Impact of socioeconomic position and distance on mental health care utilization: a nationwide Danish follow-up study

Aake Packness,Anders Halling,Lene Halling Hastrup,Erik Simonsen,Mogens Vestergaard,René Depont Christensen,Frans Boch Waldorff

doi:10.1007/s00127-017-1437-2

Abstract

PurposeTo determine the impact of socioeconomic position (SEP) and distance to provider on outpatient mental health care utilization among incident users of antidepressants.MethodA nationwide register-based cohort study of 50,374 person-years.ResultsPersons 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.ConclusionPatients 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.

Highlights

Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.In a health care system responding adequately to need, patients in most need would be expected to receive more health care service and more specialized care
Purpose To determine the impact of socioeconomic position (SEP) and distance to provider on outpatient mental health care utilization among incident users of antidepressants
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

Summary

Introduction

Electronic supplementary material The online version of this article (doi:10.1007/s00127-017-1437-2) contains supplementary material, which is available to authorized users.In a health care system responding adequately to need, patients in most need would be expected to receive more health care service and more specialized care. A study of OECD countries concludes that people with higher incomes are significantly more likely to see a specialist than people in lower SEP [2]. This is supported by population surveys in Denmark which show a linear correlation between increasing education and increasing use of specialist services [3]. In Holland, the same pattern exists as the more educated people are less likely to use primary care in the event of emotional problems and more likely to use mental health care services compared to people with shorter education [4]. Since common mental health problems are significantly more frequent in populations in

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