Prevalence and frequency of mental health care provided by general practitioners: differences between 2 national data sources for the same population.

OBJECTIVE: Estimates from Canada's first national mental health surveillance initiative-which is based on diagnostic codes in administrative health care utilization databases-indicate that the proportion of Canadians who receive mental health care is more than twice as high as reported in Canada's national mental health survey. Our study examines and clarifies the nature and extent of differences between 2 predominant types of data that are used for mental health services research and planning. METHOD: A person-by-person data linkage was conducted between the Canadian Community Health Survey: Mental Health and Well-Being and administrative health care utilization records (British Columbia Ministry of Health Services-Medical Services Plan, and Hospital Discharge Abstract Database) within a universal-access, publically funded health care system, to examine the level of agreement between the data sources and respondent characteristics associated with agreement (N = 2378). RESULTS: The prevalence of mental health care from general practitioners (GPs) was higher in administrative data (19.3%; 95% CI 17.7% to 20.9%) than survey data (8.5%; 95% CI 7.5% to 9.8%). Agreement between prevalence estimates from the 2 data sources was associated with age, mental health characteristics, and the number of GP visits. The median number of visits per person was significantly higher in the survey data. CONCLUSIONS: GPs saw more than twice as many patients for mental health issues according to administrative data, compared with survey data; however, the number of visits per patient was higher in survey data.

Beyond the patient: the broader impact of genetic discrimination among individuals at risk of Huntington disease.

We aimed to address gaps in current understanding of the scope and impact of discrimination, by examining a cohort of individuals at-risk for Huntington disease (HD), to describe the prevalence of concern for oneself and one's family in multiple domains; strategies used to mitigate discrimination; and the extent to which concerns relate to experiences. We conducted a cross-sectional survey of 293 individuals at-risk for HD (80% response rate); 167 respondents were genetically tested and 66 were not. Fear of discrimination was widespread (86%), particularly in the insurance, family and social settings. Approximately half of concerned individuals experienced discrimination (40-62%, depending on genetic status). Concern was associated with "keeping quiet" about one's risk of HD or "taking action to avoid" discrimination. Importantly, concern was highly distressing for some respondents (21% for oneself; 32% for relatives). Overall, concerned respondents with high education levels, who discovered their family history at a younger age, and those who were mutation-positive were more likely to report experiences of discrimination than others who were concerned. Concerns were rarely attributed to genetic test results alone. Concern about genetic discrimination is frequent among individuals at-risk of HD and spans many settings. It influences behavioral patterns and can result in high levels of self-rated distress, highlighting the need for practice and policy interventions. © 2012 Wiley Periodicals, Inc.

Primary mental health care visits in self-reported data versus provincial administrative records.

BACKGROUND: Survey data and provincial administrative health data are the major sources of population estimates of mental health care visits to General Practitioners (GPs). Previous research has suggested that self-reported estimates of the number of mental health-related visits per person to health professionals may exceed estimates obtained from physician reimbursement records. DATA AND METHODS: Self-reported data from the 2002 Canadian Community Health Survey (CCHS): Mental Health and Well-being and administrative records from the Medical Services Plan of British Columbia were linked. The analytic sample consisted of 145 CCHS respondents who had at least one mental health visit to a GP in the past 12 months according to both data sources. High Reporters (self-reported visits exceeded number in administrative data), Low Reporters (self-reported visits were less than number in administrative data), and Exact Matches were analyzed in two ways. The first analysis used diagnostic codes to identify mental health-related visits in the administrative data. For the second analysis, all GP visits in the administrative data were counted as "possibly" mental health-related. Differences were described based on the median number of visits. RESULTS: When diagnostic codes were used to identify mental-health-related visitis in the administrative data, High Reporters (49%) substantially exceeded Low Reporters (24%). The remaining 27% were Exact Matches. Based on a broader definition of a mental health visit, 51% were Exact Matches. High reporting was common among people with mental disorders. INTERPRETATION: Self-reported data and administrative data provide different estimates of the number of mental health visits per person to GPs. The discrepancy can be large.

Factors associated with experiences of genetic discrimination among individuals at risk for Huntington disease.

The purpose of this study was to identify factors that are associated with experiencing genetic discrimination (GD) among individuals at risk for Huntington disease (HD). Multivariable logistic regression analysis was used to examine factors associated with experiencing GD in data from a cross-sectional, self-report survey of 293 individuals at risk for HD. The study sample comprised 167 genetically tested respondents, and 66 who were not tested (80% response rate). Overall, individuals who learn they are at risk for HD at a younger age (OR = 3.1; 95% CI: 1.5-6.2; P = 0.002), are mutation-positive (OR = 2.8; 95% CI: 1.4-6.0; P = 0.006), or are highly educated (OR = 2.7; 95% CI: 1.4-5.1; P = 0.002) are more likely to experience GD, particularly in insurance, family, and social settings. Further, younger age was associated with discrimination in insurance (OR = 0.97; 95% CI: 0.94-1.00; P = 0.038). This study provides evidence that some people who are at risk for HD were more likely to experience GD than others. Individuals who learned they are at risk for HD at a younger age and those who are mutation-positive were more likely to experience GD, particularly in insurance, family, and social settings. Younger individuals were more likely to experience discrimination in the insurance setting. Overall, highly educated individuals were also more likely to report discrimination. These results provide direction for clinical and family discussions, counseling practice, and policy aimed at mitigating experiences of GD.