Mental health service utilization after physical trauma: the importance of physician referral

Despite the availability of effective treatments for posttraumatic stress reactions after serious physical injuries, many sufferers do not use mental health services. Attempts to understand the factors that facilitate mental health service use have often focused on patient-related factors without assessing provider behavior.

To examine the relative influence of patient-related factors and physician referral on mental health service utilization among patients after a traumatic physical injury.

A fully structured interview was administered prospectively by trained lay persons to Los Angeles Country trauma center injury patients. A total of 677 patients completed an initial interview. Of those who completed an initial interview, 70% (n = 476) completed a 6-month follow-up interview and 68% (n = 462) completed a 12-month interview.

We examined 3 classes of patient characteristics hypothesized to be related to mental health service use: need (eg, posttraumatic stress symptoms), predisposing factors (eg, gender), and enabling resources (eg, health insurance). Additionally, we looked at physician referral to mental health treatment as a provider behavior hypothesized to predict service use.

Age, posttraumatic stress disorder symptom severity, previous mental health treatment, and physician referral were all associated with mental health service use. Physician referral demonstrated the strongest relationship with mental health service utilization. While controlling for other factors, the odds of mental health service use were nearly 8 times higher for those respondents receiving a physician referral than for those without a referral.

Findings highlight the importance of physician referral in facilitating access to mental health services for trauma injury survivors.