Socioeconomic differences in psychiatric treatment before and after self-harm: an observational study of 4,280 adolescents and young adults

BMC Psychiatry

Mikko Aaltonen¹  Hanna Remes²  Joonas Pitkänen³  Pekka Martikainen⁴ 

[1] Institute of Criminology and Legal Policy, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland;Law School, University of Eastern Finland, Joensuu, Finland;Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, FIN-00014, Helsinki, Finland;Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, FIN-00014, Helsinki, Finland;International Max Planck Research School for Population, Health and Data Science, Rostock, Germany;Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, FIN-00014, Helsinki, Finland;Max Planck Institute for Demographic Research, Rostock, Germany;Department of Public Health Sciences, Stockholm University, Stockholm, Sweden;

关键词: Self-harm;    Young adulthood ;    Adolescence;    Psychiatric treatment;    Psychotropic medication;    Socioeconomic differences;    Parental education;   

DOI  :  10.1186/s12888-021-03654-9

来源: Springer

【 摘 要 】

BackgroundIndividuals in higher socioeconomic positions tend to utilise more mental health care, especially specialist services, than those in lower positions. Whether these disparities in treatment exist among adolescents and young adults who self-harm is currently unknown.MethodsThe study is based on Finnish administrative register data on all individuals born 1986–1994. Adolescents and young adults with an episode of self-harm treated in specialised healthcare at ages 16–21 in 2002–2015 (n=4280, 64% female) were identified and followed 2 years before and after the episode. Probabilities of specialised psychiatric inpatient admissions and outpatient visits and purchases of psychotropic medication at different time points relative to self-harm were estimated using generalised estimation equations, multinomial models and cumulative averages. Socioeconomic differences were assessed based on parental education, controlling for income.ResultsAn educational gradient in specialised treatment and prescription medication was observed, with the highest probabilities of treatment among the adolescents and young adults with the highest educated parents and lowest probabilities among those whose parents had basic education. These differences emerged mostly after self-harm. The probability to not receive any treatment, either in specialised healthcare or psychotropic medication, was highest among youth whose parents had a basic level of education (before self-harm 0.39, 95% CI 0.34–0.43, and after 0.29, 95% CI 0.25–0.33 after) and lowest among youth with higher tertiary educated parents (before self-harm: 0.22, 95% CI 0.18–0.26, and after 0.18, 95% CI 0.14–0.22). The largest differences were observed in inpatient care.ConclusionsThe results suggest that specialised psychiatric care and psychotropic medication use are common among youth who self-harm, but a considerable proportion have no prior or subsequent specialised treatment.The children of parents with lower levels of education are likely to benefit from additional support in initiating and adhering to treatment after an episode of self-harm. Further research on the mechanisms underlying the educational gradient in psychiatric treatment is needed.

【 授权许可】

CC BY