“…Although the relationship between family or marital distress and healthcare utilization has rarely been studied directly, there is considerable evidence that psychological distress is associated with higher healthcare utilization. (Andersen, Francis, Lion, & Daughety, 1977; Barsky, Wyshak, & Klerman, 1986; Godkin & Rice, 1981; Gortmaker, Eckenrode, & Gore, 1982; Manning & Wells, 1992; Mechanic, Cleary, & Greenley, 1982; Pope, 1979). Although the effect of psychological distress may be partly mediated through general and physical health perceptions, there also appear to be direct effects (Manning & Wells, 1992).…”