Among patients with chronic medical conditions and serious mental illness, being male, older, and unemployed, as well as having a lower level of education, may be linked to fewer outpatient mental health visits, according to findings published in Psychiatric Services in Advance. Furthermore, those living in neighborhoods with higher levels of residential mobility, also showed an association with fewer visits to outpatient mental health providers.

Social integration may have protective effects for community mental health, promoting relationships with family, neighbors, and local institutions. The socioeconomic character of a neighborhood, as well as accessibility of mental health care services, influence the wellbeing of patients with psychiatric disorders.

Benson S. Ku, MD, of the department of psychiatry and behavioral sciences, Emory University School of Medicine, Atlanta, Georgia, and colleagues derived data from 2 randomized trials of patients with serious mental illnesses and chronic medical illness. Between 2011 and 2017, they enrolled individuals with schizophrenia, schizoaffective disorder, bipolar disorder, major depression, obsessive-compulsive disorder (OCD), or posttraumatic stress disorder (PTSD) and 1 or more chronic medical conditions, such as hypertension, diabetes, heart disease, and hyperlipidemia. The study sites included an urban hospital in Atlanta and a suburban community mental health facility.

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The primary outcome was the number of visits to a mental health provider in the past 60 days. Individual- and neighborhood-level variables were included in the analysis, as well as the distance to the nearest mental health facility.

The 418 study participants (76% ages 41-60 years; 33% men; 62% black) had a median of 2 visits to mental health providers, and 12% of patients had no visits, 33% had 1 visit, 23% had 2 visits, and 32% had 3 or more visits during the previous 2 month period.

Individual level characteristics that were associated with fewer visits in the risk ratio for the bivariate model (RR1) and adjusted variables (RR2) included age (RR1, 0.81; RR2, 0.84; P =.004), being a man (RR1, 0.69; RR2, 0.73; P< .001), unemployment (RR1, 0.62; RR2, 0.71; P <.001), and lower education attainment (RR1, 0.76; RR2, 0.81, P <.001). Bivariate analysis of neighborhood-level characteristics showed that socioeconomic deprivation (RR1, 0.84; P <.001) and residential mobility (RR1, 0.86; P <.001) were significantly associated with fewer mental healthcare visits. After adjustment for both individual and neighborhood factors, all individual-level factors and the neighborhood-level residential mobility factor (RR2, 0.92; P =.034) remained significant.

Study limitations included the recruitment of participants from a single metropolitan area, the nonrandomized design, and the relatively high proportion of women and older patients. The researchers noted that given the characteristics of the sample, the study findings require external validation.

The researchers concluded that “this study supports the potential usefulness of addressing structural competence and increasing awareness of the social conditions and institutional policies that may shape patients’ use of services.” They also suggested that “residential segregation and discrimination may leave people with serious mental illnesses with no choice but to live in more disorganized areas.”

Disclosures: A study author is a consultant for Biogen and Alkermes. No other authors reported any conflict of interest.


Ku BS, Lally CA, Compton MT, Druss BG. Neighborhood predictors of outpatient mental health visits among persons with comorbid medical and serious mental illnesses. PS Advance. 2020. doi:10.1176/ 

This article originally appeared on Psychiatry Advisor