Socioeconomic position and mental health care use before and after first redeemed antidepressant and time until subsequent contact to psychologist or psychiatrists: a nationwide Danish follow-up study
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Socioeconomic position and mental health care use before and after first redeemed antidepressant and time until subsequent contact to psychologist or psychiatrists : a nationwide Danish follow-up study. / Packness, Aake; Wehberg, Sonja; Hastrup, Lene Halling; Simonsen, Erik; Søndergaard, Jens; Waldorff, Frans Boch.
I: Social Psychiatry and Psychiatric Epidemiology, Bind 56, 2021, s. 449–462.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › fagfællebedømt
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TY - JOUR
T1 - Socioeconomic position and mental health care use before and after first redeemed antidepressant and time until subsequent contact to psychologist or psychiatrists
T2 - a nationwide Danish follow-up study
AU - Packness, Aake
AU - Wehberg, Sonja
AU - Hastrup, Lene Halling
AU - Simonsen, Erik
AU - Søndergaard, Jens
AU - Waldorff, Frans Boch
PY - 2021
Y1 - 2021
N2 - Purpose The purpose was to investigate inequalities in access to care among people with possible depression. Method In this nationwide register-based cohort study of 30,593 persons, we observed the association between socioeconomic position (SEP, education/income) and mental health care use (MHCU) four months before the date of first redeemed antidepressant (Index Date/ID) and 12 months afterwards-and time to contact to psychologist/psychiatrist (PP). Logistic, Poisson, and Cox regression models were used, adjusted for sex, age, cohabitation, and psychiatric comorbidity. Results Before ID, high SEP was associated with less GP contact (general practitioner), higher odds ratios for GP-Mental Health Counseling (GP-MHC), psychologist contact, and admissions to hospital. This disparity decreased the following 12 months for GP-MHC but increased for contact to psychologist; same pattern was seen for rate of visits. However, the low-income group had more contact to private psychiatrist. For the 25,217 individuals with no MHCU before ID, higher educational level was associated with almost twice the rate of contact to PP the following 12 months; for the high-income group, the rate was 40% higher. 10% had contact to PP within 40 days after ID in the group with higher education; whereas, 10% of those with a short education would reach PP by day 120. High-income group had faster access as well. Conclusion Being in high SEP was positively associated with MHCU, before and after ID, and more rapid PP contact, most explicit when measured by education. Co-payment for psychologist may divert care towards private psychiatrist for low-income groups.
AB - Purpose The purpose was to investigate inequalities in access to care among people with possible depression. Method In this nationwide register-based cohort study of 30,593 persons, we observed the association between socioeconomic position (SEP, education/income) and mental health care use (MHCU) four months before the date of first redeemed antidepressant (Index Date/ID) and 12 months afterwards-and time to contact to psychologist/psychiatrist (PP). Logistic, Poisson, and Cox regression models were used, adjusted for sex, age, cohabitation, and psychiatric comorbidity. Results Before ID, high SEP was associated with less GP contact (general practitioner), higher odds ratios for GP-Mental Health Counseling (GP-MHC), psychologist contact, and admissions to hospital. This disparity decreased the following 12 months for GP-MHC but increased for contact to psychologist; same pattern was seen for rate of visits. However, the low-income group had more contact to private psychiatrist. For the 25,217 individuals with no MHCU before ID, higher educational level was associated with almost twice the rate of contact to PP the following 12 months; for the high-income group, the rate was 40% higher. 10% had contact to PP within 40 days after ID in the group with higher education; whereas, 10% of those with a short education would reach PP by day 120. High-income group had faster access as well. Conclusion Being in high SEP was positively associated with MHCU, before and after ID, and more rapid PP contact, most explicit when measured by education. Co-payment for psychologist may divert care towards private psychiatrist for low-income groups.
KW - Socioeconomic factors
KW - Mental health services
KW - Access to health care
KW - Antidepressants
KW - Inequality
KW - GENERAL-PRACTITIONER
KW - DEPRESSION
KW - DISORDERS
KW - DETERMINANTS
KW - INEQUALITIES
KW - PEOPLE
KW - LIFE
U2 - 10.1007/s00127-020-01908-7
DO - 10.1007/s00127-020-01908-7
M3 - Journal article
C2 - 32642803
VL - 56
SP - 449
EP - 462
JO - Social Psychiatry and Psychiatric Epidemiology
JF - Social Psychiatry and Psychiatric Epidemiology
SN - 0933-7954
ER -
ID: 244998696