Perceived need for treatment and non-utilization of outpatient psychotherapy in old age: two cohorts of a nationwide survey

Gellert, Paul; Lech, Sonia; Kessler, Eva‐Marie; Herrmann, Wolfram; Döpfmer, Susanne; Balke, Klaus; Oedekoven, Monika; Kuhlmey, Adelheid; Schnitzer, Susanne

doi:10.1186/s12913-021-06384-6

“…Almost half of participating PCPs described the quality of cooperation with ambulatory specialists as medium, indicating the need for further improvement of collaborations. This finding is in line with previous research [ 11 , 28 , 29 ]. For example, a recent cross-sectional study on the collaboration between PCPs and psychologists reported that the vast majority of participating psychologists (64%, n = 278) found the cooperation unsatisfactory [ 30 ].…”

Section: Discussionsupporting

confidence: 94%

Depression in primary care and the role of evidence-based guidelines: cross-sectional data from primary care physicians in Germany

Lech

¹

,

Herrmann

²

,

Trautmann

³

et al. 2022

BMC Health Serv Res

2

0

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Background Depression is the most common mental health burden worldwide. Primary care physicians (PCPs) play a key role in the care provision for people with depression. The first objective of the present study was to examine the health care situation of depression in primary care, focusing on the cooperation between PCPs and mental health specialists. Secondly, we aimed at examining the role of the German S3 Guideline for Unipolar Depression in the primary care provision. Methods Data of N = 75 PCPs were analysed from a cross-sectional online survey. Analysis of descriptive information on the current status of primary health care and depression was conducted. Further, to examine factors that are related to the usage of guidelines, multiple regression was performed. Results Only 22.1% of PCPs described the quality of cooperation with ambulatory mental health specialist as good. The most frequent problems in the cooperation were of structural nature (49.3%, long waiting list, few therapy units, as well as barriers in the communication and the information exchange). With regard to the role of the guideline, 65% of PCPs reported never or seldom using the guideline and 31.7% of PCPs perceived the guideline as not useful at all. In addition, perceived usefulness of the S3 guideline was positively associated with the usage of the guideline. Results of the logistic regression revealed a significant association between the usage of the German S3 Guideline for Unipolar Depression and rating of perceived usefulness of the guideline (OR: 4.771; 95% CI: 2.15–10.59; p < 0.001). Conclusion This study highlights the central role of PCPs and demonstrates major barriers in the outpatient health care provision of depression. Present findings suggest a strong need for collaborative health care models to resolve obstacles resulting from fragmented mental health care systems. Finally, reported perceived barriers in the implementation of the German S3 Guideline for Unipolar Depression indicate the urge to involve PCPs in the development of evidence-based guidelines, in order to ensure a successful implementation and usage of guidelines in clinical practice.

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“…Older age was associated with less frequent psychotherapy use. This is in line with earlier research [ 38 ], even though the effect of psychotherapy for depression is not known to be any lower in older age groups [ 39 ]. Psychotherapy is offered well for young age groups and students, but many lost working years could be saved with more extensive rehabilitation for older working-age people with CMDs.…”

Section: Discussionsupporting

confidence: 92%

Socioeconomic factors and use of psychotherapy in common mental disorders predisposing to disability pension

Leppänen

¹

,

Kampman

²

,

Autio

³

et al. 2022

BMC Health Serv Res

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Background Research in high-income countries has identified low socioeconomic status as a risk factor for disability pension (DP) due to common mental disorders (CMDs). Psychotherapy is an evidence-based treatment for the majority of CMDs along with medication and it is often targeted to prevent work disability. This study examines socioeconomic differences in the use of rehabilitative psychotherapy in Finland, where citizens have universal health coverage, but psychotherapy is partly dependent on personal finance. Methods The study subjects (N = 22,501) were all the Finnish citizens granted a DP due to CMD between 2010 and 2015 and a comparison group (N = 57,732) matched based on age, gender, and hospital district. Socioeconomic differences in psychotherapy use were studied using logistic regression models. Socioeconomic status was defined by education, income, and occupation. Age, gender, and family status were also examined. Results A lower level of education, lower occupational status (blue-collar worker), male gender, and older age, were associated with less frequent psychotherapy use, in both groups. Education was the strongest component of socioeconomic status associated with psychotherapy use, but the role of income was not straightforward. Unemployment when approaching DP, but not otherwise, was a risk factor for not receiving rehabilitative psychotherapy. Socioeconomic disparities were not any smaller among CMD patients approaching DP than in the comparison group. Conclusion This study demonstrates the disparity in the provision of psychotherapy for CMD patients, even on the verge of DP with an acute need for services. This disparity is partly related to a complex interplay of socioeconomic factors and the service system characteristics. Factors predisposing to unequal access to mental health services are presumably diverse and should be studied further.

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“…Older age was associated with less frequent psychotherapy use. This is in line with earlier research [37], even though the effect of psychotherapy for depression is not known to be any lower in older age groups [38]. Psychotherapy is offered well for young age groups and students, but many lost working years could be saved with more extensive rehabilitation for older working-age people with CMDs.…”

Section: Discussionsupporting

confidence: 88%

Socioeconomic Factors and Use of Psychotherapy in Common Mental Disorders Predisposing to Disability Pension

Leppänen

¹

,

Kampman

²

,

Autio

³

et al. 2022

Preprint

0

View full text Add to dashboard Cite

Background Research in high-income countries has identified low socioeconomic status as a risk factor for disability pension (DP) due to common mental disorders (CMDs). Psychotherapy is an evidence-based treatment for the majority of CMDs along with medication and it is often targeted to prevent work disability. This study examines socioeconomic differences in the use of rehabilitative psychotherapy in Finland, where citizens have universal health coverage, but psychotherapy is partly dependent on personal finance. Methods The study subjects (N = 22,501) were all the Finnish citizens granted a DP due to CMD between 2010 and 2015 and a comparison group (N = 57,732) matched based on age, gender, and hospital district. Socioeconomic differences in psychotherapy use were studied using logistic regression models. Socioeconomic status was defined by education, income, and occupation. Age, gender, and family status were also examined. Results A lower level of education, lower occupational status (blue-collar worker), male gender, and older age, were associated with less frequent psychotherapy use, in both groups. Education was the strongest component of socioeconomic status associated with psychotherapy use, but the role of income was not straightforward. Unemployment when approaching DP, but not otherwise, was a risk factor for not receiving rehabilitative psychotherapy. Socioeconomic disparities were not any smaller among CMD patients approaching DP than in the comparison group. Conclusion This study demonstrates the disparity in the provision of psychotherapy for CMD patients, even on the verge of DP with an acute need for services. This disparity is partly related to a complex interplay of socioeconomic factors and the service system characteristics. Factors predisposing to unequal access to mental health services are presumably diverse and should be studied further.

show abstract

Perceived need for treatment and non-utilization of outpatient psychotherapy in old age: two cohorts of a nationwide survey

Cited by 19 publications

References 51 publications

Depression in primary care and the role of evidence-based guidelines: cross-sectional data from primary care physicians in Germany

Depression in primary care and the role of evidence-based guidelines: cross-sectional data from primary care physicians in Germany

Socioeconomic factors and use of psychotherapy in common mental disorders predisposing to disability pension

Socioeconomic Factors and Use of Psychotherapy in Common Mental Disorders Predisposing to Disability Pension

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