CORRELATES OF USING MENTAL-HEALTH-SERVICES - IMPLICATIONS OF USING ALTERNATIVE DEFINITIONS

Background. Studies using varying definitions of mental health visits result in widely divergent estimates. This analysis examines the stabi lity of a predictive model using three varying definitions based on pr ovider type, diagnosis, psychotherapy, and psychotropic medication use . Methods. Interview and questionnaire data and claims records from th e RAND Health Insurance Experiment are used to test these models among 3138 enrollees. Results. Estimates of visits, and factors associated with them, are highly sensitive to definitions. Depression was the onl y symptom/life situation variable, and education the only sociodemogra phic measure, predictive across all three models. Risk indicators such as suicide thoughts and drinking problems were only significant for t he traditional (mental health specialty) model. While patients within the traditional model definition were significantly younger than other enrollees, those within the model using the most expansive definition were significantly older. Varying the definition also led to differen t results in respect to experimental manipulations, geographic sites, and some specific types of comorbidity. Conclusions. A reasonable defi nition, consistent with medical standards, requires, at least, a menta l health diagnostic judgment and some form of psychotherapeutic or dru g treatment. Studies of the content of mental health care are needed.