Mental Health Services Utilization Among Women Experiencing Intimate Partner Violence

Objective: To examine the patient and provider characteristics associated with utilization of mental health services (MHS) among women experiencing intimate partner violence (IPV). Study Design: Cross-sectional study among 6870 women aged 18 to 65 years with first IPV identification between May 2004 and December 2009 in Kaiser Permanente Northern California. Methods: Utilization of MHS within 60 days after first IPV identification was determined. Multivariate generalized estimating equation logistic regression models that controlled for patient and provider characteristics were used to determine predictors of utilization. Results: Thirty-seven percent of women utilized MHS. In multivariate generalized estimating equation models, the strongest predictor of utilization was electronic referral (odds ratio [OR], 4.40; 95% confidence interval [CI], 3.66-5.28). Odds of utilization were lower among black (OR, 0.71; 95% CI, 0.57-0.89), Latina (OR, 0.62; 95% CI, 0.41-0.95), and Spanish-speaking (OR, 0.71; 95% CI, 0.57-0.89) patients and were higher among those with prior posttraumatic stress disorder (OR, 2.38; 95% CI, 1.17-3.44) or depression (OR, 1.35; 95% CI, 1.17-1.57). Emergency department identification of IPV was associated with lower odds of MHS utilization (OR, 0.46; 95% CI, 0.37-0.59), while older provider identification of IPV was associated with higher odds of MHS utilization (OR, 1.33; 95% CI, 1.07-1.65). Conclusions: Additional training for providers, particularly those who are younger or are practicing in emergency departments, may be needed to increase rates of MHS utilization among patients affected by IPV. Addressing language barriers to care and cultural appropriateness may improve MHS utilization. (Am J Manag Care. 2010;16(10):731-738)