Background: Persons with schizophrenia and related disorders may be particularly sensitive to a number of
determinants of service use, including those related with illness, socio-demographic characteristics and
organizational factors. The objective of this study is to identify factors associated with outpatient contacts at
community mental health services of patients with schizophrenia or related disorders.
Methods: This cross-sectional study analyzed 1097 patients. The main outcome measure was the total number of
outpatient consultations during one year. Independent variables were related to socio-demographic, clinical and
use of service factors. Data were collected from clinical records.
Results: The multilevel linear regression model explained 46.35% of the variance. Patients with significantly more
contacts with ambulatory services were not working and were receiving welfare benefits (p = 0.02), had no formal
education (p = 0.02), had a global level of severity of two or three (four being the most severe) (p < 0.001), with
one or more inpatient admissions (p < 0.001), and in contact with both types of professional (nurses and
psychiatrists) (p < 0.001). The patients with the fewest ambulatory contacts were those with diagnoses of persistent
delusional disorders (p = 0.04) and those who were attended by four of the 13 psychiatrists (p < 0.001).
Conclusions: As expected, the variables that explained the use of community service could be viewed as proxies
for severity of illness. The most surprising finding, however, was that a group of four psychiatrists was also
independently associated with use of ambulatory services by patients with schizophrenia or related disorders. More
research is needed to carefully examine how professional support networks interact to affect use of mental health.
