APH 2008, 66, 50-68:

Mental health services use in the general Belgian population: estimating the impact of mental health and social determinants

A. Gouwy, W. Christiaens, P. Bracke

Background
At present, variations in the relationship between social factors and the use of mental health services have already been examined in several countries differing in the organisation and financing of mental health services (Alegria & Bijl et al. 2000; Pescosolido & Boyer 1999). Research of social factors influencing services use in Belgium so far often focused on general health care use (Louckx & Vanroelen and Beck 2001; Van der Heyden & Demarest et al. 2003; Van Doorslaer & Buytendijk and Geurts 2001) .

Objective
We analyse the link between mental health services use and the frequency and severity of common mental health complaints in the general population.

Methods 
Logistic regression models are estimated using both the 2001 and 2004 wave of the ‘Health Interview Survey’ - two independent samples of the general Belgian population. Use of mental health services is measured by distinguishing individuals with from patients without contact with (a) a psychiatrist, (b) a general practitioner for social or psychosocial problems, (c) a specialist for social or psychosocial problems, or (d) a psychologist. The social factors included in our models are education, household income, employment status, marital status, nationality, and two proxies for informal social support. Mental health status is measured using three dimensions – depression, anxiety, and somatisation – of the Symptom Checklist SCL-90r.

Results and conclusions
Results confirm that people with common mental health complaints are an important group making use of health services. Nevertheless, health service use, because of mental health problems, is only partially based on the mental health status: the less educated, members of poorer households, and the unemployed are less inclined to seek professional help. Finally, general practitioners are important providers of help to persons with common mental health problems and, moreover, function as key persons in tackling mental health inequalities.