Psychological distress and the decision to seek medical care

There have been a number of studies linking psychological distress with the demand for medical care. The importance of these studies lies in the finding that the distressed use of services more frequently than the non-distressed. To the extent that many of the visits of the distressed are for medically trivial reasons, which is the most frequent interpretation of this finding, there may be an argument in favor of cost containment strategies aimed at diverting the distressed away from seeking 'unneeded' medical attention. There are, however, a number of difficulties both with most of the studies that have been done to date and with how the finding of more frequent visits among the distressed is interpreted. The present study examines the reporting of illnesses, disability per illness reported, patient initiated physician visits per illness reported and physicians' judgement regarding the medical necessity of the visits reported for a representative sample of the Los Angeles metropolitan area. The 950 respondents in this analysis were divided into groups by three levels of psychological distress. Illnesses reported both prospectively and retrospectively to the measurement of psychological distress are analyzed. The data indicate that, although the distressed report more illnesses, they are no more likely either to report disability per illness or to initiate medical care per illness. Further, the distressed are no more likely either to initiate unnecessary physician visits or to avoid initiating necessary visits. The implications of these findings for the impact of cost containment strategies on equity in the delivery of medical services are discussed.