Skip to main content
Top

Open Access 29-12-2023 | Autism Spectrum Disorder | Original Paper

Are the estimated needs for mental health care among adolescents from different socioeconomic backgrounds met equally in Sweden? A longitudinal survey-registry linkage study

Authors: Joseph Jr. Muwonge, Christina Dalman, Bo Burström, Antonio Ponce de Leon, Maria Rosaria Galanti, Beata Jablonska, Anna-Clara Hollander

Published in: European Child & Adolescent Psychiatry

Login to get access

Abstract

Evidence of inequality in the utilisation of mental health care (MHC) by adolescents in Nordic countries is mixed. This study aims to investigate if there are socioeconomic differences in the utilisation of MHC, while accounting for adolescents’ mental health status. We analysed a cohort of 3517 adolescents, followed from 7 to 9th grade (ages 13–16), to examine the association between parental socioeconomic position (SEP: education and disposable income), adolescents’ estimated needs, and the utilisation of MHC (defined as visits to secondary psychiatric care or receipt of psychotropic medication). Logistic and negative binomial regression models, with mental health status as moderator, were used to predict utilisation during each grade. Lower SEP predicted higher odds of utilising MHC in adolescents with no/mild symptoms (e.g., odds ratio, OR = 1.33, 95% CI 1.04–1.72, lower vs highest education), but not in those with moderate-to-severe symptoms (estimates close to one and non-significant). This pattern was largely explained by treatment of attention deficit hyperactivity disorder/autism spectrum disorders (ADHD/ASD) in boys. For girls with severe symptoms, lower SEP predicted reduced odds of utilising MHC for other mental disorders (OR = 0.48, 95% CI 0.25–0.92, lower education), and fewer outpatient visits when in contact with such care, although non-significant (incidence rate ratio, IRR = 0.51, 95% CI 0.25–1.05, lowest vs highest income). Our findings suggest a more equitable use of MHC for treating ADHD/ASD, but not other mental disorders such as depression and anxiety, particularly among girls.
Appendix
Available only for authorised users
Literature
1.
go back to reference Kessler RC et al (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62(6):593–602CrossRefPubMed Kessler RC et al (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62(6):593–602CrossRefPubMed
4.
go back to reference Reiss F (2013) Socioeconomic inequalities and mental health problems in children and adolescents: a systematic review. Soc Sci Med 90:24–31CrossRefPubMed Reiss F (2013) Socioeconomic inequalities and mental health problems in children and adolescents: a systematic review. Soc Sci Med 90:24–31CrossRefPubMed
5.
go back to reference McLaughlin KA et al (2011) Childhood socio-economic status and the onset, persistence, and severity of DSM-IV mental disorders in a US national sample. Soc Sci Med (1982) 73(7):1088–1096CrossRef McLaughlin KA et al (2011) Childhood socio-economic status and the onset, persistence, and severity of DSM-IV mental disorders in a US national sample. Soc Sci Med (1982) 73(7):1088–1096CrossRef
6.
go back to reference Burström B (2009) Market-oriented, demand-driven health care reforms and equity in health and health care utilization in Sweden. Int J Health Serv 39(2):271–285CrossRefPubMed Burström B (2009) Market-oriented, demand-driven health care reforms and equity in health and health care utilization in Sweden. Int J Health Serv 39(2):271–285CrossRefPubMed
7.
go back to reference Burström B (2020) Promoting equity through health services. In: Gulliford M, Jessop E (eds) Healthcare public health. Oxford University Press, Oxford, pp 23–32 Burström B (2020) Promoting equity through health services. In: Gulliford M, Jessop E (eds) Healthcare public health. Oxford University Press, Oxford, pp 23–32
8.
go back to reference Packness A et al (2019) Are perceived barriers to accessing mental healthcare associated with socioeconomic position among individuals with symptoms of depression? Questionnaire-results from the Lolland-Falster Health Study, a rural Danish population study. BMJ Open 9(3):e023844CrossRefPubMedPubMedCentral Packness A et al (2019) Are perceived barriers to accessing mental healthcare associated with socioeconomic position among individuals with symptoms of depression? Questionnaire-results from the Lolland-Falster Health Study, a rural Danish population study. BMJ Open 9(3):e023844CrossRefPubMedPubMedCentral
9.
go back to reference Packness A et al (2017) Impact of socioeconomic position and distance on mental health care utilization: a nationwide Danish follow-up study. Soc Psychiatry Psychiatr Epidemiol 52(11):1405–1413CrossRefPubMedPubMedCentral Packness A et al (2017) Impact of socioeconomic position and distance on mental health care utilization: a nationwide Danish follow-up study. Soc Psychiatry Psychiatr Epidemiol 52(11):1405–1413CrossRefPubMedPubMedCentral
10.
go back to reference Diderichsen F et al (2012) Health Inequality—determinants and policies. Scan J Public Health 40(8_suppl):12–105CrossRef Diderichsen F et al (2012) Health Inequality—determinants and policies. Scan J Public Health 40(8_suppl):12–105CrossRef
11.
go back to reference Holman D (2015) Exploring the relationship between social class, mental illness stigma and mental health literacy using British national survey data. Health 19(4):413–429CrossRefPubMed Holman D (2015) Exploring the relationship between social class, mental illness stigma and mental health literacy using British national survey data. Health 19(4):413–429CrossRefPubMed
12.
go back to reference Zajacova A, Lawrence EM (2018) The relationship between education and health: reducing disparities through a contextual approach. Annu Rev Public Health 39:273–289CrossRefPubMedPubMedCentral Zajacova A, Lawrence EM (2018) The relationship between education and health: reducing disparities through a contextual approach. Annu Rev Public Health 39:273–289CrossRefPubMedPubMedCentral
13.
go back to reference Braveman P, Gottlieb L (2014) The Social Determinants of Health: It’s Time to Consider the Causes of the Causes. Public Health Rep 129(1_suppl2):19–31CrossRefPubMedPubMedCentral Braveman P, Gottlieb L (2014) The Social Determinants of Health: It’s Time to Consider the Causes of the Causes. Public Health Rep 129(1_suppl2):19–31CrossRefPubMedPubMedCentral
14.
go back to reference Pitkänen J et al (2022) Socioeconomic differences in psychiatric treatment before and after self-harm: an observational study of 4,280 adolescents and young adults. BMC Psychiatry 22(1):14CrossRefPubMedPubMedCentral Pitkänen J et al (2022) Socioeconomic differences in psychiatric treatment before and after self-harm: an observational study of 4,280 adolescents and young adults. BMC Psychiatry 22(1):14CrossRefPubMedPubMedCentral
15.
go back to reference Jablonska B et al (2020) Neighborhood socioeconomic characteristics and utilization of ADHD medication in schoolchildren: a population multilevel study in Stockholm County. J Atten Disord 24(2):265–276CrossRefPubMed Jablonska B et al (2020) Neighborhood socioeconomic characteristics and utilization of ADHD medication in schoolchildren: a population multilevel study in Stockholm County. J Atten Disord 24(2):265–276CrossRefPubMed
16.
go back to reference Bøe T et al (2021) Do parental education-related inequality matter in child and adolescent utilization of mental health services: results from a Norwegian Register Linkage Study. Health Services Insights 14:11786329211055302CrossRefPubMedPubMedCentral Bøe T et al (2021) Do parental education-related inequality matter in child and adolescent utilization of mental health services: results from a Norwegian Register Linkage Study. Health Services Insights 14:11786329211055302CrossRefPubMedPubMedCentral
17.
go back to reference Paananen R et al (2012) Socioeconomic and regional aspects in the use of specialized psychiatric care—a Finnish nationwide follow-up study. Eur J Pub Health 23(3):372–377CrossRef Paananen R et al (2012) Socioeconomic and regional aspects in the use of specialized psychiatric care—a Finnish nationwide follow-up study. Eur J Pub Health 23(3):372–377CrossRef
18.
go back to reference Ivert A-K, Torstensson Levander M, Merlo J (2013) Adolescents’ utilisation of psychiatric care, neighbourhoods and neighbourhood socioeconomic deprivation: a multilevel analysis. PLoS ONE 8(11):e81127CrossRefPubMedPubMedCentral Ivert A-K, Torstensson Levander M, Merlo J (2013) Adolescents’ utilisation of psychiatric care, neighbourhoods and neighbourhood socioeconomic deprivation: a multilevel analysis. PLoS ONE 8(11):e81127CrossRefPubMedPubMedCentral
19.
20.
go back to reference Johansson N, Jakobsson N, Svensson M (2018) Regional variation in health care utilization in Sweden—the importance of demand-side factors. BMC Health Serv Res 18(1):403CrossRefPubMedPubMedCentral Johansson N, Jakobsson N, Svensson M (2018) Regional variation in health care utilization in Sweden—the importance of demand-side factors. BMC Health Serv Res 18(1):403CrossRefPubMedPubMedCentral
21.
go back to reference Sirén A-L et al (2018) Follow-up of the First line of care for mental health problems in children and adolescents Uppföljning av första linjen psykiska ohälsa barn och unga. Centrum för epidemiologi och samhällsmedicin (CES), Stockholm Sirén A-L et al (2018) Follow-up of the First line of care for mental health problems in children and adolescents Uppföljning av första linjen psykiska ohälsa barn och unga. Centrum för epidemiologi och samhällsmedicin (CES), Stockholm
22.
go back to reference Sveriges-Kommuner-och-Regioner (2023) Psykiatrin i siffror - kartläggning av barn- och ungdomspsykiatrin 2022 [Psychiatry in numbers - Mapping of Child and Adolescent psychiatry 2022]. Sveriges Kommuner och Regioner Sveriges-Kommuner-och-Regioner (2023) Psykiatrin i siffror - kartläggning av barn- och ungdomspsykiatrin 2022 [Psychiatry in numbers - Mapping of Child and Adolescent psychiatry 2022]. Sveriges Kommuner och Regioner
23.
go back to reference Beata J, Anna O, Henrik D (2022) Autismspektrumtillstånd och adhd bland barn och ungdomar i Stockholms län: förekomst i befolkningen samt vårdkonsumtion. En uppföljningsrapport. [Autism spectrum disorders and ADHD among children and adolescents in Stockholm County: prevalence in the population and healthcare consumption. A follow-up report.]. Centrum för epidemiologi och samhällsmedicin, Region Stockholm: Stockholm Beata J, Anna O, Henrik D (2022) Autismspektrumtillstånd och adhd bland barn och ungdomar i Stockholms län: förekomst i befolkningen samt vårdkonsumtion. En uppföljningsrapport. [Autism spectrum disorders and ADHD among children and adolescents in Stockholm County: prevalence in the population and healthcare consumption. A follow-up report.]. Centrum för epidemiologi och samhällsmedicin, Region Stockholm: Stockholm
25.
go back to reference The-Swedish-Government (2014) Patientlag (2014:821) [Patient Act], Socialdepartementet, Editor. The Swedish Government. The-Swedish-Government (2014) Patientlag (2014:821) [Patient Act], Socialdepartementet, Editor. The Swedish Government.
26.
go back to reference László KD, Andersson F, Galanti MR (2019) School climate and mental health among Swedish adolescents: a multilevel longitudinal study. BMC Public Health 19(1):1695CrossRefPubMedPubMedCentral László KD, Andersson F, Galanti MR (2019) School climate and mental health among Swedish adolescents: a multilevel longitudinal study. BMC Public Health 19(1):1695CrossRefPubMedPubMedCentral
27.
go back to reference Chavira DA et al (2004) Child anxiety in primary care: prevalent but untreated. Depress Anxiety 20(4):155–164CrossRefPubMed Chavira DA et al (2004) Child anxiety in primary care: prevalent but untreated. Depress Anxiety 20(4):155–164CrossRefPubMed
28.
go back to reference Malmberg M, Rydell A-M, Smedje H (2003) Validity of the Swedish version of the Strengths and Difficulties Questionnaire (SDQ-Swe). Nord J Psychiatry 57(5):357–363CrossRefPubMed Malmberg M, Rydell A-M, Smedje H (2003) Validity of the Swedish version of the Strengths and Difficulties Questionnaire (SDQ-Swe). Nord J Psychiatry 57(5):357–363CrossRefPubMed
29.
go back to reference Gustafsson BM, Gustafsson PA, Proczkowska-Björklund M (2016) The Strengths and Difficulties Questionnaire (SDQ) for preschool children—a Swedish validation. Nord J Psychiatry 70(8):567–574CrossRefPubMed Gustafsson BM, Gustafsson PA, Proczkowska-Björklund M (2016) The Strengths and Difficulties Questionnaire (SDQ) for preschool children—a Swedish validation. Nord J Psychiatry 70(8):567–574CrossRefPubMed
30.
go back to reference Göran Svedin C, Priebe G (2008) The Strengths and Difficulties Questionnaire as a screening instrument in a community sample of high school seniors in Sweden. Nordic J Psychiatry 62(3):225–232CrossRef Göran Svedin C, Priebe G (2008) The Strengths and Difficulties Questionnaire as a screening instrument in a community sample of high school seniors in Sweden. Nordic J Psychiatry 62(3):225–232CrossRef
31.
go back to reference Koskelainen M, Sourander A, Kaljonen A (2000) The Strengths and Difficulties Questionnaire among Finnish school-aged children and adolescents. Eur Child Adolesc Psychiatry 9(4):277–284CrossRefPubMed Koskelainen M, Sourander A, Kaljonen A (2000) The Strengths and Difficulties Questionnaire among Finnish school-aged children and adolescents. Eur Child Adolesc Psychiatry 9(4):277–284CrossRefPubMed
32.
go back to reference Goodman R (2001) Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry 40(11):1337–1345CrossRefPubMed Goodman R (2001) Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry 40(11):1337–1345CrossRefPubMed
34.
go back to reference Ene M et al (2015) Multilevel models for categorical data using SAS® PROC GLIMMIX: the basics. University of South Carolina Ene M et al (2015) Multilevel models for categorical data using SAS® PROC GLIMMIX: the basics. University of South Carolina
35.
go back to reference Hjern A, Weitoft G, Lindblad F (2010) Social adversity predicts ADHD-medication in school children—a national cohort study. Acta Paediatr 99(6):920–924CrossRefPubMed Hjern A, Weitoft G, Lindblad F (2010) Social adversity predicts ADHD-medication in school children—a national cohort study. Acta Paediatr 99(6):920–924CrossRefPubMed
36.
go back to reference Ivert A-K et al (2011) Pathways to child and adolescent psychiatric clinics: a multilevel study of the significance of ethnicity and neighbourhood social characteristics on source of referral. Child Adolesc Psychiatry Ment Health 5(1):6CrossRefPubMedPubMedCentral Ivert A-K et al (2011) Pathways to child and adolescent psychiatric clinics: a multilevel study of the significance of ethnicity and neighbourhood social characteristics on source of referral. Child Adolesc Psychiatry Ment Health 5(1):6CrossRefPubMedPubMedCentral
37.
go back to reference Bradley RH, Corwyn RF (2002) Socioeconomic status and child development. Annu Rev Psychol 53:371–399CrossRefPubMed Bradley RH, Corwyn RF (2002) Socioeconomic status and child development. Annu Rev Psychol 53:371–399CrossRefPubMed
38.
go back to reference Aisbett DL et al (2007) Understanding barriers to mental health service utilization for adolescents in rural Australia. Rural Remote Health 7(1):624PubMed Aisbett DL et al (2007) Understanding barriers to mental health service utilization for adolescents in rural Australia. Rural Remote Health 7(1):624PubMed
39.
go back to reference Radez J et al (2021) Why do children and adolescents (not) seek and access professional help for their mental health problems? A systematic review of quantitative and qualitative studies. Eur Child Adolesc Psychiatry 30(2):183–211CrossRefPubMed Radez J et al (2021) Why do children and adolescents (not) seek and access professional help for their mental health problems? A systematic review of quantitative and qualitative studies. Eur Child Adolesc Psychiatry 30(2):183–211CrossRefPubMed
40.
go back to reference Gulliver A, Griffiths KM, Christensen H (2010) Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry 10:113CrossRefPubMedPubMedCentral Gulliver A, Griffiths KM, Christensen H (2010) Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry 10:113CrossRefPubMedPubMedCentral
41.
go back to reference Sørensen TH, Olsen KR, Vedsted P (2009) Association between general practice referral rates and patients’ socioeconomic status and access to specialised health care: a population-based nationwide study. Health Policy 92(2):180–186CrossRefPubMed Sørensen TH, Olsen KR, Vedsted P (2009) Association between general practice referral rates and patients’ socioeconomic status and access to specialised health care: a population-based nationwide study. Health Policy 92(2):180–186CrossRefPubMed
43.
go back to reference Wettergren B et al (2016) Child health systems in Sweden. J Pediatr 177:S187–S202CrossRef Wettergren B et al (2016) Child health systems in Sweden. J Pediatr 177:S187–S202CrossRef
44.
go back to reference Kosidou K (2016) Which diagnoses account for the increase in young people’s psychiatric care consumption? [Vilka diagnoser står för ökningen av unga vuxnas vårdkonsumtion för psykiatriska tillstånd?]. Center for Epidemiology and Community Medicine CES [Centrum för epidemiologi och samhällsmedicin], Stockholm Kosidou K (2016) Which diagnoses account for the increase in young people’s psychiatric care consumption? [Vilka diagnoser står för ökningen av unga vuxnas vårdkonsumtion för psykiatriska tillstånd?]. Center for Epidemiology and Community Medicine CES [Centrum för epidemiologi och samhällsmedicin], Stockholm
Metadata
Title
Are the estimated needs for mental health care among adolescents from different socioeconomic backgrounds met equally in Sweden? A longitudinal survey-registry linkage study
Authors
Joseph Jr. Muwonge
Christina Dalman
Bo Burström
Antonio Ponce de Leon
Maria Rosaria Galanti
Beata Jablonska
Anna-Clara Hollander
Publication date
29-12-2023
Publisher
Springer Berlin Heidelberg
Published in
European Child & Adolescent Psychiatry
Print ISSN: 1018-8827
Electronic ISSN: 1435-165X
DOI
https://doi.org/10.1007/s00787-023-02341-2