We propose a continuing competing research project of the ongoing study, Mental Health Care Utilization among Puerto Ricans (ROI MH42655) that will allow us to understand the mental health utilization process over time. A goal of this continuation study is to examine a model of mental health services utilization for the poor with prospective data. Building on previous research, the proposed research has the following specific aims: 1) to identify if there are changes in the use of mental health services over the three data collection periods; 2) to determine the extent to which factors identified in the decision making model reduce or increase the likelihood of seeking mental health services over time; 3) to identify among utilizers of mental health services the factors associated with the decision to change, cease, or continue receiving mental health care; 4) to determine whether changes in need, as assessed by multiple measures, predict prospective use of mental health services; and 5) to compare our findings to similar studies conducted in the U.S. with different ethnic groups, to enhance our understanding of the use of mental health services by the poor. Data will be collected by two follow up interviews of the original sample initially interviewed in 1988. This sample was selected by a stratified design that divides the enumeration districts by income substrata. A probability islandwide community sample of 1,777 respondents living in poor areas was successfully interviewed, yielding a completion rate of 91.8%. To examine specific hypothesis, we will augment this sample by increasing the number of households to be interviewed in each segment of our original sampling frame. Collection of data in three points will facilitate the assessment of changes in the patterns of use of mental health services. The decision making model of the help seeking process will be tested by estimating three logistic regression models. The mental health care utilization process will also be Assessed through the development of Markov chains as a way of understanding the transitions within the health care system to deal with mental health problems.
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