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Socioeconomic differences in psychiatric treatment before and after self-harm: an observational study of 4,280 adolescents and young adults

BACKGROUND: Individuals in higher socioeconomic positions tend to utilise more mental health care, especially specialist services, than those in lower positions. Whether these disparities in treatment exist among adolescents and young adults who self-harm is currently unknown. METHODS: The study is...

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Autores principales: Pitkänen, Joonas, Remes, Hanna, Aaltonen, Mikko, Martikainen, Pekka
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8728977/
https://www.ncbi.nlm.nih.gov/pubmed/34986806
http://dx.doi.org/10.1186/s12888-021-03654-9
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author Pitkänen, Joonas
Remes, Hanna
Aaltonen, Mikko
Martikainen, Pekka
author_facet Pitkänen, Joonas
Remes, Hanna
Aaltonen, Mikko
Martikainen, Pekka
author_sort Pitkänen, Joonas
collection PubMed
description BACKGROUND: Individuals in higher socioeconomic positions tend to utilise more mental health care, especially specialist services, than those in lower positions. Whether these disparities in treatment exist among adolescents and young adults who self-harm is currently unknown. METHODS: The study is based on Finnish administrative register data on all individuals born 1986–1994. Adolescents and young adults with an episode of self-harm treated in specialised healthcare at ages 16–21 in 2002–2015 (n=4280, 64% female) were identified and followed 2 years before and after the episode. Probabilities of specialised psychiatric inpatient admissions and outpatient visits and purchases of psychotropic medication at different time points relative to self-harm were estimated using generalised estimation equations, multinomial models and cumulative averages. Socioeconomic differences were assessed based on parental education, controlling for income. RESULTS: An educational gradient in specialised treatment and prescription medication was observed, with the highest probabilities of treatment among the adolescents and young adults with the highest educated parents and lowest probabilities among those whose parents had basic education. These differences emerged mostly after self-harm. The probability to not receive any treatment, either in specialised healthcare or psychotropic medication, was highest among youth whose parents had a basic level of education (before self-harm 0.39, 95% CI 0.34–0.43, and after 0.29, 95% CI 0.25–0.33 after) and lowest among youth with higher tertiary educated parents (before self-harm: 0.22, 95% CI 0.18–0.26, and after 0.18, 95% CI 0.14–0.22). The largest differences were observed in inpatient care. CONCLUSIONS: The results suggest that specialised psychiatric care and psychotropic medication use are common among youth who self-harm, but a considerable proportion have no prior or subsequent specialised treatment. The children of parents with lower levels of education are likely to benefit from additional support in initiating and adhering to treatment after an episode of self-harm. Further research on the mechanisms underlying the educational gradient in psychiatric treatment is needed. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12888-021-03654-9.
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spelling pubmed-87289772022-01-06 Socioeconomic differences in psychiatric treatment before and after self-harm: an observational study of 4,280 adolescents and young adults Pitkänen, Joonas Remes, Hanna Aaltonen, Mikko Martikainen, Pekka BMC Psychiatry Research BACKGROUND: Individuals in higher socioeconomic positions tend to utilise more mental health care, especially specialist services, than those in lower positions. Whether these disparities in treatment exist among adolescents and young adults who self-harm is currently unknown. METHODS: The study is based on Finnish administrative register data on all individuals born 1986–1994. Adolescents and young adults with an episode of self-harm treated in specialised healthcare at ages 16–21 in 2002–2015 (n=4280, 64% female) were identified and followed 2 years before and after the episode. Probabilities of specialised psychiatric inpatient admissions and outpatient visits and purchases of psychotropic medication at different time points relative to self-harm were estimated using generalised estimation equations, multinomial models and cumulative averages. Socioeconomic differences were assessed based on parental education, controlling for income. RESULTS: An educational gradient in specialised treatment and prescription medication was observed, with the highest probabilities of treatment among the adolescents and young adults with the highest educated parents and lowest probabilities among those whose parents had basic education. These differences emerged mostly after self-harm. The probability to not receive any treatment, either in specialised healthcare or psychotropic medication, was highest among youth whose parents had a basic level of education (before self-harm 0.39, 95% CI 0.34–0.43, and after 0.29, 95% CI 0.25–0.33 after) and lowest among youth with higher tertiary educated parents (before self-harm: 0.22, 95% CI 0.18–0.26, and after 0.18, 95% CI 0.14–0.22). The largest differences were observed in inpatient care. CONCLUSIONS: The results suggest that specialised psychiatric care and psychotropic medication use are common among youth who self-harm, but a considerable proportion have no prior or subsequent specialised treatment. The children of parents with lower levels of education are likely to benefit from additional support in initiating and adhering to treatment after an episode of self-harm. Further research on the mechanisms underlying the educational gradient in psychiatric treatment is needed. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12888-021-03654-9. BioMed Central 2022-01-05 /pmc/articles/PMC8728977/ /pubmed/34986806 http://dx.doi.org/10.1186/s12888-021-03654-9 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
Pitkänen, Joonas
Remes, Hanna
Aaltonen, Mikko
Martikainen, Pekka
Socioeconomic differences in psychiatric treatment before and after self-harm: an observational study of 4,280 adolescents and young adults
title Socioeconomic differences in psychiatric treatment before and after self-harm: an observational study of 4,280 adolescents and young adults
title_full Socioeconomic differences in psychiatric treatment before and after self-harm: an observational study of 4,280 adolescents and young adults
title_fullStr Socioeconomic differences in psychiatric treatment before and after self-harm: an observational study of 4,280 adolescents and young adults
title_full_unstemmed Socioeconomic differences in psychiatric treatment before and after self-harm: an observational study of 4,280 adolescents and young adults
title_short Socioeconomic differences in psychiatric treatment before and after self-harm: an observational study of 4,280 adolescents and young adults
title_sort socioeconomic differences in psychiatric treatment before and after self-harm: an observational study of 4,280 adolescents and young adults
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8728977/
https://www.ncbi.nlm.nih.gov/pubmed/34986806
http://dx.doi.org/10.1186/s12888-021-03654-9
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