It has been estimated that between 45% and 50% of patients who seek treatment in a primary care setting have a significant psychosocial problem (Hoeper et. al., 1979). Furthermore, 54% of patients with mental disorders are seen only in primary care settings (Regier, Golberg, & Taube, 1978). A complete understanding of the psychiatric and psychosocial factors that influence medical utilization among a low-income primary care population is necessary in order to better assist this population and reduce health care costs. We propose to perform the first cross-sectional and longitudinal investigation of the role of stress and psychopathology in medical utilization in a primary. care setting for a low-income population We will also attempt to determine whether coping strategies and social support moderate the effects of stress on medical utilization. Initial assessment of psychological distress, minor stress, social support, and coping strategies will be performed. Telephone interviews will be conducted bimonthly for 12 months to assess the occurrence of minor stressors and the frequency of medical utilization. The occurrence of major stressors will be evaluated at 6 and 12 months following the initial contact. At the end of 12 months, a psychiatric interview will be conducted in order to evaluate clinical and sub-clinical levels of psychopathology as well as social support and coping strategies. Medical utilization will be measured by telephone interviews 6 and 12 months after the psychiatric interview to determine whether stress and psychopathology predicts medical utilization. Chart reviews of medical utilization will be performed for comparison with the self-report measure. Regression will be used to determine the degree of association and the mechanisms by which the targeted variables affect medical utilization.
