Socioeconomic position and mental health care use before and after first redeemed antidepressant and time until subsequent contact to psychologist or psychiatrists: a nationwide Danish follow-up study

Aake Packness,Frans Boch Waldorff,Jens Søndergaard,Lene Halling Hastrup,Sonja Wehberg,Erik Simonsen

doi:10.1007/s00127-020-01908-7

Abstract

PurposeThe purpose was to investigate inequalities in access to care among people with possible depression.MethodIn this nationwide register-based cohort study of 30,593 persons, we observed the association between socioeconomic position (SEP, education/income) and mental health care use (MHCU) four months before the date of first redeemed antidepressant (Index Date/ID) and 12 months afterwards—and time to contact to psychologist/psychiatrist (PP). Logistic, Poisson, and Cox regression models were used, adjusted for sex, age, cohabitation, and psychiatric comorbidity.ResultsBefore ID, high SEP was associated with less GP contact (general practitioner), higher odds ratios for GP-Mental Health Counseling (GP-MHC), psychologist contact, and admissions to hospital. This disparity decreased the following 12 months for GP-MHC but increased for contact to psychologist; same pattern was seen for rate of visits. However, the low-income group had more contact to private psychiatrist.For the 25,217 individuals with no MHCU before ID, higher educational level was associated with almost twice the rate of contact to PP the following 12 months; for the high-income group, the rate was 40% higher. 10% had contact to PP within 40 days after ID in the group with higher education; whereas, 10% of those with a short education would reach PP by day 120. High-income group had faster access as well.ConclusionBeing in high SEP was positively associated with MHCU, before and after ID, and more rapid PP contact, most explicit when measured by education. Co-payment for psychologist may divert care towards private psychiatrist for low-income groups.

Highlights

Depression is a common disorder in high-income countries with the 12-month prevalence estimated at 5.5% and the lifetime prevalence at 14.6 [1]
To be in high socioeconomic position (SEP) was associated with higher chance of contact—and two to three times more rapidly contact to a psychologist or psychiatrist after initiated treatment with antidepressant and no previous mental health care treatment; most evident when measured by education
Beyond general practitioner (GP) consultation, we found a social gradient in mental health care use (MHCU) favoring patients in high SEP in all areas in the adjusted analyses, except for contact to private psychiatrist where the lowest income group had much higher odds for contact

Summary

Introduction

Depression is a common disorder in high-income countries with the 12-month prevalence estimated at 5.5% and the lifetime prevalence at 14.6 [1]. Being in low socioeconomic position (SEP) is generally associated with higher morbidity [2], true for depressive disorders as well [3] with a dose–response relationship to income and education, and with higher incidence and stronger persistence of the disorder [4, 5]. Childhood trauma, psychosocial impairment, older age, and socioeconomically disadvantaged status are found to be associated with proxies of need for highly specialized care of depression [6]. Social Psychiatry and Psychiatric Epidemiology (2021) 56:449–462 need receive minimally adequate treatment of depression in high-income countries [7], and being in low SEP is an additional risk for this [8]. Strongly associated with SEP, having a lifelong impact, and associated with considerable disability, and reduced life expectancy [9], make depression a relevant and good indicator to examining potential social inequality in mental health care

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