Social determinants of the utilization of psychotherapeutic care in Germany

Abstract

As the rate of mental disorders increases in Germany, psychotherapy is gaining in importance for the health-care system. However, there is currently very little information available on the type of patient who has access to psychotherapy, especially outpatient psychotherapy. This chapter “Social determinants of utilization of psychotherapy in Germany” describes studies on social inequality and utilization of psychotherapy. For this purpose we will focus on the individual predisposing factor “social structure,” which encompasses education, occupation, and ethnicity (Andersen RM, J Health Soc Behav 36:1-10, 1995), and will examine the influence of social status on the utilization of outpatient psychotherapy in Germany. Methods Conducting systematic literature searches on social determinants of utilization in the Medline and PsycINFO databases, limited to Germany and the time period from 2002 through 2012. Results In the Medline database, the above search strategy brought up 17 publications, only one of which included a relevant paper. The second search in the PsycINFO database resulted in 12 hits, but again only one paper was found to be relevant to our research question. Through the manual search, we found two additional publications on the topic. All of the four studies that we were able to include in the review show that patients with a higher level of education often have more access to psychotherapy than those with a lower level, although the latter suffer more frequently from mental disorders. The combined view of epidemiological data and studies on utilization of psychotherapy indicates that patients with a lower education level are inadequately provided for within the system. Discussion and Conclusion The results consistently show that mentally ill people with a higher level of education are more commonly in therapy than those with a lower level of education. However, there is currently very little evidence available on this issue.