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Predictors of non-drug psychiatric/psychotherapeutic treatment in children and adolescents with mental or behavioural disorders

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Abstract

Children and adolescents with mental health problems need effective and safe therapies to support their emotional and social development and to avoid functional impairment and progress of social deficits. Though psychotropic drugs seem to be the preferential treatment, psychotherapy and psychosocial interventions are essential in mental health care. For Germany, current data on the utilization of psychotherapy and psychosocial interventions in children with mental health problems is lacking. To analyse why certain children and adolescents with mental or behavioural disorders do and others do not receive non-drug treatment, we assessed predictors associated with specific non-drug psychiatric/psychotherapeutic treatment including psychosocial interventions, psychotherapy and other non-drug treatments. The study is based on data of two large German health insurance funds, AOK and TK, comprising 30 % of the German child and adolescent population. Predictors of non-drug psychiatric/psychotherapeutic treatment were analysed for 23,795 cases and two controls for every case of the same age and sex in children aged 0–17 years following a new diagnosis of mental or behavioural disorder in 2010. Predictors were divided according to Andersen’s behavioural model into predisposing, need and enabling factors. The most prominent and significant predictors positively associated with non-drug psychiatric/psychotherapeutic treatment were the residential region as predisposing factor; specific, both ex- and internalizing, mental and behavioural disorders, psychiatric co-morbidity and psychotropic drug use as need factors; and low area deprivation and high accessibility to outpatient physicians and inpatient institutions with non-drug psychiatric/psychotherapeutic department as enabling factors. In conclusion, the present study suggests that the residential region as proxy for supply of therapist and socioeconomic situation is an influencing factor for the use of psychotherapy. The analysis sheds further light on predisposing, need and enabling factors as predictors of non-drug psychotherapeutic/psychiatric treatment in children and adolescents with mental or behavioural health disorders in Germany. More research is needed to further understand the factors promoting the gap between the need and utilization of mental health care.

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Acknowledgments

We thank the Deutsche Post Direkt GmbH for providing postal code/municipality relation tables (Datafactory Basic) and the National Association of Statutory Health Insurance Physicians for providing data of the federal registry of physicians. We further thank the scientific advisory council, Dr. Anselm Bönte, Prof. Dr. Oliver Fricke and Dr. Monika Panhuysen for their input and the fruitful discussions.

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Authors and Affiliations

  1. PMV Research Group at the Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Herderstr. 52, 50931, Cologne, Germany

    Sascha Abbas, Peter Ihle & Ingrid Schubert

  2. Scientific Research Institute of the AOK (WIdO), Berlin, Germany

    Jürgen-Bernhard Adler & Christian Günster

  3. Scientific Institute of the Techniker Krankenkasse for Benefit and Efficiency in Health Care (WINEG), Hamburg, Germany

    Susanne Engel & Roland Linder

  4. LWL-University Hospital for Child and Adolescent Psychiatry, Ruhr-University Bochum, Hamm, Germany

    Martin Holtmann

  5. GeoMed Research Forschungsgesellschaft mbH, Bad Honnef, Germany

    Axel Kortevoss

  6. Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany

    Werner Maier

  7. Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Cologne, Germany

    Gerd Lehmkuhl

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  1. Sascha Abbas
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Correspondence to Ingrid Schubert.

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Conflict of interest

Sascha Abbas, Jürgen-Bernhard Adler, Susanne Engel, Christian Günster, Peter Ihle, Axel Kortevoss, Gerd Lehmkuhl, Roland Linder, Werner Maier and Ingrid Schubert have no conflict of interest to declare. Martin Holtmann served in an advisory or consultancy role for Lilly, Shire and Medice, and received conference attendance support or was paid for public speaking by Bristol-Myers Squibb, Lilly, Medice, Neuroconn and Shire. The PMV Research Group has received unrestricted research grants for the university from the Ministry of Health, Ministry of Education and Research, sickness funds, private foundations and drug companies. The study was funded by a Grant of the German Federal Ministry of Education and Research (Grant Number: 01GY1130).

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Abbas, S., Ihle, P., Adler, JB. et al. Predictors of non-drug psychiatric/psychotherapeutic treatment in children and adolescents with mental or behavioural disorders. Eur Child Adolesc Psychiatry 26, 433–444 (2017). https://doi.org/10.1007/s00787-016-0900-z

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  • DOI: https://doi.org/10.1007/s00787-016-0900-z

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