| Summary: | Introduction/Objectives The healthcare intake process plays a significant role in informing medical personnel about patients’ demographic information, subjective health status, and health complaints. Intake forms can help providers personalize care to assist patients in getting proper referrals and treatment. Previous studies examined factors that could be included in intake forms independently, but this study analyzed loneliness, religiousness, household income, and social integration together to see how the combined effect influences mental and physical health status. This study aims to determine which of those 4 variables better inform patients’ mental versus physical health status. Methods One hundred and seventy-nine participants completed surveys, including the SF-12 ® Health Survey, measuring perceived physical and mental health, UCLA 3-item Loneliness Scale, and a demographics questionnaire with questions about household income and time spent dedicated to religious practice, if applicable. Additionally, individuals answered social integration questions about how often they contact close family and friends or volunteer in the community. Using loneliness, household income, religiousness, social integration as independent variables, and controlling for demographic variables such as age, gender, and race, 2 regression models were built with Mental and Physical Health Composite Scores from the the SF-12 ® Health Survey as dependent variables. Results Loneliness was associated with mental health measures ( b = −2.190, P < .001), while household income was associated with physical health measures ( b = 0.604, P = .019) above and beyond other variables in the regression models. Conclusions Integrating the 3 loneliness questions into intake forms can help approximate an individual’s mental health status. This would allow the provider to be able to assess mental health problems more effectively and provide needed resources.
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