Discrepancies between survey and administrative data on the use of mental health services in the general population: findings from a study conducted in Québec

Abstract

BackgroundPopulation surveys and health services registers are the main source of data for the management of public health. Yet, the validity of survey data on the use of mental health services has been questioned repeatedly due to the sensitive nature of mental illness and to the risk of recall bias. The main objectives of this study were to compare data on the use of mental health services from a large scale population survey and a national health services register and to identify the factors associated with the discrepancies observed between these two sources of data.MethodsThis study was based on the individual linkage of data from the cycle 1.2 of the Canadian Community Health Survey (CCHS-1.2) and from the health services register of the Régie de l'assurance maladie du Québec (RAMQ). The RAMQ is the governmental agency managing the Quebec national health insurance program. The analyses mostly focused on the 637 Quebecer respondents who were recorded as users of mental health services in the RAMQ and who were self-reported users or non users of these services in the CCHS-1.2.ResultsRoughly 75%, of those recorded as users of mental health services users in the RAMQ's register did not report using mental health services in the CCHS-1.2. The odds of disagreement between survey and administrative data were higher in seniors, individuals with a lower level of education, legal or de facto spouses and mothers of young children. They were lower in individuals with a psychiatric disorder and in frequent and more recent users of mental health services according to the RAMQ's register.ConclusionsThese findings support the hypotheses that social desirability and recall bias are likely to affect the self-reported use of mental health services in a population survey. They stress the need to refine the investigation of mental health services in population surveys and to combine survey and administrative data, whenever possible, to obtain an optimal estimation of the population need for mental health care.

Gender differences in mental health service utilization among respondents reporting depression in a national health survey

“…These latter findings are in contrast to our finding that there were no significant differences in use of specialized services, albeit the lack of significance might be partially explained by the small sample of respondents actually seeing specialists. Drapeau [24] suggests that the role of worker hinders the use of general and psychiatric services in men, but not among women.…”

“…Socio-demographic variables associated with mental health utilization [24] are included as control variables in the analysis-marital status, educational attainment, annual household income, ethno-racial origin, immigration status and urban or rural location. We also adjust for several health behaviours known to differ by gender and which are associated with health utilization, including smoking status, drinking level and self-reported health [30][31][32][33].…”

“…Gender is often examined as a covariate in research on the use of mental health services among those with a psychiatric disorder, but fewer studies have examined gender interaction effects with psychiatric disorder. Data sources for these gender-based studies are often either self-report or medical records; more rare are studies that use linked self-report and medical records [13,18,24]. Among those studies specifically exploring gender effects on psychiatric outcomes, one study found that the gender difference was larger for general mental health services than for psychiatric services, although in both cases women reported greater use than men [18].…”

“…In the specialty sector, positive attitudes towards mental health care increased the use of specialty services for men and women with a psychiatric disorder. Drapeau [24] also explored gender differences and found that professional anchorage (e.g., employment status) was a factor in the help seeking behaviour of men and women with respect to general mental health and psychiatric services. Specifically, the role of "worker" was found to hinder the use of general and psychiatric services in men, but was less influential for women.…”

Associations of Early Exposure to Intimate Partner Violence and Parental Depression With Subsequent Mental Health Outcomes

“…56,57 Social desirability and recall bias are, therefore, more likely to bias studies relying on parental report of child behavior, especially if the reporting parent has a known history of IPV or depression. 58 …”