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

Abstract

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.

Psychotherapy duration and work disability: A prospective Finnish register study

“…[15][16][17] However, a more detailed analysis has revealed that among individuals who were granted a disability pension, 11-60 psychotherapy sessions were associated with a partial or full return to work, whereas longer psychotherapies did not. 18 In addition, some evidence suggests that short-term therapies are linked with quicker improvement in workability, while long-term psychotherapy offers more enduring gains. 19 Overall, limited research has explored the association between long-term psychotherapy duration and work disability in naturalistic conditions.…”

“…Evidence suggests that, at a population level, long‐term psychotherapy might be linked to decreased work disability 15–17 . However, a more detailed analysis has revealed that among individuals who were granted a disability pension, 11–60 psychotherapy sessions were associated with a partial or full return to work, whereas longer psychotherapies did not 18 . In addition, some evidence suggests that short‐term therapies are linked with quicker improvement in workability, while long‐term psychotherapy offers more enduring gains 19 .…”

Exploring patterns in mental health treatment and interests of single adults in the United States: a secondary data analysis

“…With regards to age, most studies have found that younger people are more likely than older people to be in psychotherapy ( 32 , 43 , 44 ), although Terlizzi and Norris’ ( 32 ) sample of U.S. adults found a reversed pattern of results for psychiatric medication use—older age was associated with more use. Further, there appears to be a robust effect for socioeconomic standing, but with a different direction of effect depending on country and type of mental health treatment assessed.…”

“…Further, there appears to be a robust effect for socioeconomic standing, but with a different direction of effect depending on country and type of mental health treatment assessed. In Brazil and Finland, higher education level and occupational status were associated with seeking mental health treatment [( 42 , 43 ); but see Suokas et al ( 51 )]. Conversely, in Spain, people with lower education and income levels were more likely to seek mental health treatment ( 44 ).…”

Occupational Grade, Mental Distress, and the Use of Psychotherapy

“…Previous studies have shown that manual workers (eg, electricians, plumbers, carers, and cleaners) tend to use less psychotherapy than non-manual workers (eg, teachers, journalists, nurses, and salespersons). 1 This gap may be linked to individual factors, such as lower mental health literacy-which reduces help-seeking and the willingness to pay for psychotherapy-as well as external factors, such as availability, accessibility, and the cost of psycho therapy. 2 However, compared to non-manual workers, the need for psychotherapy may be the same or even higher among manual workers.…”