Journal
SOCIAL PSYCHIATRY AND PSYCHIATRIC EPIDEMIOLOGY
Volume 52, Issue 11, Pages 1405-1413Publisher
SPRINGER HEIDELBERG
DOI: 10.1007/s00127-017-1437-2
Keywords
Socioeconomic factors; Mental health services; Access to health care; Antidepressants; Geographic information system
Categories
Funding
- Health Research Foundation of Region Zealand
- Program for Clinical Research Infrastructure (PROCRIN)
- Lundbeck Foundation
- Novo Nordisk Foundation
- Lundbeck Foundation [R155-2012-11280, R155-2014-2647] Funding Source: researchfish
- Novo Nordisk Fonden [NNF14SA0015794] Funding Source: researchfish
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To determine the impact of socioeconomic position (SEP) and distance to provider on outpatient mental health care utilization among incident users of antidepressants. A nationwide register-based cohort study of 50,374 person-years. 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. 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.
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