Does health service utilisation mediate the effect of disability on psychological distress: Evidence from a national representative survey in Australia

Little was known about the role of health service utilisation on psychological distress. Using a national representative survey data in Australia, we aimed to quantify the role of disability status, types of disability, and severity of disability in their respective relationship to psychological distress in adults, and further explore the mediating effect of health service use on the disability-distress association. Data were derived from the 2015 Australian National Health Survey. Five individual actions taken for health were measured respectively, in terms of number of annual visits to general practitioner, specialist, outpatient clinic, hospital inpatient, and psychologist services. Disability was significantly associated with high psychological distress (OR = 4.46). Substantial increase in risk of high psychological distress was observed in people with psychological disability, head injury, stroke or brain damage, and intellectual disability (OR = 26.34, 18.26, 7.62). For the mediating effect of different health service use, GP services demonstrated the greatest decrease of the effect of disability on high psychological distress. GPs in the primary healthcare setting rather than psychological professionals hold a more important place to deal with the disabling and/or secondary clinical conditions as 'potential stressors'. Early screening provided by GPs for mental disorders are essential and integrated therapy will be beneficial.Little was known about the role of health service utilisation on psychological distress. Using a national representative survey data in Australia, we aimed to quantify the role of disability status, types of disability, and severity of disability in their respective relationship to psychological distress in adults, and further explore the mediating effect of health service use on the disability-distress association. Data were derived from the 2015 Australian National Health Survey. Five individual actions taken for health were measured respectively, in terms of number of annual visits to general practitioner, specialist, outpatient clinic, hospital inpatient, and psychologist services. Disability was significantly associated with high psychological distress (OR = 4.46). Substantial increase in risk of high psychological distress was observed in people with psychological disability, head injury, stroke or brain damage, and intellectual disability (OR = 26.34, 18.26, 7.62). For the mediating effect of different health service use, GP services demonstrated the greatest decrease of the effect of disability on high psychological distress. GPs in the primary healthcare setting rather than psychological professionals hold a more important place to deal with the disabling and/or secondary clinical conditions as 'potential stressors'. Early screening provided by GPs for mental disorders are essential and integrated therapy will be beneficial.This work was supported by National Social Science Fund of China (grant number 17CGL051) and the Program for Young Excellent Talents, University of International Business and Economics (grant number 17YQ12) for their financial support