The Role of Physical Health Functioning, Mental Health, and Sociodemographic Factors in Determining the Intensity of Mental Health Care Use Among Primary Care Medical Patients Brenda M. Lindsay Nour The University of South Dakota Jon D. Elhai University of Toledo Julian D. Ford University of Connecticut Health Center B. Christopher Frueh Baylor College of Medicine The present study examined sociodemographic and attitudinal predisposing factors (gender, age, marital status, health insurance, household income, attitudes about mental health care), and need/illness variables (depression severity, physical and mental health functional status) as predictors of past-year mental health care use intensity (i.e., visit counts) and use/nonuse. The sample included 283 adult primary care patients from the Midwestern United States in a cross-sectional study. Nonlinear regression models demonstrated that past-year treatment use intensity was significantly associated with both married status and poorer physical health functioning, while the use (vs. nonuse) of treatment was associated with depression severity. A sociodemographic and attitudinal multivariate predictor model only explained 5% of the variance in treatment use intensity, but a need/illness model significantly contributed an additional 23% variance. Poorer physical health functioning was significant in predicting treatment use intensity, while depression severity was significant in predicting the use (vs. nonuse) of treatment. Results demonstrate the particular importance of physical health problems in determining the intensity of mental health care use, and depression severity in determining the use/nonuse of treatment, notwithstanding the restricted socio- demographic contour of the sample. Keywords: primary care, health disparities, mental health service use, functional impairment, behavioral model of health care use A significant disparity continues to exist be- tween the need for and actual use of mental health services nationally. For instance, studies of the general population indicate that between only one fifth to one third of individuals with a mental disorder recently sought mental health care (Kessler, Demler et al., 2005). Among the minority of those in need of treatment who do seek mental health care, a significant proportion appear to prefer discussing their mental health problems with their primary care physicians, thus bypassing the mental health specialty ser- vice sector (Del Piccolo, Saltini, & Zimmer- man, 1998; Wang et al., 2006). However, rela- tively little research has sufficiently explored factors that predict primary care patients’ use of mental health care. The Behavioral Model of Health Service Use One important and widely used theoretical framework for understanding individual determi- nants of health care use is Andersen’s behavioral model of health care use (Andersen & Newman, Brenda M. Lindsay Nour, Department of Psychology, The University of South Dakota; Jon D. Elhai, Department of Psychology, University of Toledo; Julian D. Ford, De- partment of Psychiatry, University of Connecticut Health Center, Farmington, CT; and B. Christopher Frueh, Men- ninger Clinic and Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine. This paper is based on Brenda M. Lindsay Nour’s doc- toral dissertation; she is now affiliated with the Avera Be- havioral Health Center, Sioux Falls, SD. Dr. Frueh is now with the Department of Psychology, University of Hawaii at Hilo. Declaration of Interest: No competing or financial inter- ests are reported for the authors regarding this paper. Correspondence concerning this article should be ad- dressed to Jon D. Elhai, Department of Psychology, Uni- versity of Toledo, Mail Stop #948, 2801 W. Bancroft St., Toledo, OH 43606-3390. E-mail: jonelhai@gmail.com Psychological Services © 2009 American Psychological Association 2009, Vol. 6, No. 4, 243–252 1541-1559/09/$12.00 DOI: 10.1037/a0017375 243 This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.