Mental Illness Inequalities by Multimorbidity, Use of Health Resources and Socio-Economic Status in an Aging Society

Abstract

Background: Mental illness, multi-morbidity, and socio-economic inequalities are some of the main challenges for the public health system nowadays, and are further aggravated by the process of population aging. Therefore, it is widely accepted that health systems need to focus their strategies for confronting such concerns. With guaranteed access to health care services under universal coverage in many health systems, it is expected that all services be provided equally to patients with the same level of need. Methods: In this paper, we explore the existence of inequalities in the access to services of patients with mental illness taking into account whether they are multimorbid patients, their socioeconomic status, and their age. We take advantage of a one-year (2010–2011) database on individual healthcare utilization and expenditures for the total population (N = 2,262,698) of the Basque Country. Results: More comorbidity leads to greater inequality in prevalence, being the poor sicker, although with age, this inequality decreases. All health services are more oriented towards greater utilization of the poor and sicker, particularly in the case of visits to specialists and emergency care. Conclusions: Mental health inequalities in prevalence have been identified as being disproportionally concentrated in the least affluent areas of the Basque Country. However, inequalities in the utilization of publicly-provided health services present a pro-poor orientation. As this region has adopted a system-wide transformation towards integrated care, its mental health delivery model offers excellent potential for international comparisons and benchlearning.

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“…Disease-specific approaches to the provision of health services for PLHIV are likely to be inefficient, particularly because it is common for multiple comorbidities to share the same risk factors, resulting in syndemics 50 . Integrated healthcare models tailored to reflect the multimorbidity-related needs of PLHIV in different geographical settings have the potential to deliver better health outcomes, if implemented equitably 51 , and can do so costeffectively 52 . By addressing the prevention, screening, and management of comorbidities in a person-centered manner, guided by the needs of individual patients, health systems can also respond flexibly to the multidimensional process of aging with HIV, taking into account both chronic and episodic healthrelated needs 53 .…”

A Systematic Review of the Literature Regarding the Relationship Between Oxidative Stress and Electroconvulsive Therapy

“…Psychiatric disorders are leading causes of disability, 1 with high rates of morbidity and premature death. 2 , 3 For example, the risk of oncologic diseases 4 or cardiovascular diseases 5 increase significantly, even the metabolic risk factors were controlled for. The medical comorbidities may emerge both directly, through biological pathways, and indirectly, through risky health behaviors.…”