Impact of socioeconomic position and distance on mental health care utilization: a nationwide Danish follow-up study

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Impact of socioeconomic position and distance on mental health care utilization : a nationwide Danish follow-up study. / Packness, Aake; Waldorff, Frans Boch; Christensen, René De Pont; Hastrup, Lene Halling; Simonsen, Erik B.; Vestergaard, Mogens; Halling, Anders.

I: Social Psychiatry and Psychiatric Epidemiology, Vol. 52, Nr. 11, 2017, s. 1405-1413.

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Packness, Aake ; Waldorff, Frans Boch ; Christensen, René De Pont ; Hastrup, Lene Halling ; Simonsen, Erik B. ; Vestergaard, Mogens ; Halling, Anders. / Impact of socioeconomic position and distance on mental health care utilization : a nationwide Danish follow-up study. I: Social Psychiatry and Psychiatric Epidemiology. 2017 ; Vol. 52, Nr. 11. s. 1405-1413.

RIS

TY - JOUR

T1 - Impact of socioeconomic position and distance on mental health care utilization

T2 - a nationwide Danish follow-up study

AU - Packness, Aake

AU - Waldorff, Frans Boch

AU - Christensen, René De Pont

AU - Hastrup, Lene Halling

AU - Simonsen, Erik B.

AU - Vestergaard, Mogens

AU - Halling, Anders

PY - 2017

Y1 - 2017

N2 - Purpose: To determine the impact of socioeconomic position (SEP) and distance to provider on outpatient mental health care utilization among incident users of antidepressants. Method: A nationwide register-based cohort study of 50,374 person-years. Results: Persons in low SEP were more likely to have outpatient psychiatrist contacts [odds ratio (OR) 1.25; confidence interval (CI) 1.17–1.34], but less likely to consult a co-payed psychologist (OR 0.49; CI 0.46–0.53) and to get mental health service from a GP (MHS-GP) (OR 0.81; CI 0.77–0.86) compared to persons in high SEP after adjusting for socio-demographics, comorbidity and car ownership. Furthermore, persons in low SEP who had contact to any of these therapists tended to have lower rates of visits compared to those in high SEP. When distance to services increased by 5 km, the rate of visits to outpatient psychiatrist tended to decrease by 5% in the lowest income group (IRR 0.95; CI 0.94–0.95) and 1% in the highest (IRR 0.99; CI 0.99–1.00). Likewise, contact to psychologists decreased by 11% in the lowest income group (IRR 0.89; CI 0.85–0.94), whereas rate of visits did not interact. Conclusion: Patients in low SEP have relatively lower utilization of mental health services even when services are free at delivery; co-payment and distance to provider aggravate the disparities in utilization between patients in high SEP and patients in low SEP.

AB - Purpose: To determine the impact of socioeconomic position (SEP) and distance to provider on outpatient mental health care utilization among incident users of antidepressants. Method: A nationwide register-based cohort study of 50,374 person-years. Results: Persons in low SEP were more likely to have outpatient psychiatrist contacts [odds ratio (OR) 1.25; confidence interval (CI) 1.17–1.34], but less likely to consult a co-payed psychologist (OR 0.49; CI 0.46–0.53) and to get mental health service from a GP (MHS-GP) (OR 0.81; CI 0.77–0.86) compared to persons in high SEP after adjusting for socio-demographics, comorbidity and car ownership. Furthermore, persons in low SEP who had contact to any of these therapists tended to have lower rates of visits compared to those in high SEP. When distance to services increased by 5 km, the rate of visits to outpatient psychiatrist tended to decrease by 5% in the lowest income group (IRR 0.95; CI 0.94–0.95) and 1% in the highest (IRR 0.99; CI 0.99–1.00). Likewise, contact to psychologists decreased by 11% in the lowest income group (IRR 0.89; CI 0.85–0.94), whereas rate of visits did not interact. Conclusion: Patients in low SEP have relatively lower utilization of mental health services even when services are free at delivery; co-payment and distance to provider aggravate the disparities in utilization between patients in high SEP and patients in low SEP.

KW - Access to health care

KW - Antidepressants

KW - Geographic information system

KW - Mental health services

KW - Socioeconomic factors

UR - http://www.scopus.com/inward/record.url?scp=85028568295&partnerID=8YFLogxK

U2 - 10.1007/s00127-017-1437-2

DO - 10.1007/s00127-017-1437-2

M3 - Article

VL - 52

SP - 1405

EP - 1413

JO - Social Psychiatry

JF - Social Psychiatry

SN - 0037-7813

IS - 11

ER -