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These findings support previous data reporting that high levels of adult depression lead to high service use [ 33, 34].
Conversely, having a more severe mental disorder (e.g. psychotic disorder) was significantly associated with lower odds of high service use [AOR 0.59 (0.97, 0.97)].
Some studies highlight such iatrogenic dependency [ 15], and show very high service use of non-psychotic patients across health and social services [ 10].
Having a regular family physician, and negative feelings about 'the things you do with other people' were enabling factors associated with significantly greater odds of high service use.
10 Further, obesity coupled with depression has significant economic implications, owing to high service use 11– 13 and reduced participation in the labour force.
7, 8 Many studies of medically unexplained symptoms have used selective entry criteria, resulting in samples with high rates of mental disorders, high service use or symptom syndromes.
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A three-level categorical variable (low, medium and high services use) was created by applying cut-points at the upper and lower quartiles of the distribution, corresponding to 18 and 76 Medicare services used.
Other studies, 31 33 with correction for severity, also showed higher service use for jobless populations, compared with the employed.
Several studies on the relation between acculturation and service use suggest that increased adaption to the host culture is associated with higher service use [ 9].
Higher service use may reflect greater mental health need due to exposure to resettlement stressors (e.g., discrimination, unemployment) that appear more pronounced for this immigrant group.
The level of education can also play a role, and our results show that a lower educational attainment increases the risk of higher service use.
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