Healthcare attendance styles among long-term unemployed people with substance-related and mood disorders

Abstract

Background: Both increased and decreased health service usage and unmet care needs are more prevalent among unemployed people than in the general population.

Study design: This study investigates the associations of substance-related and mood disorders among long-term unemployed people with styles of healthcare attendance in Finland.

Methods: The study material consisted of the health register information on 498 long-term unemployed people in a project screening for work disabilities. The data were analysed by mixed methods: qualitative typological analysis was applied to identify differential healthcare attendance styles, and the associations of the obtained styles with mental health disorders were analysed quantitatively by multinomial logistic regression.

Results: Three styles, characterized as smooth, faltering and marginalized, were identified. Compared with participants with the smooth attendance style without mental disorders, those with the faltering style had tenfold relative risk for substance-related disorder and fourfold relative risk for mood disorder. Those with the marginalized style had fivefold relative risk for substance-related disorder and twofold relative risk for mood disorder. Adjusting for background characteristics did not alter the statistical significance of substance-related disorder. In the case of mood disorders, the statistical significance persisted throughout the adjustments in the faltering style.

Conclusion: Dysfunctional use of health services is more common among people with substance-related or mood disorders, who are at risk of drifting towards long-term unemployment and work disabilities. The early detection of those with faltering or marginalized healthcare attendance style may prevent prolonged unemployment, enable rehabilitation measures and reduce the risk of disability pensions.

Keywords: Depression; Healthcare attendance; Identification; Mixed methods; Substance-related disorder; Unemployment.