Income differences in persons seeking outpatient treatment for mental disorders: a comparison of the United States with Ontario and The Netherlands

Arch Gen Psychiatry. 2000 Apr;57(4):383-91. doi: 10.1001/archpsyc.57.4.383.


Background: Variations in the relationships among income, use of mental health services, and sector of care are examined by comparing data from 3 countries that differ in the organization and financing of mental health services.

Methods: Data come from the 1990-1992 National Comorbidity Survey (n = 5,384), the 1990-1991 Mental Health Supplement to the Ontario Health Survey (n = 6,321), and the 1996 Netherlands Mental Health Survey and Incidence Study (n = 6031). Analysis of the association between income and use of mental health services was carried out for the population that was between ages 18 and 54 years. Differential use of mental health treatment was examined in 3 sectors: the general medical sector, the specialty sector, and the human services sector.

Results: No significant association between income and probability of any mental health treatment was observed for persons with psychiatric disorders in any of the 3 countries. However, there were significant differences among countries in the association between income and sector of mental health care treatment. In the United States, income is positively related to treatment being received in the specialty sector and negatively related to treatment being received in the human services sector. In the Netherlands, patients in the middle-income bracket are less likely to receive specialty care, while those in the high-income bracket are less likely to be seen in the human service sector. Income is unrelated to the sector of care for patients in Ontario.

Conclusions: Future research should examine whether differential access to the specialty sector for low-income people in the United States is associated with worse mental health outcomes.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Ambulatory Care* / statistics & numerical data
  • Community Mental Health Services / legislation & jurisprudence
  • Community Mental Health Services / statistics & numerical data
  • Delivery of Health Care / legislation & jurisprudence
  • Delivery of Health Care / statistics & numerical data
  • Female
  • Humans
  • Income*
  • Male
  • Mental Disorders / epidemiology
  • Mental Disorders / therapy*
  • National Health Programs / statistics & numerical data
  • Netherlands / epidemiology
  • Ontario / epidemiology
  • Outcome Assessment, Health Care
  • Patient Acceptance of Health Care* / statistics & numerical data
  • Prevalence
  • Severity of Illness Index
  • United States / epidemiology