Does educational background explain inequalities in care service use for mental health problems in the Dutch general population?

Objective: To investigate whether (1) education predicts the use of care services for mental health problems, independently of mental disorder and functional impairment and (2) education modifies the association between mental disorder and service use. Method: Predictors of service use were recorded at baseline, and service use itself at 12-month follow-up, in a representative sample (N =7076) of the Dutch population, using the Composite International Diagnostic Interview. Results: People with more education were less likely to use primary care but more likely to use mental health care. The effects on both types of care remained significant after adjustment for mental disorder and functional impairment. Lower education tended to strengthen the association between mood or anxiety disorder and primary care use. Conclusion: Further research on inequalities in service use will benefit from additional explanatory analyses and from the inclusion of sociopsychological variables, like cost-benefit considerations in decisions to use services.