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，符合抑郁症诊断标准的人中，大约有三分之一的人接触过精神卫生保健。使用精神卫生服务的原因在诸如“使用卫生服务的行为模型”等理论模型中加以说明。与解释卫生行为变化的模型相反，病人的观点很少被纳入“卫生服务使用行为模型”。由于确定的特征不能充分解释精神卫生服务的使用情况，因此应将感知和评估的个人特征，如疾病和治疗信念以及主观需求纳入模型。拟议研究的目的是将主观特征纳入“卫生服务使用行为模型”，并调查这些特征是否能改善对抑郁症患者使用卫生服务的预测。此外，重点关注那些与客观或主观需求不一致、使用或不使用针对抑郁症的保健服务的人。这些人的百分比将被描述。最后，将研究卫生服务使用不协调的解释。将进行前瞻性、纵向和具有地方代表性的调查。额外的定性访谈将用于解释定量数据。在第10和12个月后（t1），将通过电话访谈定量收集既定和主观特征。此外，将对精神障碍进行标准化诊断访谈。此外，将选择多达32人进行定性访谈，并询问他们使用精神卫生服务的原因。除了描述性和回归分析，一个接地理论为基础的分析将用于探讨有关不一致的卫生服务使用的理论。本研究结果对于卫生服务研究的理论基础具有重要意义。它们可以用来补充“服务使用行为模型”，并对模型进行经验验证。此外，患者的观点将提供对不一致的卫生服务使用的见解。此外，关于卫生服务使用的结果可用于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子是增加符合抑郁症患者客观和主观需求的卫生服务使用战略的起点。

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.