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Investigating geographical variation in the use of mental health services by area of England: a cross-sectional ecological study
BACKGROUND: There is evidence of geographical variation in the use of mental health services in the UK and in international settings. It is important to understand whether this variation reflects differences in the prevalence of mental disorders, or if there is evidence of variation related to other...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8434730/ https://www.ncbi.nlm.nih.gov/pubmed/34507575 http://dx.doi.org/10.1186/s12913-021-06976-2 |
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author | Maconick, Lucy Sheridan Rains, Luke Jones, Rebecca Lloyd-Evans, Brynmor Johnson, Sonia |
author_facet | Maconick, Lucy Sheridan Rains, Luke Jones, Rebecca Lloyd-Evans, Brynmor Johnson, Sonia |
author_sort | Maconick, Lucy |
collection | PubMed |
description | BACKGROUND: There is evidence of geographical variation in the use of mental health services in the UK and in international settings. It is important to understand whether this variation reflects differences in the prevalence of mental disorders, or if there is evidence of variation related to other factors, such as population socioeconomic status and access to primary care services. METHODS: This is a cross-sectional ecological study using Public Health England data. The unit of analysis was the population served by clinical commissioning groups (CCGs), National Health Service (NHS) catchment areas. The analysis explored associations between area characteristics and the number of people in contact with mental health services using regression modelling. Explanatory variables included age, gender, prevalence of severe mental illness (SMI), prevalence of common mental disorder (CMD), index of multiple deprivation (IMD), unemployment, proportion of the population who are Black and Minority Ethnic (BAME), population density, access to and recovery in primary care psychological therapies. Unadjusted results are reported, as well as estimates adjusted for age, prevalence of CMD and prevalence of SMI. RESULTS: The populations of 194 CCGs were included, clustered within 62 trusts (NHS providers of mental health services). The number of people in contact with mental health services showed wide variation by area (range from 1131 to 5205 per 100,000 population). Unemployment (adjusted IRR 1.11; 95% CI 1.05 to 1.17; p < 0.001) and deprivation (adjusted IRR 1.02 95% CI 1.01 to 1.04; p < 0.001) were associated with more people being in contact with mental health services. Areas with a higher proportion of the population who are BAME (IRR 0.95 95% CI 0.92 to 0.99 p = 0.007) had lower service use per 100,000 population. There was no evidence for association with access to primary care psychological therapies. CONCLUSIONS: There is substantial variation in the use of mental health services by area of England. Social factors including deprivation, unemployment and population ethnicity continued to be associated with the outcome after controlling for the prevalence of mental illness. This suggests that there are factors that influence the local population use of mental health services in addition to the prevalence of mental disorder. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-021-06976-2. |
format | Online Article Text |
id | pubmed-8434730 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-84347302021-09-13 Investigating geographical variation in the use of mental health services by area of England: a cross-sectional ecological study Maconick, Lucy Sheridan Rains, Luke Jones, Rebecca Lloyd-Evans, Brynmor Johnson, Sonia BMC Health Serv Res Research BACKGROUND: There is evidence of geographical variation in the use of mental health services in the UK and in international settings. It is important to understand whether this variation reflects differences in the prevalence of mental disorders, or if there is evidence of variation related to other factors, such as population socioeconomic status and access to primary care services. METHODS: This is a cross-sectional ecological study using Public Health England data. The unit of analysis was the population served by clinical commissioning groups (CCGs), National Health Service (NHS) catchment areas. The analysis explored associations between area characteristics and the number of people in contact with mental health services using regression modelling. Explanatory variables included age, gender, prevalence of severe mental illness (SMI), prevalence of common mental disorder (CMD), index of multiple deprivation (IMD), unemployment, proportion of the population who are Black and Minority Ethnic (BAME), population density, access to and recovery in primary care psychological therapies. Unadjusted results are reported, as well as estimates adjusted for age, prevalence of CMD and prevalence of SMI. RESULTS: The populations of 194 CCGs were included, clustered within 62 trusts (NHS providers of mental health services). The number of people in contact with mental health services showed wide variation by area (range from 1131 to 5205 per 100,000 population). Unemployment (adjusted IRR 1.11; 95% CI 1.05 to 1.17; p < 0.001) and deprivation (adjusted IRR 1.02 95% CI 1.01 to 1.04; p < 0.001) were associated with more people being in contact with mental health services. Areas with a higher proportion of the population who are BAME (IRR 0.95 95% CI 0.92 to 0.99 p = 0.007) had lower service use per 100,000 population. There was no evidence for association with access to primary care psychological therapies. CONCLUSIONS: There is substantial variation in the use of mental health services by area of England. Social factors including deprivation, unemployment and population ethnicity continued to be associated with the outcome after controlling for the prevalence of mental illness. This suggests that there are factors that influence the local population use of mental health services in addition to the prevalence of mental disorder. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-021-06976-2. BioMed Central 2021-09-11 /pmc/articles/PMC8434730/ /pubmed/34507575 http://dx.doi.org/10.1186/s12913-021-06976-2 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 Maconick, Lucy Sheridan Rains, Luke Jones, Rebecca Lloyd-Evans, Brynmor Johnson, Sonia Investigating geographical variation in the use of mental health services by area of England: a cross-sectional ecological study |
title | Investigating geographical variation in the use of mental health services by area of England: a cross-sectional ecological study |
title_full | Investigating geographical variation in the use of mental health services by area of England: a cross-sectional ecological study |
title_fullStr | Investigating geographical variation in the use of mental health services by area of England: a cross-sectional ecological study |
title_full_unstemmed | Investigating geographical variation in the use of mental health services by area of England: a cross-sectional ecological study |
title_short | Investigating geographical variation in the use of mental health services by area of England: a cross-sectional ecological study |
title_sort | investigating geographical variation in the use of mental health services by area of england: a cross-sectional ecological study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8434730/ https://www.ncbi.nlm.nih.gov/pubmed/34507575 http://dx.doi.org/10.1186/s12913-021-06976-2 |
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