Approximately one out of every three people in Germany who meets the diagnostic criteria for major depression has contact with mental health services. Therefore, according to treatment guidelines, two thirds of all individuals with depression are insufficiently treated. In the past, the subjective perspective of people who (do not) make use of mental health services has been neglected. Factors related to the use of health services are described in Andersen’s Behavioral Model of Health Services Use.

Figure 1: Supplementation of the “Behavioral Model of Health Services Use”
with subjectively perceived and evaluated characteristics.

In order to identify characteristics related to the utilization of mental health services by people with major depression, a systematic review was conducted, which revealed a lack of prospective cohort studies as well as studies on the influence of subjectively perceived and evaluated characteristics (1). Based on the systematic review, a pilot study (DFG BR4859/3-1) was conducted to integrate subjectively perceived and evaluated individual characteristics into the “Behavioral Model of Health Services Use” and to discover associations between them and the utilization behavior of patients with depression. The studies were carried out within the framework of a cross-sectional mixed-method design with depressive patients from different settings (GP care, outpatient specialist care, inpatient specialist care) and members of self-help groups.

Building on this preliminary work, a representative longitudinal study with two measurement points will now be carried out to determine whether the supplementation of subjectively perceived and evaluated individual characteristics in the "Behavioral Model of Health Services Use" better explain the utilization behavior of people with depression. For this purpose, established and subjective characteristics as well as utilization of mental health services are recorded quantitatively via telephone interviews at T0 and 12 months later (T1). Furthermore, persons who make or do not make use of depression-specific care incongruent to their objective or subjective need are examined in more detail. First, we will describe the proportion of these persons. Afterwards, we will examine how people explain the incongruence in their behavior (qualitative survey). Identified modifiable influencing factors are promising starting points for strategies to increase the utilization of mental health services by people with depressive disorders in line with their objective and subjective needs.

1.  Magaard, J. L., Seeralan, T., Schulz, H., & Brütt, A. L. (2017). Factors associated with help-seeking behaviour among individuals with major depression: A systematic review. PloS one, 12(5), e0176730. doi.org/10.1371/journal.pone.0176730