Factors associated with quality of services for marginalized groups with mental health problems in 14 European countries.
BACKGROUND
Different service characteristics are known to influence mental health care delivery. Much less is known about the impact of contextual factors, such as the socioeconomic circumstances, on the provision of care to socially marginalized groups.The objectives of this work were to assess the organisational characteristics of services providing mental health care for marginalized groups in 14 European capital cities and to explore the associations between organisational quality, service features and country-level characteristics.


METHODS
617 services were assessed in two highly deprived areas in 14 European capital cities. A Quality Index of Service Organisation (QISO) was developed and applied across all sites. Service characteristics and country level socioeconomic indicators were tested and related with the Index using linear regressions and random intercept linear models.


RESULTS
The mean (standard deviation) of the QISO score (minimum = 0; maximum = 15) varied from 8.63 (2.23) in Ireland to 12.40 (2.07) in Hungary. The number of different programmes provided was the only service characteristic significantly correlated with the QISO (p < 0.05). The national Gross Domestic Product (GDP) was inversely associated with the QISO. Nearly 15% of the variance of the QISO was attributed to country-level variables, with GDP explaining 12% of this variance.


CONCLUSIONS
Socioeconomic contextual factors, in particular the national GDP are likely to influence the organisational quality of services providing mental health care for marginalized groups. Such factors should be considered in international comparative studies. Their significance for different types of services should be explored in further research.
Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Alameda Prof Hernani Monteiro, 4200-319 Porto, Portugal. dmcosta@med.up.pt.
Diogo
D
Costa
Aleksandra
A
Matanov
Reamonn
R
Canavan
Edina
E
Gabor
Tim
T
Greacen
Petra
P
Vondráčková
Ulrike
U
Kluge
Pablo
P
Nicaise
Jacek
J
Moskalewicz
José Manuel
JM
Díaz-Olalla
Christa
C
Straßmayr
Martijn
M
Kikkert
Joaquim J F
JJ
Soares
Andrea
A
Gaddini
Henrique
H
Barros
Stefan
S
Priebe
D005060:Europe; D005163:Factor Analysis, Statistical; D006801:Humans; D001523:Mental Disorders / Q000628:therapy; D008605:Mental Health Services / Q000458:organization & administration / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards; D062487:Social Marginalization; D012959:Socioeconomic Factors