Effects of a statutory reform on waiting times for outpatient psychotherapy: A multicentre cohort study

Abstract

Aims: Social inequality in access to mental health care is a current concern across the world. The authors determined whether differences in waiting times for outpatient psychotherapy changed after a statutory reform of the German psychotherapy law. Methods:The dates of first contact, first visit and treatment start, along with sociodemographic and clinical data, were extracted from patient records in communitybased psychotherapy practices. Predictors of waiting times for first visit and treatment start were investigated using multilevel Cox regression models to estimate adjusted hazard ratios (HR adj ).Results: Data from 1548 patient records from nine practices were extracted. Before the reform, the time span between first contact and first visit was longer for patients with compulsory education than for patients with a college degree (HR adj 0.8, 95% CI 0.6-1.0), whereas this was no longer the case after the law changed (HR adj 1.0, 95% CI 0.8-1.3). Patients whose treatment was covered by the state were at higher risk of a long waiting time from last visit to treatment start compared with patients with statutory health insurance after the law changed (HR adj 0.4, 95% CI 0.3-0.7), which had not been the case before the law changed (HR adj 1.3, 95% CI 0.8-2.2).Conclusions: Social inequality in access to psychotherapy was reduced in part by the updated psychotherapy law in terms of educational groups; however, it increased in other aspects. This shows how political decisions can powerfully impact clinical practice, ultimately helping one group of patients while disadvantaging another.

Personalization strategies in digital mental health interventions: a systematic review and conceptual framework for depressive symptoms

“…At an estimated lifetime prevalence of more than 10% (1,2), major depressive disorder (MDD) is the second leading cause of years lived in disability (3). While this makes efficient treatments urgently needed, traditional approaches such as face-to-face psychotherapy are difficult to access for a significant part of patients (4)(5)(6). However, providing treatment through digital channels such as mobile applications and online formats (7) is effective in reducing depressive symptoms (8,9) in a cost-effective way (10).…”

Psychometric evaluation and Rasch analyses of the German Overall Anxiety Severity and Impairment Scale (OASIS-D)

“…Treatment progress (including the severity of anxiety symptoms) should be monitored by primary care physicians, and patients should be referred to mental health specialists if the interventions offered in primary care prove to be not successful 15 , 16 . However, there is a shortage of mental health specialists in many (especially rural) areas 17 , 18 , resulting, for example, in an average waiting time for psychotherapeutic outpatient treatment in Germany of about 19 weeks 19 . Against this background, it seems of utmost importance to further improve the quality of diagnosis and treatment of mental disorders in primary care.…”

Überblick über Digitale Gesundheitsanwendungen mit Fokus Depression

“…Die Überrepräsentation von DiGA aus diesem Bereich spiegelt sich in der Anzahl der Verordnungen wider [1]. Die prominente Stellung von digitalen Interventionen mit psychiatrischem Fokus mag einerseits dadurch begründet sein, dass das Format von internetbasierter Therapie sich gut eignet, um Inhalte wie Psychoedukation zu vermitteln, andererseits reflektiert dies die nach wie vor große Versorgungslücke und lange Wartezeiten mit Blick auf Psychotherapieplätze in Deutschland [2].…”