Charité - Universitätsmedizin Berlin, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany.
MSB Medical School Berlin, Department of Psychology, Working Unit Geropsychology, Berlin, Germany.
BMC Health Serv Res. 2021 May 10;21(1):442. doi: 10.1186/s12913-021-06384-6.
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.
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).
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.
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.
有心理健康问题的老年人可能受益于心理治疗；然而，与门诊心理治疗的未利用率相比，他们对治疗的认知需求，以及 Andersen 健康保健利用模型中解释这些差异的倾向因素、促成因素和需求因素，都需要进一步研究。
我们使用了德国全国性电话调查的两个独立队列（2014 年和 2019 年），共纳入了 12197 名德语成年人参与者。在这两个队列中，有 12.9%（加权）的人报告了对心理健康问题治疗的需求，并被选入进一步的分析。使用逻辑广义估计方程（GEE）对 2014 年和 2019 年队列中，有治疗需求者（需求因素）中治疗需求（处置因素）与心理治疗（结局）未利用率之间的关联进行建模。
2014 年，6087 名参与者中有 11.8%因心理健康问题而报告了治疗需求。2016 年，这一比例显著上升至 6110 名参与者中的 14.0%。在报告有治疗需求的人群中，2014 年有 36.4%和 2019 年有 36.9%的人没有看心理治疗师，而在最年长的年龄组（59.3/52.5%；75+），心理治疗的未利用率远高于最年轻的年龄组（29.1/10.7%；18-25 岁）。关于与未利用率相关的因素，多变量分析结果表明，参加 2014 年队列（OR 0.94）、年龄较大（55-64 岁 OR 1.02，65-74 岁 OR 1.47，75+岁 OR 4.76）、男性（OR 0.83）、教育程度较低（OR 0.84）、农村居住（OR 1.38）、独居（OR 1.37）和看全科医生（OR 1.39）与心理治疗的未利用率有关；当模型中包含全科医生就诊时，一般健康状况与未利用率无显著相关性。
在门诊心理治疗的未利用率方面，存在明显的年龄效应。医疗保健专业人员和患者的个体特征以及结构性障碍可能会加剧这种情况。需要制定有效的策略来提高有未满足治疗需求的老年患者的心理治疗率。
