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Psychosocial Factors Related to Underuse of Medical Services

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Abstract

In this longitudinal study, we applied structural equation modeling (SEM) to examine the historical, predisposing, enabling/barrier, and need factors as related to the underuse of medical services during early midlife. We gathered longitudinal data on a prospective cohort of community-dwelling men and women (N = 548) followed from adolescence to early midlife. The findings supported a mediational model: A mutually affectionate parent–child relationship in early adolescence was inversely related to underuse of medical services in early midlife via the mediational roles played by later predisposing factors (i.e., depressive mood and cigarette smoking), need factor (i.e., physical health problems), barriers (i.e., financial difficulty), and enabling factors (i.e., social support for health services in early midlife). In addition, satisfaction with medical services in the neighborhood had an association with less underuse of medical services in early midlife. Family therapy focused on an increase in the affectionate relationship between the adolescents and his/her parents and cognitive-behavioral treatment of depressive mood may lead to a decrease in the underuse of medical services.

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Acknowledgments

This research was supported by NIH grants DA032603 and DA003188 from the National Institute on Drug Abuse awarded to Dr. Judith S. Brook. The authors wish to thank Dr. Stephen J. Finch for his critical review of this manuscript.

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Authors and Affiliations

  1. Department of Psychiatry, New York University School of Medicine, 215 Lexington Ave., 15th Floor, New York, NY, 10016, USA

    Chenshu Zhang, Judith S. Brook & David W. Brook

  2. Department of Behavioral Sciences, University of Kentucky, Lexington, KY, USA

    Carl G. Leukefeld

Authors
  1. Chenshu Zhang
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  2. Judith S. Brook
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  3. Carl G. Leukefeld
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  4. David W. Brook
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Corresponding author

Correspondence to Judith S. Brook.

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Research Highlights

• A distant parent–child attachment predicted underuse of medical services.

• Earlier depressive mood correlated with underuse of medical services.

• Financial difficulty was associated with underuse of medical services.

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Zhang, C., Brook, J.S., Leukefeld, C.G. et al. Psychosocial Factors Related to Underuse of Medical Services. J Urban Health 93, 652–665 (2016). https://doi.org/10.1007/s11524-016-0067-4

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