title: Predictors of non-drug psychiatric/psychotherapeutic treatment in children and adolescents with mental or behavioural disorders.
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.
authors.affiliation: PMV Research Group at the Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Herderstr. 52, 50931, Cologne, Germany.
authors.forename: Sascha
authors.initials: S
authors.lastname: Abbas
authors.affiliation: PMV Research Group at the Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Herderstr. 52, 50931, Cologne, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Ihle
authors.affiliation: Scientific Research Institute of the AOK (WIdO), Berlin, Germany.
authors.forename: Jürgen-Bernhard
authors.initials: JB
authors.lastname: Adler
authors.affiliation: Scientific Institute of the Techniker Krankenkasse for Benefit and Efficiency in Health Care (WINEG), Hamburg, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Engel
authors.affiliation: Scientific Research Institute of the AOK (WIdO), Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Günster
authors.affiliation: LWL-University Hospital for Child and Adolescent Psychiatry, Ruhr-University Bochum, Hamm, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Holtmann
authors.affiliation: GeoMed Research Forschungsgesellschaft mbH, Bad Honnef, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Kortevoss
authors.affiliation: Scientific Institute of the Techniker Krankenkasse for Benefit and Efficiency in Health Care (WINEG), Hamburg, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Linder
authors.affiliation: Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Maier
authors.affiliation: Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Cologne, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Lehmkuhl
authors.affiliation: PMV Research Group at the Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Herderstr. 52, 50931, Cologne, Germany. ingrid.schubert@uk-koeln.de.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Schubert
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D005858:Germany; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D000066553:Problem Behavior / Q000523:psychology*; D011613:Psychotherapy / Q000379:methods*; D012111:Residence Characteristics
keywords: Children and adolescents; Mental and behavioural disorder; Mental health; Predictors; Psychotherapy