title: [Provision of outpatient specialist care for mental disorders : Minor regional differences in treatment needs, major regional differences in availability].
abstract: BACKGROUND
  Due to the high burden attributed to mental disorders, an important purpose of a general healthcare system is to provide comprehensive medical specialist care that is both locally available and in line with demand; however, the density of outpatient physicians and psychotherapists significantly varies between regions in Germany. To verify if these variations reflect regional variations of morbidity rates, routine data of statutory health insurance companies are analyzed on a regular basis. But these administrative data directly depend on the actual regional health care supply. Hence, independent epidemiological data on prevalence rates of mental disorders could be a valuable supplement.
  
  
  METHODS
  Analyses are based on prevalence rates of the representative epidemiological German health interview and examination survey and its mental health module (DEGS1-MH) as well as supplemental data from the German national and regional associations of statutory health insurance physicians. The associations between prevalence rates and density of outpatient physicians and psychotherapists were computed for the DEGS sample points, representing 139 different German districts. Transregional care provision for neighboring regions was taken into account.
  
  
  RESULTS
  There were neither significant associations of regional density of outpatient physicians and psychotherapists with prevalence rates of mental disorders in general nor with prevalence rates of severe mental disorders; however, taking into account transregional care provision for neighboring regions the huge variability of provider density decreases.
  
  
  CONCLUSIONS
  The regional inequality of physician and psychotherapist density cannot be explained by regional differences in treatment needs. The results indicate potential improvements in healthcare provision for mental disorders in Germany through the adaptation to actual morbidity rates; however, the definition of treatment needs in mental disorders requires further evaluation.
authors.affiliation: Klinische Psychologie und Psychotherapie, Psychologische Hochschule Berlin (PHB), Am Köllnischen Park 2, 10179, Berlin, Deutschland. f.jacobi@psychologische-hochschule.de.
authors.forename: F
authors.initials: F
authors.lastname: Jacobi
authors.affiliation: Klinische Psychologie und Psychotherapie, Psychologische Hochschule Berlin (PHB), Am Köllnischen Park 2, 10179, Berlin, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Becker
authors.affiliation: Klinische Psychologie und Psychotherapie, Psychologische Hochschule Berlin (PHB), Am Köllnischen Park 2, 10179, Berlin, Deutschland.
authors.forename: J
authors.initials: J
authors.lastname: Bretschneider
authors.affiliation: Klinische Psychologie und Psychotherapie, Psychologische Hochschule Berlin (PHB), Am Köllnischen Park 2, 10179, Berlin, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Müllender
authors.affiliation: Klinische Psychologie und Psychotherapie, Psychologische Hochschule Berlin (PHB), Am Köllnischen Park 2, 10179, Berlin, Deutschland.
authors.forename: J
authors.initials: J
authors.lastname: Thom
authors.affiliation: Robert Koch-Institut, Berlin, Deutschland.
authors.forename: U
authors.initials: U
authors.lastname: Hapke
authors.affiliation: Klinik für Psychiatrie und Psychotherapie, Universität Bonn, Bonn, Deutschland.|Deutsches Zentrum für neurodegenerative Erkrankungen (DZNE), Bonn, Deutschland.
authors.forename: W
authors.initials: W
authors.lastname: Maier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D015276:Health Care Rationing / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D008875:Middle Aged; D015995:Prevalence; D011613:Psychotherapy / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Mental health care; Morbidity; Physician density; Regional differences; Treatment needs