Faculty of Social Sciences (Psychology), Tampere University, Arvo Ylpön katu 34, FI-33520, Tampere, Finland.
Faculty of Social Sciences (Unit of Health Sciences), Tampere University, Tampere, Finland.
BMC Health Serv Res. 2021 Oct 11;21(1):1081. doi: 10.1186/s12913-021-07099-4.
We investigated the regional differences in all mental disorder disability pensions (DP) between 2010 and 2015 in Finland, and separately in mood disorders and non-affective psychotic disorder DP. We also studied the contribution of several district-level contextual and mental health service factors to mental disorder DP.
Subjects were all those granted mental disorder DP for the first time between 2010 and 2015 in Finland (N = 36,879). Associations between the district-level contextual and mental health service factors and regional DP risks collected from the year 2015 were studied with negative binomial regression analysis in the Finnish hospital districts. The population number on the age (18 to 65 years), gender, occupational status and residential hospital district of the Finnish population from 2015 was used as exposure in the model.
Significant differences in the regional mental disorder DP risks between and within hospital districts did not appear to follow the traditional Finnish health differences. A lower risk of DP was associated with contextual indicators of higher regional socioeconomic level. Furthermore, population density as a proxy for access to mental health services indicated a higher regional DP risk for lower density in all mental (IRR 1.10; 95% CI 1.06-1.14) and mood disorder (IRR 1.12; 95% CI 1.08-1.16) DP. Both the highest and the lowest regional numbers of all mental health outpatient visits were associated with a higher DP risk in all mental and mood disorder DP, whereas particularly low regional numbers of inpatient treatment periods and of patients were associated with a lower risk of DP.
In this comprehensive population-level study, we found evidence of significant regional variation in mental disorder DP and related district-level factors. This variation may at least partly relate to differences in regional mental health service systems and treatment practices. Adapting to the needs of the local population appears to be indicated for both regional mental health service systems and treatment practices to achieve optimal performance.
我们调查了 2010 年至 2015 年芬兰所有精神障碍残疾抚恤金（DP）的地区差异，分别对心境障碍和非情感性精神病性障碍 DP 进行了研究。我们还研究了几个地区层面的背景和精神卫生服务因素对精神障碍 DP 的贡献。
研究对象为 2010 年至 2015 年间芬兰首次获得精神障碍 DP 的所有人（N=36879）。2015 年收集的地区层面背景和精神卫生服务因素与区域 DP 风险之间的关联，使用芬兰医院区的负二项回归分析进行了研究。模型中的暴露因素是 2015 年芬兰人口的年龄（18-65 岁）、性别、职业状况和居住医院区的人口数量。
医院区之间和内部的区域精神障碍 DP 风险差异似乎没有遵循传统的芬兰健康差异。DP 风险较低与区域社会经济水平较高的背景指标相关。此外，人口密度作为获得精神卫生服务的替代指标，表明在所有精神（IRR 1.10；95%CI 1.06-1.14）和心境障碍（IRR 1.12；95%CI 1.08-1.16）DP 中，密度较低的区域 DP 风险较高。所有精神卫生门诊就诊次数最高和最低的地区数量均与所有精神和心境障碍 DP 的 DP 风险增加相关，而住院治疗期和患者数量特别低的地区与 DP 风险降低相关。
在这项全面的人群水平研究中，我们发现精神障碍 DP 存在显著的地区差异，以及相关的地区层面因素。这种差异至少部分与区域精神卫生服务系统和治疗实践的差异有关。为了实现最佳绩效，区域精神卫生服务系统和治疗实践似乎都需要适应当地人口的需求。
