Economic Change and Admissions to Public Outpatient Community Mental Health Facilities: an Ecological Analysis.

Abstract

Previous research suggests that a connection between macroeconomic decline and increases in community level distress exists. Stressful life events theory and research suggests that undesirable changes as well as change may lead to the use of mental health services. In order to study the short-term effects of directional and absolute economic change on admission rates, new rates under treatment (N = 122,858) to Michigan's public outpatient community mental health facilities were correlated with monthly changes in unemployment rates over a six year period (October, 1973 through September,1979) in eleven St and ard Metropolitan Statistical Areas. The results indicate that neither economic decline or economic instability accounts for a statistically significant amount of the variance in admission rates. However, trends in the data do emerge. These trends indicate that economic decline is generally related to an overall decline in total new admission rates. Increases in absolute changes of the unemployment rates are associated with overall increases in total new admissions. Disaggregation of admission rates by sex indicate that as unemployment rates increase, admission rates increase for males and decrease for females. An increase of absolute change in the unemployment rate is associated with increased admission rates for both males and females. Economic instability tends to be linked to higher rates of admissions for males than for females. These findings suggest that change per se may be more stressful than undesirable change. Reasons for the differential patterns of admission rates by sex are suggested. Implications of the findings for future stressful life events research, and the mental health service delivery system are discussed.