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Perceived need for treatment and non-utilization of outpatient psychotherapy in old age: two cohorts of a nationwide survey

BEACKGROUND: Older adults with mental health problems may benefit from psychotherapy; however, their perceived need for treatment in relation to rates of non-utilization of outpatient psychotherapy as well as the predisposing, enabling, and need factors proposed by Andersen’s Model of Health Care Ut...

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Autores principales: Gellert, Paul, Lech, Sonia, Kessler, Eva-Marie, Herrmann, Wolfram, Döpfmer, Susanne, Balke, Klaus, Oedekoven, Monika, Kuhlmey, Adelheid, Schnitzer, Susanne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8111709/
https://www.ncbi.nlm.nih.gov/pubmed/33971863
http://dx.doi.org/10.1186/s12913-021-06384-6
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author Gellert, Paul
Lech, Sonia
Kessler, Eva-Marie
Herrmann, Wolfram
Döpfmer, Susanne
Balke, Klaus
Oedekoven, Monika
Kuhlmey, Adelheid
Schnitzer, Susanne
author_facet Gellert, Paul
Lech, Sonia
Kessler, Eva-Marie
Herrmann, Wolfram
Döpfmer, Susanne
Balke, Klaus
Oedekoven, Monika
Kuhlmey, Adelheid
Schnitzer, Susanne
author_sort Gellert, Paul
collection PubMed
description BEACKGROUND: Older adults with mental health problems may benefit from psychotherapy; however, their perceived need for treatment in relation to rates of non-utilization of outpatient psychotherapy as well as the predisposing, enabling, and need factors proposed by Andersen’s Model of Health Care Utilization that account for these differences warrant further investigation. METHODS: We used two separate cohorts (2014 and 2019) of a weighted nationwide telephone survey in Germany of German-speaking adults with N = 12,197 participants. Across the two cohorts, 12.9% (weighted) reported a perceived need for treatment for mental health problems and were selected for further analyses. Logistic Generalized Estimation Equations (GEE) was applied to model the associations between disposing (age, gender, single habiting, rural residency, general health status), enabling (education, general practitioner visit) non-utilization of psychotherapy (outcome) across cohorts in those with a need for treatment (need factor). RESULTS: In 2014, 11.8% of 6087 participants reported a perceived need for treatment due to mental health problems. In 2016, the prevalence increased significantly to 14.0% of 6110 participants. Of those who reported a perceived need for treatment, 36.4% in 2014 and 36.9%in 2019 did not see a psychotherapist – where rates of non-utilization of psychotherapy were vastly higher in the oldest age category (59.3/52.5%; 75+) than in the youngest (29.1/10.7%; aged 18–25). Concerning factors associated with non-utilization, multivariate findings indicated participation in the cohort of 2014 (OR 0.94), older age (55–64 OR 1.02, 65–74 OR 1.47, 75+ OR 4.76), male gender (OR 0.83), lower educational status (OR 0.84), rural residency (OR 1.38), single habiting (OR 1.37), and seeing a GP (OR 1.39) to be related with non-utilization of psychotherapy; general health status was not significantly associated with non-utilization when GP contact was included in the model. CONCLUSION: There is a strong age effect in terms of non-utilization of outpatient psychotherapy. Individual characteristics of both healthcare professionals and patients and structural barriers may add to this picture. Effective strategies to increase psychotherapy rates in those older adults with unmet treatment needs are required. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-021-06384-6.
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spelling pubmed-81117092021-05-11 Perceived need for treatment and non-utilization of outpatient psychotherapy in old age: two cohorts of a nationwide survey Gellert, Paul Lech, Sonia Kessler, Eva-Marie Herrmann, Wolfram Döpfmer, Susanne Balke, Klaus Oedekoven, Monika Kuhlmey, Adelheid Schnitzer, Susanne BMC Health Serv Res Research Article BEACKGROUND: Older adults with mental health problems may benefit from psychotherapy; however, their perceived need for treatment in relation to rates of non-utilization of outpatient psychotherapy as well as the predisposing, enabling, and need factors proposed by Andersen’s Model of Health Care Utilization that account for these differences warrant further investigation. METHODS: We used two separate cohorts (2014 and 2019) of a weighted nationwide telephone survey in Germany of German-speaking adults with N = 12,197 participants. Across the two cohorts, 12.9% (weighted) reported a perceived need for treatment for mental health problems and were selected for further analyses. Logistic Generalized Estimation Equations (GEE) was applied to model the associations between disposing (age, gender, single habiting, rural residency, general health status), enabling (education, general practitioner visit) non-utilization of psychotherapy (outcome) across cohorts in those with a need for treatment (need factor). RESULTS: In 2014, 11.8% of 6087 participants reported a perceived need for treatment due to mental health problems. In 2016, the prevalence increased significantly to 14.0% of 6110 participants. Of those who reported a perceived need for treatment, 36.4% in 2014 and 36.9%in 2019 did not see a psychotherapist – where rates of non-utilization of psychotherapy were vastly higher in the oldest age category (59.3/52.5%; 75+) than in the youngest (29.1/10.7%; aged 18–25). Concerning factors associated with non-utilization, multivariate findings indicated participation in the cohort of 2014 (OR 0.94), older age (55–64 OR 1.02, 65–74 OR 1.47, 75+ OR 4.76), male gender (OR 0.83), lower educational status (OR 0.84), rural residency (OR 1.38), single habiting (OR 1.37), and seeing a GP (OR 1.39) to be related with non-utilization of psychotherapy; general health status was not significantly associated with non-utilization when GP contact was included in the model. CONCLUSION: There is a strong age effect in terms of non-utilization of outpatient psychotherapy. Individual characteristics of both healthcare professionals and patients and structural barriers may add to this picture. Effective strategies to increase psychotherapy rates in those older adults with unmet treatment needs are required. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-021-06384-6. BioMed Central 2021-05-10 /pmc/articles/PMC8111709/ /pubmed/33971863 http://dx.doi.org/10.1186/s12913-021-06384-6 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Gellert, Paul
Lech, Sonia
Kessler, Eva-Marie
Herrmann, Wolfram
Döpfmer, Susanne
Balke, Klaus
Oedekoven, Monika
Kuhlmey, Adelheid
Schnitzer, Susanne
Perceived need for treatment and non-utilization of outpatient psychotherapy in old age: two cohorts of a nationwide survey
title Perceived need for treatment and non-utilization of outpatient psychotherapy in old age: two cohorts of a nationwide survey
title_full Perceived need for treatment and non-utilization of outpatient psychotherapy in old age: two cohorts of a nationwide survey
title_fullStr Perceived need for treatment and non-utilization of outpatient psychotherapy in old age: two cohorts of a nationwide survey
title_full_unstemmed Perceived need for treatment and non-utilization of outpatient psychotherapy in old age: two cohorts of a nationwide survey
title_short Perceived need for treatment and non-utilization of outpatient psychotherapy in old age: two cohorts of a nationwide survey
title_sort perceived need for treatment and non-utilization of outpatient psychotherapy in old age: two cohorts of a nationwide survey
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8111709/
https://www.ncbi.nlm.nih.gov/pubmed/33971863
http://dx.doi.org/10.1186/s12913-021-06384-6
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