Table 3.

Estimation results of the associations among health, ambulatory physical and mental healthcare utilization and emergency care utilization

	Direct effect (coefficients)			Indirect effect (derived)			Total effects (derived)
	Coeff	95% CI	p-value	Effect	95% CI	p-value	Effect	95% CI	p-value
Fair, poor or very poor self-rated health
Age	0.003	(-0.002; 0.009)	0.232				0.003	(-0.002; 0.009)	0.232
Chronic disease	0.463	(0.314; 0.612)	< 0.001				0.463	(0.314; 0.612)	< 0.001
Level of pain	0.091	(0.048; 0.134)	< 0.001				0.091	(0.048: 0.134)	< 0.001
Constant	-0.057	(-0.254; 0.140)	0.571
Ambulatory care utilization
Fair, poor or very poor self-rated health	0.207	(0.050; 0.364)	0.010				0.207	(0.050; 0.364)	0.010
Chronic disease				0.096	(0.017; 0.175)	0.018	0.096	(0.017; 0.175)	0.018
Level of pain				0.019	(0.002; 0.036)	0.029	0.019	(0.002; 0.036)	0.029
< 18 months in Germany	0.053	(-0.135; 0.241)	0.582				0.053	(-0.135; 0.241)	0.582
Gender	0.038	(-0.131; 0.208)	0.658				0.038	(-0.131; 0.208)	0.658
Age				0.001	(-0.001; 0.002)	0.278	0.001	(-0.001; 0.002)	0.278
Constant	0.437	(0.311; 0.563)
Mental healthcare utilization (psychiatry and/or psychotherapy)
Depressive symptoms	0.005	(-0.146; 0.156)	0.949				0.005	(-0.146; 0.156)	0.949
Symptoms of anxiety	0.202	(0.051; 0.352)	0.009				0.202	(0.051; 0.352)	0.009
< 18 months in Germany	0.138	(-0.015; 0.291)	0.078				0.138	(-0.015; 0.291)	0.078
Gender	0.066	(-0.071; 0.204)	0.345				0.066	(-0.071; 0.204)	0.345
Constant	0.075	(-0.031; 0.182)	0.167
Emergency care utilization
Ambulatory care utilization	0.388	(-0.171; 0.948)	0.174			0.041	0.388	(-0.171; 0.948)	0.174
Fair, poor or very poor self-rated health	0.541	(-0.028; 1.109)	0.062	0.080	(-0.051; 0.211)	0.229	0.621	(0.059; 1.183)	0.03
Chronic disease				0.287	(0.012; 0.563)	0.041	0.287	(0.012; 0.563)	0.041
Level of pain				0.056	(-0.001; 0.114)	0.055	0.056	(-0.001; 0.114)	0.055
Mental healthcare utilization	0.842	(0.148; 1.535)	0.017				0.842	(0.148; 1.535)	0.017
Depressive symptoms	-0.102	(-0.725; 0.520)	0.747	0.004	(-0.123; 0.131)	0.949	-0.098	(-0.733; 0.537)	0.762
Symptoms of anxiety	0.620	(-0.028; 1.267)	0.061	0.170	(-0.019; 0.359)	0.078	0.790	(0.141; 1.438)	0.017
< 18 months in Germany	0.021	(-0.582; 0.624)	0.945	0.136	(-0.053; 0.326)	0.159	0.157	(-0.463; 0.777)	0.619
Gender	-0.398	(-0.940; 0.145)	0.151	0.071	(-0.086; 0.227)	0.375	-0.327	(-0.889; 0.234)	0.254
Age				0.002	(-0.002; 0.006)	0.295	0.002	(-0.002; 0.006)	0.295
Constant	0.088	(-0.407; 0.582)	0.728
Error variances of endogenous variables
Fair, poor or very poor self-rated health	0.129	(0.102; 0.164)
Ambulatory care utilization	0.231	(0.182; 0.293)
Mental healthcare utilization	0.152	(0.120; 0.193)
Emergency care utilization	2.304	(1.816; 2.922)
Error covariance of ambulatory and mental healthcare utilization	0.059	(0.025; 0.092)

Coefficients are direct effects; indirect effects and total effects are derived from estimated coefficients using the model structure. Effects are not necessarily causal