Background. The reasons for high use of primary care, and in particular the role of psychosocial
factors, remain unclear.
Methods. We identified and interviewed 236 frequent attenders and 420 normal users, matched by
age and sex, of a public Health Centre in Granada, Spain. Users were questioned about mental
health (GHQ-28), social support (Duke-UNC-11), family dysfunction (family APGAR) and health
beliefs (health belief model, locus of health control and medical care expectations). We also
measured a set of individual, social and illness variables.
Results. Multiple logistic regression analyses showed that mental health was the main factor
associated with frequent attender status (odds ratio = 3·1; 2·4–3·9). The association was stronger
than that between frequent attender status and perceived illness, and between the former and
reported chronic illness. Family dysfunction and perceived susceptibility to and severity of disease
were also significantly but more weakly associated with frequent attender status. Affective support
was more strongly associated with FA status than was confidant support, but both associations
disappeared when mental health and family function were controlled for.
Conclusions. Our findings document the association of psychosocial factors and primary health
care use. We suggest that the effective management of mental health problems from a family-based
approach may reduce primary health care high use.