Socioeconomic position, symptoms of depression and subsequent mental healthcare treatment: a Danish register-based 6-month follow-up study on a population survey

Abstract

ObjectiveExamine whether the severity of symptoms of depression was associated with the type of mental healthcare treatment (MHCT) received, independent of socioeconomic position (SEP).DesignRegister-based 6-month follow-up study on participants from the Danish General Suburban Population Study (GESUS) 2010–2013, who scored the Major Depression Inventory (MDI).ParticipantsNineteen thousand and eleven respondents from GESUS.InterventionsThe MHCT of the participants was tracked in national registers 4 months prior and 6 months after their MDI scores. MHCT was graduated in levels. SEP was defined by years of formal postsecondary education and income categorised into three levels. Data were analysed using logistic and Poisson regression analyses.OutcomesMHCT included number of contacts with: general practitioner (GP), GP mental health counselling, psychologist, psychiatrist, emergency contacts, admissions to psychiatric hospitals and prescriptions of antidepressants.ResultsFor 547 respondents with moderate to severe symptoms of depression there was no difference across SEP in use of services, contact (y/n), frequency of contact or level of treatment, except respondents with low SEP had more frequent contact with their GP. However, of the 547 respondents, 10% had no treatment contacts at all, and 47% had no treatment beyond GP consultation. Among respondents with no/few symptoms of depression, postsecondary education ≥3 years was associated with more contact with specialised services (adjusted OR (aOR) 1.92; 95% CI 1.18 to 3.13); however, this difference did not apply for income; additionally, high SEP was associated with fewer prescriptions of antidepressants (education aOR 0.69; CI 0.50 to 0.95; income aOR 0.56, CI 0.39 to 0.80) compared with low SEP.ConclusionParticipants with symptoms of depression were treated according to the severity of their symptoms, independent of SEP; however, more than half with moderate to severe symptoms received no treatment beyond GP consultation. People in low SEP and no/few symptoms of depression were more often treated with antidepressants. The study was approved by The Danish Data Protection Agency Journal number 2015-41-3984. Accessible at: https://www.datatilsynet.dk/fortegnelsen/soeg-i-fortegnelsen/

Factors associated with non-initiation of mental healthcare after detection of poor mental health at a scheduled health check: a cohort study

“… 12–14 However, few studies have focused on initiation of mental healthcare among newly identified screen-positive individuals. 18–20 …”

“…Initiation of mental healthcare following population-based 18 or GP-based 19 20 screening ranges from 16% 19 to 42%. 20 The studies differ in three important ways.…”

“…To motivate individuals to accept offers of mental healthcare once identified can be a challenge. 17 Few studies have focused on initiation of mental healthcare among individuals screened positive, 18–20 and only one of the identified studies provided feedback on the test result to the individual and to the GP. 20 …”

Association between over-indebtedness and antidepressant use: A cross-sectional analysis

“…Hence, increased antidepressant use in the over-indebted might also reflect factors other than psychological morbidity. On the one hand, some studies suggest that prescribing bias might lead to a higher likelihood of pharmacological treatment for patients with lower socioeconomic status [30,34,35]. However, available evidence of an association between standard SES measures and antidepressant use is inconsistent [27][28][29][30].…”

Grief symptoms and primary care use: a prospective study of family caregivers

“…Still, it is also possible that they may not have been able to reach out for support, which has previously been reported among 10% of patients with depressive symptoms who did not seek mental health services. 32 One previous study found that bereaved people were more likely to seek mental health care during bereavement if they had discussed psychological issues with a health professional before bereavement. 33 An invitation to a designated appointment from health professionals was regarded as positive and helpful among family caregivers in a qualitative study, regardless of the family caregivers' need for support.…”