | 1 | |||||
Null | 5 | 1 | 4567 | 3 2 1 | Europe N. America Australasia | 0 | |||||
Psychiatric comorbidities (general) | Comorbid mental disorders (in general) associated with service use | Good | 6 | Positive | 5 | 3 | 6295 | 3 2 1 | N. America Europe Australasia | 0 | |
Comorbid SUD | No clear pattern found | Inconsistent | 8 | Positive | 3 | 1 | 24,189 | 3 | N. America | 0 | |
Negative | 1 | 1 | 1,1,56 | 2 | N. America | 0 | |||||
Mixed | 0 | 1 | 1572 | 1 | Europe | 0 | |||||
Null | 2 | 1 | 20,445 | 2 | N. America | 0 | |||||
Comorbid mood/anxiety disorders | Comorbid mood/anxiety disorders associated with service use | Good | 6 | Positive | 5 | 4 | 26,714 | 3 2 | N. America Europe | 0 | |
Null | 1 | 0 | 102 | 1 | Europe | 0 | |||||
Other comorbid mental disorders | No clear pattern found | Inconsistent | 3 | Mixed | 3 | 1 | 8719 | 3 | N. America | 0 | |
Panic symptoms | Panic symptoms associated with service use | Good | 6 | Positive | 5 | 2 | 26,350 | 4 1 | N. America Australasia | 0 | |
Negative | 0 | 0 | 558 | 1 | N. America | 0 | |||||
Suicidality | No clear pattern found | Inconsistent | 3 | Positive | 2 | 0 | 1646 | 1 1 | N. America Europe | 0 | |
Null | 1 | 1 | 2864 | 1 | N. America | 0 | |||||
Somatisation | No evidence of any association | Good – no | 2 | Null | 2 | 1 | 1566 | 2 | N. America | 0 | |
Other CMD symptoms | No clear pattern found | Inconsistent | 5 | Mixed | 2 | 1 | 15,941 | 3 2 | N. America Europe | 0 | |
Adverse childhood events | No clear pattern found | Poor | 4 | Positive | 0 | 2 | 1926 | 2 | Europe | 0 | |
Mixed | 1 | 1 | 1201 | 2 | Europe | 0 | |||||
Contextual factors | |||||||||||
Place of residence | Urban/rural residence | No evidence of any association | Good – no | 7 | Null | 6 | 1 | 16,677 | 3 2 1 1 | N. America Europe Australasia L. America | 1 |
Country | No clear pattern found | Inconsistent | 3 | Mixed | 2 | 0 | 4111 | 1 1 | N. America/Europe N. America/ Australasia | 0 | |
Null | 0 | 0 | 751 | 1 | N. America | 0 | |||||
Region (within-country) | No clear pattern found | Inconsistent | 3 | Positive | 1 | 1 | 7620 | 1 1 | N. America L. America | 1 | |
Null | 1 | 0 | 7153 | 1 | N. America | 0 | |||||
Health service factors | Service availability (perceived) | No clear pattern found | Poor | 1 | Positive | 0 | 1 | 435 | 1 | N. America | 0 |
Service accessibility | No clear pattern found | Poor | 1 | Null | 0 | 0 | 56 | 1 | Asia | 1 | |
Regular source of care | No clear pattern found | Poor | 2 | Mixed | 1 | 0 | 436 | 2 | N. America | 0 | |
Organisation of services (gatekeeper) | No clear pattern found | Poor | 1 | Negative | 1 | 0 | 1498 | 1 | N. America | 0 | |
Service capacity/waiting times/opening hours | Not investigated | 0 | N/A | 0 | 0 | 0 | 0 | ||||
Resources available | Not investigated | 0 | N/A | 0 | 0 | 0 | 0 | ||||
Healthcare policy | Not investigated | 0 | N/A | 0 | 0 | 0 | 0 | ||||
Quality of care | Not investigated | 0 | N/A | 0 | 0 | 0 | 0 | ||||
Social factors | Neighbourhood norms | Not investigated | 0 | N/A | 0 | 0 | 0 | 0 | |||