TY - JOUR

T1 - Equity in the use of publicly subsidized psychotherapy among elderly Danish cancer patients--a register-based cohort study

AU - von Heymann-Horan, Annika Berglind

AU - Bidstrup, Pernille E

AU - Kristiansen, Luise C

AU - Olsen, Anja

AU - Andersen, Klaus K

AU - Elsass, Peter

AU - Johansen, Christoffer

AU - Dalton, Susanne O

PY - 2013/2

Y1 - 2013/2

N2 - Approximately 30% of cancer patients suffer from psychological distress, and psychotherapy has been shown to be effective in alleviating it. Based on the ‘Behavioral Model of Health Service Use’, we investigated equity in the use of publicly subsidized psychotherapy in a cohort of Danish cancer patients. We present descriptive data on patients’ use of psychotherapy and examine characteristics of those who used this service. Material and methods. The study population comprised 3646 participants in the prospective Diet, Cancer and Health cohort, diagnosed with a first cancer between 2003 and 2009, aged 56–80 years. Data on cancer diagnosis, psychotherapy use and comorbid conditions were obtained from registers, whereas data on demographics, social support and health status were obtained from questionnaires. Cox proportional hazards regression was used to identify factors related to use, which were subsequently evaluated with regard to equity. Results. Subsidized psychotherapy was used by 2.3% of the cancer patients. Longer education (> 10 years compared to < 8) was associated with greater likelihood of initiating psychotherapy [hazard ratio (HR), 1.97; 95% confidence interval (CI), 1.06–3.65], as was previous psychotherapy use compared to no previous use (2.86; 1.32–6.20). Patients with partners who did not reliably provide emotional support were significantly more likely to use psychotherapy than those without a partner (2.36; 1.05–5.30), a difference not found for those with partners who did provide support. Further, a higher SF-36 mental component score (0.96; 0.94–0.98, per point increase), and older age were associated with less use (65–69 years: 0.43; 0.21–0.89, 70–74 years: 0.17, 0.07–0.41; > 74 years: 0.07, 0.01–0.57, compared to < 60 years). Conclusions. The results allow several possible interpretations. We found that mental health plays a role for accessing subsidized psychotherapy, suggesting that use of psychotherapy is predicted by need and thus characterized by equity. However, education and previous psychotherapy use also play a role, suggesting elements of inequity.

AB - Approximately 30% of cancer patients suffer from psychological distress, and psychotherapy has been shown to be effective in alleviating it. Based on the ‘Behavioral Model of Health Service Use’, we investigated equity in the use of publicly subsidized psychotherapy in a cohort of Danish cancer patients. We present descriptive data on patients’ use of psychotherapy and examine characteristics of those who used this service. Material and methods. The study population comprised 3646 participants in the prospective Diet, Cancer and Health cohort, diagnosed with a first cancer between 2003 and 2009, aged 56–80 years. Data on cancer diagnosis, psychotherapy use and comorbid conditions were obtained from registers, whereas data on demographics, social support and health status were obtained from questionnaires. Cox proportional hazards regression was used to identify factors related to use, which were subsequently evaluated with regard to equity. Results. Subsidized psychotherapy was used by 2.3% of the cancer patients. Longer education (> 10 years compared to < 8) was associated with greater likelihood of initiating psychotherapy [hazard ratio (HR), 1.97; 95% confidence interval (CI), 1.06–3.65], as was previous psychotherapy use compared to no previous use (2.86; 1.32–6.20). Patients with partners who did not reliably provide emotional support were significantly more likely to use psychotherapy than those without a partner (2.36; 1.05–5.30), a difference not found for those with partners who did provide support. Further, a higher SF-36 mental component score (0.96; 0.94–0.98, per point increase), and older age were associated with less use (65–69 years: 0.43; 0.21–0.89, 70–74 years: 0.17, 0.07–0.41; > 74 years: 0.07, 0.01–0.57, compared to < 60 years). Conclusions. The results allow several possible interpretations. We found that mental health plays a role for accessing subsidized psychotherapy, suggesting that use of psychotherapy is predicted by need and thus characterized by equity. However, education and previous psychotherapy use also play a role, suggesting elements of inequity.

KW - Aged

KW - Aged, 80 and over

KW - Cohort Studies

KW - Denmark

KW - Female

KW - Financing, Government

KW - Healthcare Disparities

KW - Humans

KW - Male

KW - Middle Aged

KW - Neoplasms

KW - Psychotherapy

KW - Questionnaires

KW - Registries

U2 - 10.3109/0284186X.2012.742965

DO - 10.3109/0284186X.2012.742965

M3 - Journal article

C2 - 23244710

VL - 52

SP - 355

EP - 363

JO - Acta Odontologica Scandinavica

JF - Acta Odontologica Scandinavica

SN - 0001-6357

IS - 2

ER -