Exploring socio-economic inequalities in mental healthcare utilization in adults with self-reported psychological distress: a survey-registry linked cohort design
Abstract Aims Although individuals with lower socio-economic position (SEP) have a higher prevalence of mental health problems than others, there is no conclusive evidence on whether mental healthcare (MHC) is provided equitably. We investigated inequalities in MHC use among adults in Stockholm Coun...
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Cambridge University Press
2025-01-01
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| Series: | Epidemiology and Psychiatric Sciences |
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| Online Access: | https://www.cambridge.org/core/product/identifier/S2045796024000842/type/journal_article |
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| author | J. J. Muwonge C. Dalman B. Burström B. Jablonska A-C. Hollander |
| author_facet | J. J. Muwonge C. Dalman B. Burström B. Jablonska A-C. Hollander |
| author_sort | J. J. Muwonge |
| collection | DOAJ |
| description | Abstract
Aims
Although individuals with lower socio-economic position (SEP) have a higher prevalence of mental health problems than others, there is no conclusive evidence on whether mental healthcare (MHC) is provided equitably. We investigated inequalities in MHC use among adults in Stockholm County (Sweden), and whether inequalities were moderated by self-reported psychological distress.
Methods
MHC use was examined in 31,433 individuals aged 18–64 years over a 6-month follow-up period, after responding to the General Health Questionnaire-12 (GHQ-12) in 2014 or the Kessler Six (K6) in 2021. Information on their MHC use and SEP indicators, education, and household income, were sourced from administrative registries. Logistic and negative binomial regression analyses were used to estimate inequalities in gained MHC access and frequency of outpatient visits, with psychological distress as a moderating variable.
Results
Individuals with lower education or income levels were more likely to gain access to MHC than those with high SEP, irrespective of distress levels. Education-related differences in gained MHC access diminished with increasing distress, from a 74% higher likelihood when reporting no distress (odds ratio, OR = 1.74 [95% confidence interval, 95% CI: 1.43–2.12]) to 30% when reporting severe distress (OR = 1.30 [0.98–1.72]). Comparable results were found for secondary care but not primary care i.e., lower education predicted reduced access to primary care in moderate-to-severe distress groups (e.g., OR = 0.63 [0.45–0.90]), and for physical but not digital services. Income-related differences in gained MHC access remained stable or increased with distress, especially for secondary care and physical services.
Among MHC users, we found marginal socio-economic differences in the frequency of outpatient visits, and these differences decreased with increasing distress. Yet, having only primary education with severe distress was associated with fewer outpatient visits compared with having post-secondary education (rate ratio, RR = 0.82; 95% CI: 0.67–1.00). These inequities were especially evident among women and for visits to psychologists, counsellors, or psychotherapists.
Although lower-income groups used services more than others, they still had higher odds of not using services when reporting distress (i.e., those not in contact with services despite scoring ≥3 on the GHQ-12 or ≥8 on the K6; OR = 1.27; 95% CI: 1.15–1.40).
Conclusions
Overall, individuals with lower education and income used MHC services more than their counterparts with higher socio-economic status; however, low-educated individuals faced inequities in primary care and underutilized non-physician services such as visits to psychologists.
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| format | Article |
| id | doaj-art-e8b36bd4f3e942999d9282690dec5221 |
| institution | Kabale University |
| issn | 2045-7960 2045-7979 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Cambridge University Press |
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| series | Epidemiology and Psychiatric Sciences |
| spelling | doaj-art-e8b36bd4f3e942999d9282690dec52212025-01-23T09:37:07ZengCambridge University PressEpidemiology and Psychiatric Sciences2045-79602045-79792025-01-013410.1017/S2045796024000842Exploring socio-economic inequalities in mental healthcare utilization in adults with self-reported psychological distress: a survey-registry linked cohort designJ. J. Muwonge0https://orcid.org/0000-0002-9219-9752C. Dalman1https://orcid.org/0000-0002-3579-2357B. Burström2https://orcid.org/0000-0001-5770-9422B. Jablonska3https://orcid.org/0000-0002-0246-6643A-C. Hollander4https://orcid.org/0000-0002-1246-5804Department of Global Public Health, Karolinska Institute, Stockholm, Sweden Centre for Epidemiology and Community Medicine, Stockholm Health Care Services, Region Stockholm, Stockholm, SwedenDepartment of Global Public Health, Karolinska Institute, Stockholm, Sweden Centre for Epidemiology and Community Medicine, Stockholm Health Care Services, Region Stockholm, Stockholm, SwedenDepartment of Global Public Health, Karolinska Institute, Stockholm, Sweden Centre for Epidemiology and Community Medicine, Stockholm Health Care Services, Region Stockholm, Stockholm, SwedenDepartment of Global Public Health, Karolinska Institute, Stockholm, Sweden Centre for Epidemiology and Community Medicine, Stockholm Health Care Services, Region Stockholm, Stockholm, SwedenDepartment of Global Public Health, Karolinska Institute, Stockholm, SwedenAbstract Aims Although individuals with lower socio-economic position (SEP) have a higher prevalence of mental health problems than others, there is no conclusive evidence on whether mental healthcare (MHC) is provided equitably. We investigated inequalities in MHC use among adults in Stockholm County (Sweden), and whether inequalities were moderated by self-reported psychological distress. Methods MHC use was examined in 31,433 individuals aged 18–64 years over a 6-month follow-up period, after responding to the General Health Questionnaire-12 (GHQ-12) in 2014 or the Kessler Six (K6) in 2021. Information on their MHC use and SEP indicators, education, and household income, were sourced from administrative registries. Logistic and negative binomial regression analyses were used to estimate inequalities in gained MHC access and frequency of outpatient visits, with psychological distress as a moderating variable. Results Individuals with lower education or income levels were more likely to gain access to MHC than those with high SEP, irrespective of distress levels. Education-related differences in gained MHC access diminished with increasing distress, from a 74% higher likelihood when reporting no distress (odds ratio, OR = 1.74 [95% confidence interval, 95% CI: 1.43–2.12]) to 30% when reporting severe distress (OR = 1.30 [0.98–1.72]). Comparable results were found for secondary care but not primary care i.e., lower education predicted reduced access to primary care in moderate-to-severe distress groups (e.g., OR = 0.63 [0.45–0.90]), and for physical but not digital services. Income-related differences in gained MHC access remained stable or increased with distress, especially for secondary care and physical services. Among MHC users, we found marginal socio-economic differences in the frequency of outpatient visits, and these differences decreased with increasing distress. Yet, having only primary education with severe distress was associated with fewer outpatient visits compared with having post-secondary education (rate ratio, RR = 0.82; 95% CI: 0.67–1.00). These inequities were especially evident among women and for visits to psychologists, counsellors, or psychotherapists. Although lower-income groups used services more than others, they still had higher odds of not using services when reporting distress (i.e., those not in contact with services despite scoring ≥3 on the GHQ-12 or ≥8 on the K6; OR = 1.27; 95% CI: 1.15–1.40). Conclusions Overall, individuals with lower education and income used MHC services more than their counterparts with higher socio-economic status; however, low-educated individuals faced inequities in primary care and underutilized non-physician services such as visits to psychologists. https://www.cambridge.org/core/product/identifier/S2045796024000842/type/journal_articleinequitiescovid-19psychiatric servicesSwedenGHQ-12kessler sixdigital servicespsychotherapyprimary carespecialized care |
| spellingShingle | J. J. Muwonge C. Dalman B. Burström B. Jablonska A-C. Hollander Exploring socio-economic inequalities in mental healthcare utilization in adults with self-reported psychological distress: a survey-registry linked cohort design Epidemiology and Psychiatric Sciences inequities covid-19 psychiatric services Sweden GHQ-12 kessler six digital services psychotherapy primary care specialized care |
| title | Exploring socio-economic inequalities in mental healthcare utilization in adults with self-reported psychological distress: a survey-registry linked cohort design |
| title_full | Exploring socio-economic inequalities in mental healthcare utilization in adults with self-reported psychological distress: a survey-registry linked cohort design |
| title_fullStr | Exploring socio-economic inequalities in mental healthcare utilization in adults with self-reported psychological distress: a survey-registry linked cohort design |
| title_full_unstemmed | Exploring socio-economic inequalities in mental healthcare utilization in adults with self-reported psychological distress: a survey-registry linked cohort design |
| title_short | Exploring socio-economic inequalities in mental healthcare utilization in adults with self-reported psychological distress: a survey-registry linked cohort design |
| title_sort | exploring socio economic inequalities in mental healthcare utilization in adults with self reported psychological distress a survey registry linked cohort design |
| topic | inequities covid-19 psychiatric services Sweden GHQ-12 kessler six digital services psychotherapy primary care specialized care |
| url | https://www.cambridge.org/core/product/identifier/S2045796024000842/type/journal_article |
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