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Social Psychiatry and Psychiatric Epidemiology
Published in: Social Psychiatry and Psychiatric Epidemiology 8/2017

Open Access 01-08-2017 | Original Paper

Socioeconomic inequalities in treatment of individuals with common mental disorders regarding subsequent development of mental illness

Authors: Thomas E. Dorner, Ellenor Mittendorfer-Rutz

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 8/2017

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Abstract

Purpose

Socioeconomic differences appear to be reflected in both, the development and the treatment of common mental disorders (CMDs, i.e. depressive, anxiety and stress-related disorders). Underlying mechanisms of these inequalities are to date not fully understood. This study aimed to investigate if (1) there are socioeconomic differences with regard to type of treatment and (2) if the socioeconomic status modifies the association between treatment and subsequent inpatient care or suicide attempt, respectively, in individuals with CMDs.

Methods

The study population comprised 66,097 individuals aged 18–59 on sick-leave due to a CMD during 2006 in Sweden. Cox regression with a follow-up from 2007 through 2010 estimated crude and multivariate hazard ratios (HR) with 95% confidence intervals (CI).

Results

Individuals with sickness absence due to CMDs and a higher educational level were had a lower proportions of specialised health care and combined psychiatric medication than their counterparts with lower education. However, if high educated CMD patients received more combined medication, associations with subsequent mental inpatient care (p < 0.01) and suicide attempt (p < 0.05) were stronger than for their counterparts with low education. Moreover, previous inpatient care due to mental disorders was associated with higher HRs of subsequent suicide attempt in CMD patients with high education (HR 5.88; CI 3.02–11.45) compared to those with low education (1.96; 1.06–3.60).

Conclusion

Findings suggest that socioeconomic inequalities shape differences in treatment measures and mental health development in individuals with CMDs. These differences might signal discrepancies in treatment per se or reflect morbidity differences requiring different treatment regimens, or may be due to the fact that different diagnoses are given in different educational strata due to differential role of stigma.
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Metadata
Title
Socioeconomic inequalities in treatment of individuals with common mental disorders regarding subsequent development of mental illness
Authors
Thomas E. Dorner
Ellenor Mittendorfer-Rutz
Publication date
01-08-2017
Publisher
Springer Berlin Heidelberg
Published in
Social Psychiatry and Psychiatric Epidemiology / Issue 8/2017
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-017-1389-6

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