Influence of perceived and evaluated individual characteristics on mental health services utilization of patients with depressive disorders - a longidudinal study to supplement the Behavioral Model of Health Services Use and to explore adaquacy of health

在德国，几乎每三分之一符合抑郁症诊断标准的人都接触过精神卫生保健。使用精神卫生服务的原因在理论模型中被描述，如“卫生服务使用的行为模型”。与解释健康行为变化的模型不同，病人的观点很少被包括在“卫生服务使用行为模型”中。由于已建立的特征不能充分解释精神卫生服务的使用，感知和评估的个体特征，如疾病和治疗信念以及主观需求，应纳入模型。这项研究的目的是将主观特征整合到“健康服务使用行为模型”中，并调查这些特征是否能改善对抑郁症患者健康服务使用的预测。此外，重点关注那些与客观或主观需求不一致、使用或不使用抑郁症特定健康服务的人。这些人的百分比将被描述。最后，对卫生服务使用不协调的原因进行了研究。将进行前瞻性、纵向和具有地方代表性的调查。另外还将使用定性访谈来解释定量数据。在t0和12个月后(T1)，将通过电话访谈定量收集已建立的和主观的特征。此外，还将进行标准化的精神障碍诊断性面谈。此外，多达32人将被选中进行定性访谈，并询问他们使用精神健康服务的原因。除了描述性和回归分析外，还将使用基于扎根理论的分析来探索与不一致的卫生服务使用有关的理论。建议的研究结果与卫生服务研究的理论基础相关。它们可以用来补充“服务使用行为模型”，并对该模型进行实证验证。此外，患者的视角将提供对不协调的卫生服务使用的洞察。此外，关于卫生服务使用的结果可以用来创建以患者为中心的卫生服务：卫生服务使用的可变预测因素是增加卫生服务使用的战略的起点，以符合抑郁症患者的客观和主观需求。

Just about every third person in Germany who meets the diagnostic criteria for depression has contact to mental health care. The reasons for using mental health services are described in theoretical models such as the "Behavioural Model of Health Services Use". In contrast to models explaining health behaviour change, the patient's perspective has rarely been included in the “Behavioural Model of Health Services Use”. As established characteristics cannot sufficiently explain mental health services use, perceived and evaluated individual characteristics such as illness and treatment beliefs as well as subjective need should be integrated into the model. The aim of the proposed study is to integrate the subjective characteristics in the "Behavioural Model of Health Services Use" and to investigate whether these improve prediction of health services use in persons with depression. Additionally, a focus lies on persons who incongruently to objective or subjective need, use or not use depression-specific health services. The percentage of those persons will be described. Finally, explanations of the incongruity in health services use will be studied. A prospective, longitudinal and locally representative survey will be conducted. Additional qualitative interviews will be used to explain quantitative data. At t0 and 12 months later (t1), established and subjective characteristics will be quantitatively collected via telephone interviews. Moreover, standardized diagnostic interviews for mental disorders will be conducted. Additionally, up to 32 persons will be selected for qualitative interviews and questioned about reasons for their use of mental health services. Besides descriptive and regression analysis, a grounded theory based analysis will be used to explore theories regarding incongruent health services use. The results of the proposed study are relevant regarding the theoretical foundation of health services research. They can be used to complement the "Behavioural Model of Service Use" and to empirically validate the model. Additionally, the perspective of patients will offer insights into incongruent health services use. Furthermore, the results regarding health services use can be used to create patient-centered health services: Changeable predictors of health services use are starting points for strategies to increase health services use congruent to objective and subjective needs of persons with depression.