Elien Colman

Divorce, divorce rates, and professional care seeking for mental health problems in Europe: a cross-sectional population-based study

BackgroundLittle is known about differences in professional care seeking based on marital status. The few existing studies show more professional care seeking among the divorced or separated compared to the married or cohabiting. The aim of this study is to determine whether, in a sample of the European general population, the divorced or separated seek more professional mental health care than the married or cohabiting, regardless of self-reported mental health problems. Furthermore, we examine whether two country-level features--the supply of mental health professionals and the country-level divorce rates--contribute to marital status differences in professional care-seeking behavior.MethodsWe use data from the Eurobarometer 248 on mental well-being that was collected via telephone interviews. The unweighted sample includes 27,146 respondents (11,728 men and 15,418 women). Poisson hierarchical regression models were estimated to examine whether the divorced or separated have higher professional health care use for emotional or psychological problems, after controlling for mental and somatic health, sociodemographic characteristics, support from family and friends, and degree of urbanization. We also considered country-level divorce rates and indicators of the supply of mental health professionals, and applied design and population weights.ResultsWe find that professional care seeking is strongly need based. Moreover, the divorced or separated consult health professionals for mental health problems more often than people who are married or who cohabit do. In addition, we find that the gap between the divorced or separated and the married or cohabiting is highest in countries with low divorce rates.ConclusionsThe higher rates of professional care seeking for mental health problems among the divorced or separated only partially correlates with their more severe mental health problems. In countries where marital dissolution is more common, the marital status gap in professional care seeking is narrower, partially because professional care seeking is more common among the married or cohabiting.

Professional health care use and subjective unmet need for social or emotional problems: a cross-sectional survey of the married and divorced population of Flanders

BackgroundThe high mental health care consumption rates of divorced singles may constitute a heavy burden on the public health care system. This raises the question of whether their higher health care use stems from a greater need, or whether there are other factors contributing to these high consumption rates. We examine both health care use and subjective unmet need (perceiving a need for care without seeking it) because of social or emotional problems of the divorced singles, the repartnered divorcees, and the married. Moreover, we investigate how health care use and subjective unmet need relate to each other.MethodsWe conduct several gender specific logistic regressions employing data from the Divorce in Flanders Survey (N men = 2884; N women = 3317).ResultsResults show that the divorced singles have more contact with professional health care providers (general practitioners, psychiatrists, and psychologists) because of social or emotional problems, and more often perceive unmet needs. The higher health care use rates and greater subjective unmet needs can largely be attributed to higher levels of depressive symptoms. Surprisingly, we find that non-frequent health care users more often perceive a subjective unmet need than frequent health care users and those who have not contacted any health care provider.ConclusionThe single divorced consult health care providers more often because of social or emotional problems and they also perceive unmet needs more often.

Spousal influence on mammography screening: A life course perspective

Recently, researchers have challenged the basic tenet that marriage is universally protective for all individuals. We scrutinize socio-economic differences between married couples to shed light on the mechanisms underlying the effects of marriage. We introduce the life course perspective to investigate if differences in positive health behavior between couples are related to their early life conditions. Within the theoretical framework of cultural health capital, we hypothesize that the accumulation of cultural health capital proceeds at the marriage level when partners provide each other with health-related information and norms. For this purpose, we examine the influence of the childhood preventive health care behavior of both wives and husbands on the initiation of mammography screening for a sample of Belgian women (N = 734). Retrospective life histories of both partners are provided by the Survey of Health, Ageing and Retirement (SHARE) and are examined by means of event history analysis. The results show that a partners cultural health capital affects the initiation of mammography screening by a woman in later life, even after her own cultural health capital and traditional measures of socio-economic status (SES) are taken into account. In line with cumulative advantage theory, it seems that inequalities in cultural health capital are accumulated at the marriage level. In order to shed further light on the spousal influence on health behavior, researchers should revert to early life in order to discern the attribution of premarital and marital conditions.

The use of mental health care, psychotropic drugs and social services by divorced people: does informal support matter?

This study compares the mental health care, psychotropic drugs and social service use of divorced people (re-partnered or single) with that of married people. This paper questions whether the availability of informal support facilitates or substitutes for formal care seeking. Data from the Divorce in Flanders survey of 2009–2010 are used. Logistic regression analyses are performed separately for women (N = 3450) and men (N = 3020). Greater use of mental health care, psychotropic drugs and social services by single divorced men is explained by their higher need for care, while divorced women (especially single divorced) more frequently contact a general practitioner (GP), a psychiatrist, or a psychologist, regardless of their mental health, socio-economic background and informal support. Women who have support from non-family members are more inclined to use social services and to contact a GP, while support from family members is only positively related to GP consultations. With regard to men, informal support from non-family members positively influences each type of formal care seeking. Our results suggest that non-family members (and only among women, family members as well) can provide help and advice about seeking professional mental health care and social services, but they do not have an influence on psychotropic drug use.

The Role of Perceived Helpfulness in Predicting Subjective Unmet Need and the Frequency of Health Care Use

OBJECTIVES We scrutinize the health care use of divorcees, in order to explain why users of mental health care have a higher risk of perceiving an unmet need. We hypothesize that a perception of low helpfulness of received care heightens the risk of perceiving an unmet need and becoming a less frequent health care user. METHODS Three subsamples from the Divorce in Flanders survey are selected: those who contacted a general practitioner (n=816), a psychiatrist (n=205), or a psychologist (n=251) because of social or emotional problems. Logistic regressions are used in order to explore the correlates of subjective unmet need and the frequency of contact with a health care provider among each subsample. RESULTS show that patients who perceived that care was not helpful more often reported an unmet need and made less frequent use of health care. CONCLUSIONS These findings suggest that people are less inclined to seek further help when they perceive previous help as being ineffective.

Mental Health Care Use Among Recently Cohabiting and Newlywed Couples: An Application of the Social Control Theory

Drawing on health-related social control theory, we examine how young partners influence each others mental health care use. We use the data of a sample of newlywed and recently cohabiting heterosexual couples (N = 798) of the survey “Relationships in Flanders.” Logistic regression analyses are performed, stratifying all analyses by gender. Results reveal that married men are less likely to use health care than cohabiting men. No effect of parenthood is shown. Women consume less mental health care the longer they live together with their male partner, and when their partner has not contacted a health care provider. Hence, the results show limited support for a social learning process.