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Articles   |    
A Latent Class Analysis of Age Differences in Choosing Service Providers to Treat Mental and Substance Use Disorders
Amanda Toler Woodward, Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200401
View Author and Article Information

Dr. Woodward is with the School of Social Work, Michigan State University, 655 Auditorium Rd., Room 222, East Lansing, MI 48824 (e-mail: awoodwar@msu.edu).

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  This study investigated choice of service provider for treatment of a mental or substance use disorder and its association with consumers’ age.

Methods  Data were from the Collaborative Psychiatric Epidemiology Surveys. Service users born between 1946 and 1964 were compared with those born in 1945 or earlier (N=4,082). Latent class analysis was used to identify groups of service users according to nine dichotomous items reflecting lifetime visits with different types of professionals. Multinomial logistic regression was used to analyze factors predicting latent class membership, with particular focus on both the direct and moderating effects of age. Analyses controlled for sociodemographic characteristics and disorder-related variables.

Results  Five classes of service user were identified. Class 1 (10.8%) included individuals who visited six of the nine types of providers (multiple providers visited). Class 2 (21.9%) had low probability of visiting most providers (limited providers visited). Class 3 (24.1%) visited a psychiatrist (primarily psychiatrist). Class 4 (28.1%) visited a family physician or other physician (primarily family physician). Class 5 (15.1%) visited a psychologist (primarily psychologist). A higher proportion of service users born before 1946 were in the primarily family physician class. Although 21% of service users born later also fell into this class, overall they were more evenly distributed across the five classes.

Conclusions  Family physicians played a significant role in behavioral health treatment for both age groups. However, findings suggest that younger adults may rely on more complex combinations of service providers that will require greater coordination between the behavioral and general health care systems in the future.

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Figure 1 Latent class profile of service providers visited by consumers born in 1964 or earlier
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Table 1Sociodemographic, disorder-related, and service use characteristics of the samplea
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a The Ns are unweighted, and the percentages are weighted.

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b Rao-Scott design-adjusted chi square

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Table 2Relative risk ratios (RRR) from multinomial logistic regression predicting classification of service use, by provider type, among users born in 1964 or earliera
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a Reference: primarily family physician

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b Design-corrected Wald significant at p<.05

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c Design-corrected Wald not significant at p<.05

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* p<.05, **p<.01, ***p<.001

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Table 3Significant interactions of characteristics with age, among service users born before 1946, by provider type visited
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* p<.05, **p<.01, ***p<.001

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References

Wang  PS;  Lane  M;  Olfson  M  et al:  Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication.  Archives of General Psychiatry 62:629–640, 2005
[CrossRef] | [PubMed]
 
Neighbors  HW;  Caldwell  C;  Williams  DR  et al:  Race, ethnicity, and the use of services for mental disorders: results from the National Survey of American Life.  Archives of General Psychiatry 64:485–494, 2007
[CrossRef] | [PubMed]
 
Neighbors  HW;  Woodward  AT;  Bullard  KM  et al:  Mental health service use among older African Americans: the National Survey of American Life.  American Journal of Geriatric Psychiatry 16:948–956, 2008
[CrossRef] | [PubMed]
 
Garrido  MM;  Kane  RL;  Kaas  M  et al:  Use of mental health care by community-dwelling older adults.  Journal of the American Geriatrics Society 59:50–56, 2011
[CrossRef] | [PubMed]
 
Han  B;  Gfroerer  JC;  Colpe  LJ  et al:  Serious psychological distress and mental health service use among community-dwelling older US adults.  Psychiatric Services 62:291–298, 2011
[CrossRef] | [PubMed]
 
Bogner  HR;  de Vries  HF;  Maulik  PK  et al:  Mental health services use: Baltimore Epidemiologic Catchment Area follow-up.  American Journal of Geriatric Psychiatry 17:706–715, 2009
[CrossRef] | [PubMed]
 
Rice  NE;  Lang  IA;  Henley  W  et al:  Baby boomers nearing retirement: the healthiest generation? Rejuvenation Research 13:105–114, 2010
[CrossRef] | [PubMed]
 
Colliver  JD;  Compton  WM;  Gfroerer  JC  et al:  Projecting drug use among aging baby boomers in 2020.  Annals of Epidemiology 16:257–265, 2006
[CrossRef] | [PubMed]
 
Knickman  JR;  Snell  EK:  The 2030 problem: caring for aging baby boomers.  Health Services Research 37:849–884, 2002
[CrossRef] | [PubMed]
 
Hebert  LE;  Beckett  LA;  Scherr  PA  et al:  Annual incidence of Alzheimer disease in the United States projected to the years 2000 through 2050.  Alzheimer Disease and Associated Disorders 15:169–173, 2001
[CrossRef] | [PubMed]
 
Gfroerer  J;  Penne  M;  Pemberton  M  et al:  Substance abuse treatment need among older adults in 2020: the impact of the aging baby-boom cohort.  Drug and Alcohol Dependence 69:127–135, 2003
[CrossRef] | [PubMed]
 
Rosen  D;  Smith  ML;  Reynolds  CF,  III:  The prevalence of mental and physical health disorders among older methadone patients.  American Journal of Geriatric Psychiatry 16:488–497, 2008
[CrossRef] | [PubMed]
 
Phillipson  C;  Leach  R;  Money  A  et al:  Social and cultural constructions of ageing: the case of the baby boomers.  Sociological Research Online 13(3):5, 2008
[CrossRef]
 
Muthén  BO:  Latent variable modeling in epidemiology.  Alcohol Health and Research World 16:286–292, 1992
 
Choi  S;  Morrow-Howell  N;  Proctor  E:  Configuration of services used by depressed older adults.  Aging and Mental Health 10:240–249, 2006
[CrossRef] | [PubMed]
 
Carragher  N;  Adamson  G;  Bunting  B  et al:  Treatment-seeking behaviours for depression in the general population: results from the National Epidemiologic Survey on Alcohol and Related Conditions.  Journal of Affective Disorders 121:59–67, 2010
[CrossRef] | [PubMed]
 
Heeringa SG, Berglund P: Collaborative Psychiatric Epidemiology Survey Program (CPES) Data Set: Integrated Weights and Sampling Error Codes for Design-Based Analysis. Rockville, Md, National Institute of Mental Health, 2007. Available at www.icpsr.umich.edu/icpsrweb/CPES/about_cpes/weighting/index.jsp
 
Kessler  RC;  Ustün  TB:  The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI).  International Journal of Methods in Psychiatric Research 13:93–121, 2004
[CrossRef] | [PubMed]
 
Muthén  LK;  Muthén  BO:  Mplus: Statistical Analysis With Latent Variables User’s Guide .  Los Angeles,  Muthen & Muthen, 2001
 
Nylund  KL;  Asparouhov  T;  Muthén  BO:  Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study.  Structural Equation Modeling 14:535–569, 2007
[CrossRef]
 
Thorpe  JM;  Thorpe  CT;  Kennelty  KA  et al:  Patterns of perceived barriers to medical care in older adults: a latent class analysis.  BMC Health Services Research 11:181, 2011
[CrossRef] | [PubMed]
 
Collins  LM;  Lanza  ST:  Latent Class and Latent Transition Analysis: With Applications in the Social, Behavioral, and Health Sciences .  Hoboken, NJ,  Wiley, 2010
 
 Stata Statistical Software: Release 12 .  College Station, Tex,  StataCorp, 2011
 
Johnson  PB;  Sung  H-E:  Substance abuse among aging baby boomers: health and treatment implications.  Journal of Addictions Nursing 20:124–126, 2009
[CrossRef]
 
Unützer  J;  Katon  W;  Callahan  CM  et al:  Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial.  JAMA 288:2836–2845, 2002
[CrossRef] | [PubMed]
 
Unützer  J;  Tang  L;  Oishi  S  et al:  Reducing suicidal ideation in depressed older primary care patients.  Journal of the American Geriatrics Society 54:1550–1556, 2006
[CrossRef] | [PubMed]
 
Kessler  RC;  Berglund  P;  Demler  O  et al:  The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R).  JAMA 289:3095–3105, 2003
[CrossRef] | [PubMed]
 
Williams  DR;  Neighbors  HW;  Jackson  JS:  Racial/ethnic discrimination and health: findings from community studies.  American Journal of Public Health 93:200–208, 2003
[CrossRef] | [PubMed]
 
Logan JR, Deane G: Black Diversity in Metropolitan America. Albany, State University of New York, Mumford Center for Comparative Urban and Regional Research, 2003. Available at mumford1.dyndns.org/cen2000/BlackWhite/BlackDiversityReport/black-diversity01.htm
 
Williams  DR;  González  HM;  Neighbors  HW  et al:  Prevalence and distribution of major depressive disorder in African Americans, Caribbean blacks and non-Hispanic whites: results from the National Survey of American Life.  Archives of General Psychiatry 64:305–315, 2007
[CrossRef] | [PubMed]
 
Woodward  AT;  Chatters  LM;  Taylor  RJ  et al:  Differences in professional and informal help-seeking among older African Americans, black Caribbeans, and non-Hispanic whites.  Journal of the Society for Social Work and Research 1:124–139, 2010
[CrossRef] | [PubMed]
 
Robinson  KM:  Policy issues in mental health among the elderly.  Nursing Clinics of North America 45:627–634, vii, 2010
[CrossRef] | [PubMed]
 
Trivedi  AN;  Swaminathan  S;  Mor  V:  Insurance parity and the use of outpatient mental health care following a psychiatric hospitalization.  JAMA 300:2879–2885, 2008
[CrossRef] | [PubMed]
 
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