Introduction
Methods
Data
Sample
Characteristics of treatment
Duration of treatment
-
Diagnostic activities (intake, psychiatric/psychological/neurological/personality examination, intelligence testing, anamnestic interview).
-
Psychological therapy (including all types of psychotherapy, counseling, psycho-education and other psychological activities).
-
Pharmacotherapy (time spent on consultations).
Return into mental health care
Characteristics of the sample
Demographic variables
Clinical information
Statistical analyses
Results
Characteristics study sample
Overall population (N = 85,754) (100 %) | No return into mental health care (n = 73,677) (85.9 %) | Return into mental health care (n = 12,077) (14.1 %) |
χ
2
|
p
| ||||
---|---|---|---|---|---|---|---|---|
N
| % |
N
| % |
N
| % | |||
Demographics | ||||||||
Gender, women | 54,716 | 63.8 | 46,999 | 63.8 | 7717 | 63.9 | 0.05 | 0.82 |
Age, mean (SD)a
| 44.1 (13.2) | 44.2 (15.6) | 43.5 (15.5) | |||||
Age | 15.17 | 0.001* | ||||||
18–45 | 48,288 | 56.3 | 41,291 | 56.0 | 6997 | 57.9 | ||
46–65 | 29,375 | 34.3 | 25,398 | 34.5 | 3977 | 32.9 | ||
>65 | 8091 | 9.4 | 6988 | 9.5 | 1103 | 9.1 | ||
Characteristics health care received | ||||||||
Duration in minutes | 235.55 | <0.001* | ||||||
5–250 | 11,598 | 13.5 | 9633 | 13.1 | 1965 | 16.3 | ||
251–500 | 18,239 | 21.3 | 15,442 | 21.0 | 2797 | 23.2 | ||
501–750 | 13,754 | 16.0 | 11,823 | 16.0 | 1931 | 16.0 | ||
751–1000 | 11,027 | 12.9 | 9350 | 12.7 | 1677 | 13.9 | ||
>1000 | 31,136 | 36.3 | 27,429 | 37.2 | 3707 | 30.2 | ||
Treatment receivedb, c
| ||||||||
Diagnostic activities | 77,996 | 91.0 | 67,450 | 91.5 | 10,591 | 87.7 | 181.28 | <0.001* |
Psychotherapy | ||||||||
Psycho-analytic therapy | 149 | 0.2 | 136 | 0.2 | 13 | 0.1 | 3.54 | 0.06 |
Psycho-dynamic therapy | 4574 | 5.3 | 3882 | 5.3 | 692 | 5.7 | 4.37 | 0.04 |
Behavioral therapy | 1589 | 1.9 | 1402 | 1.9 | 187 | 1.5 | 7.17 | 0.007* |
Cognitive behavioral therapy | 18,174 | 21.2 | 16,184 | 22.0 | 1990 | 16.5 | 187.15 | <0.001* |
Interpersonal therapy | 1674 | 2.0 | 147 | 2.0 | 207 | 1.7 | 4.16 | 0.04 |
Client focused therapy | 3754 | 4.4 | 3364 | 4.6 | 390 | 3.2 | 44.28 | <0.001* |
Systemic therapy | 2245 | 2.6 | 1962 | 2.7 | 283 | 2.3 | 4.16 | 0.04 |
Supportive therapy, counseling | 37,388 | 43.6 | 31,854 | 43.2 | 5534 | 45.8 | 28.26 | <0.001* |
Other therapeutic interventionsd
| 19,627 | 22.9 | 17,155 | 23.3 | 2472 | 20.5 | 46.61 | <0.001* |
Creative therapye
| 18,120 | 21.1 | 14,735 | 20.0 | 3385 | 28.0 | 401.37 | <0.001* |
Pharmacotherapy | 31,886 | 37.2 | 27,269 | 37.0 | 4617 | 38.2 | 6.59 | 0.01 |
Treatment setting | ||||||||
Psychotherapy only | 36,944 | 43.1 | 32190 | 43.7 | 4754 | 39.4 | 100.06 | <0.001* |
Medication only | 10,789 | 12.6 | 9222 | 12.5 | 1567 | 13.0 | ||
Psychotherapy and medication | 21,097 | 24.6 | 18,047 | 24.5 | 3050 | 25.3 | ||
Other therapy | 16,924 | 19.7 | 14,218 | 19.3 | 2706 | 22.4 | ||
Severity of complaints | ||||||||
GAF scores, mean (SD)f
| ||||||||
Start treatmentg
| 60.0 (9.4) | 60.0 (9.4) | 60.0 (9.7) | 98.88 | <0.001* | |||
End treatmenth
| 67.0 (12.3) | 67.0 (12.3) | 66.0 (12.2) | 212.44 | <0.001* | |||
As I comorbidity, yes | 23,287 | 27.2 | 21,485 | 29.2 | 1802 | 14.9 | 1063.68 | <0.001* |
As II comorbidityi, yes | 8810 | 10.3 | 8048 | 10.9 | 762 | 6.3 | 239.62 | <0.001* |
As III comorbidity, yes | 29,234 | 34.1 | 25,500 | 34.6 | 3734 | 30.9 | 62.96 | <0.001* |
As IV comorbidity, yes | 73,170 | 85.3 | 62,998 | 85.5 | 10172 | 84.2 | 13.57 | <0.001 |
Reason for closing treatment | 8.69 | 0.003* | ||||||
Drop out client | 23,055 | 26.9 | 19,675 | 26.7 | 3380 | 28.0 | ||
In collaboration | 62,699 | 73.1 | 54,002 | 73.3 | 8697 | 72.0 |
Return to mental health care
Duration of treatment and its association with demographics and clinical variables
Univariate | Multivariate | |||||
---|---|---|---|---|---|---|
OR | 95 % CI |
p
| OR | 95 % CI |
p
| |
Determinants | ||||||
Female (ref: male) | ||||||
Total group | 1.08 | 1.05–1.12 | <0.001* | 1.08 | 1.05–1.11 | <0.001* |
Psychotherapy only | 1.13 | 1.08–1.18 | <0.001* | 1.13 | 1.08–1.18 | <0.001* |
Medication only | 1.24 | 1.14–1.34 | <0.001* | 1.23 | 1.14–1.34 | <0.001* |
Psychotherapy and medication | 1.11 | 1.05–1.18 | <0.001* | 1.10 | 1.04–1.17 | 0.002* |
Other therapy only | 1.22 | 1.14–1.31 | <0.001* | 1.21 | 1.12–1.30 | <0.001* |
Age (ref: >65) | ||||||
Total group | ||||||
18–45 | 1.46 | 1.39–1.53 | <0.001* | 1.52 | 1.45–1.60 | <0.001* |
46–65 | 1.36 | 1.29–1.42 | <0.001* | 1.37 | 1.30–1.44 | <0.001* |
Psychotherapy only | ||||||
18–45 | 1.74 | 1.61–1.89 | <0.001* | 1.84 | 1.69–1.99 | <0.001* |
46–65 | 1.60 | 1.48–1.74 | <0.001* | 1.61 | 1.48–1.76 | <0.001* |
Medication only | ||||||
18–45 | 1.61 | 1.41–1.84 | <0.001* | 1.47 | 1.28–1.69 | <0.001* |
46–65 | 1.37 | 1.19–1.57 | <0.001* | 1.30 | 1.13–1.49 | <0.001* |
Psychotherapy and medication | ||||||
18–45 | 1.41 | 1.29–1.536 | <0.001* | 1.37 | 1.24–1.51 | <0.001* |
46–65 | 1.24 | 1.12–1.37 | <0.001* | 1.19 | 1.08–1.32 | 0.001* |
Other therapy only | ||||||
18–45 | 1.42 | 1.26–1.60 | <0.001* | 1.51 | 1.32–1.71 | <0.001* |
46–65 | 1.28 | 1.13–1.46 | <0.001* | 1.34 | 1.17–1.52 | <0.001* |
GAF score 6–10a (start) (ref: 1–5) | ||||||
Total group | 1.02 | 0.98–1.05 | 0.32 | – | – | – |
Psychotherapy only | 1.04 | 0.98–1.09 | 0.18 | – | – | – |
Medication only | 1.33 | 1.22–1.45 | <0.001* | 1.34 | 1.23–1.47 | <0.001* |
Psychotherapy and medication | 1.14 | 1.07–1.21 | <0.001* | 1.14 | 1.07–1.22 | <0.001* |
Other therapy only | 1.33 | 1.23–1.44 | <0.001* | 1.32 | 1.21–1.43 | <0.001* |
Comorbidity Axis I (ref: no) | ||||||
Total group | 1.54 | 1.49–1.59 | <0.001* | 1.59 | 1.54–1.64 | <0.001* |
Psychotherapy only | 1.45 | 1.38–1.51 | <0.001* | 1.53 | 1.46–1.60 | <0.001* |
Medication only | 1.95 | 1.79–2.13 | <0.001* | 1.85 | 1.70–2.03 | <0.001* |
Psychotherapy and medication | 1.50 | 1.40–1.61 | <0.001* | 1.48 | 1.38–1.59 | <0.001* |
Other therapy only | 1.57 | 1.46–1.69 | <0.001* | 1.64 | 1.51–1.79 | <0.001* |
Comorbidity Axis II (ref: no) | ||||||
Total group | 1.18 | 1.13–1.23 | 0.03 | 1.33 | 1.27–1.39 | <0.001* |
Psychotherapy only | 1.26 | 1.18–1.35 | <0.001* | 1.43 | 1.33–1.53 | <0.001* |
Medication only | 0.86 | 0.75–0.97 | 0.02 | – | – | – |
Psychotherapy and medication | 0.92 | 0.84–1.004 | 0.06 | – | – | – |
Other therapy only | 1.16 | 1.03–1.30 | 0.02* | 1.34 | 1.18–1.51 | <0.001* |
Comorbidity Axis III (ref: no) | ||||||
Total group | 1.10 | 1.07–1.13 | <0.001* | 1.13 | 1.10–1.17 | <0.001* |
Psychotherapy only | 1.06 | 1.02–1.11 | 0.008* | 1.12 | 1.07–1.17 | <0.001* |
Medication only | 1.07 | 0.99–1.16 | 0.09 | – | – | – |
Psychotherapy and medication | 0.94 | 0.89–1.001 | 0.05 | – | – | – |
Other therapy only | 1.08 | 1.001–1.16 | 0.05 | 1.14 | 1.06–1.24 | <0.001* |
Comorbidity Axis IV (ref: no) | ||||||
Total group | 1.70 | 1.64–1.77 | <0.001* | 1.66 | 1.60–1.73 | <0.001* |
Psychotherapy only | 1.53 | 1.44–1.62 | <0.001* | 1.50 | 1.41–1.60 | <0.001* |
Medication only | 2.30 | 2.05–2.86 | <0.001* | 2.13 | 1.89–2.40 | <0.001* |
Psychotherapy and medication | 1.91 | 1.76–2.07 | <0.001* | 1.84 | 1.69–1.99 | <0.001* |
Other therapy only | 1.39 | 1.27–1.52 | <0.001* | 1.43 | 1.30–1.57 | <0.001* |
Treatment closed in collaboration (ref: drop out of treatment) | ||||||
Total group | 1.65 | 1.60–1.71 | <0.001* | 1.79 | 1.73–1.84 | <0.001* |
Psychotherapy only | 1.86 | 1.77–1.95 | <0.001* | 1.99 | 1.89–2.09 | <0.001* |
Medication only | 1.03 | 0.95–1.11 | 0.54 | 1.13 | 1.04–1.23 | 0.004* |
Psychotherapy and medication | 1.63 | 1.52–1.74 | <0.001* | 1.71 | 1.60–1.83 | <0.001* |
Other therapy only | 1.58 | 1.47–1.770 | <0.001* | 1.70 | 1.58–1.84 | <0.001* |
Duration of different types of treatment and its association with demographics and clinical variables
Duration of treatment and its association with return into mental health care
Univariate | Multivariate | ||||||||
---|---|---|---|---|---|---|---|---|---|
HR | 95 % CI |
p
| HR | 95 % CI |
p
| HR | 95 % CI |
p
| |
Step 1 | Step 2 | ||||||||
Determinants | |||||||||
Female (ref: male) | |||||||||
Total group | 1.005 | 0.97–1.04 | 0.81 | – | – | – | – | – | – |
Psychotherapy only | 1.04 | 0.98–1.11 | 0.16 | – | – | – | – | – | – |
Medication only | 0.96 | 0.87–1.06 | 0.41 | – | – | – | – | – | – |
Psychotherapy and medication | 0.99 | 0.93–1.07 | 0.92 | – | – | – | – | – | – |
Other therapy only | 0.99 | 0.92–1.08 | 0.82 | – | – | – | – | – | – |
Age (ref: >65) | |||||||||
Total group | |||||||||
18–45 | 1.07 | 1.007–1.14 | 0.03 | 1.09 | 1.02–1.16 | 0.009 | 1.10 | 1.04–1.18 | 0.003* |
46–65 | 1.00 | 0.94–1.07 | 0.94 | 1.007 | 0.94–1.07 | 0.84 | 1.02 | 0.95–1.09 | 0.65 |
Psychotherapy only | |||||||||
18–45 | 0.96 | 0.86–1.06 | 0.22 | – | – | – | – | – | – |
46–65 | 0.94 | 0.82–1.02 | 0.40 | – | – | – | – | – | – |
Medication only | |||||||||
18–45 | 1.20 | 1.09–1.43 | 0.04 | 1.23 | 1.03–1.47 | 0.03 | 1.23 | 1.03–1.47 | 0.03 |
46–65 | 1.11 | 0.93–1.33 | 0.26 | 1.12 | 0.93–1.34 | 0.23 | 1.12 | 0.93–1.34 | 0.23 |
Psychotherapy and medication | |||||||||
18–45 | 1.29 | 1.14–1.46 | <0.001* | 1.23 | 1.08–1.40 | 0.002 | 1.23 | 1.08–1.40 | 0.002* |
46–65 | 1.12 | 0.98–1.28 | 0.10 | 1.08 | 0.95–1.25 | 0.25 | 1.08 | 0.95–1.247 | 0.25 |
Other therapy only | |||||||||
18–45 | 1.04 | 0.91–1.18 | 0.58 | – | – | – | – | – | – |
46–65 | 0.99 | 0.86–1.13 | 0.83 | – | – | – | – | – | – |
GAF score 6–10a (start) (ref: 1–5) | |||||||||
Total group | 0.81 | 0.78–0.84 | <0.001* | 0.80 | 0.76–0.82 | 0.000 | 0.78 | 0.75–0.82 | <0.001* |
Psychotherapy only | 0.82 | 0.77–0.88 | <0.001* | 0.78 | 0.73–0.84 | 0.000 | 0.78 | 0.73–0.84 | <0.001* |
Medication only | 0.87 | 0.79–0.98 | 0.02 | 0.86 | 0.77–0.95 | 0.005 | 0.86 | 0.77–0.95 | 0.005* |
Psychotherapy and medication | 0.85 | 0.79–0.91 | <0.001* | 0.86 | 0.80–0.92 | <0.001 | 0.86 | 0.80–0.92 | <0.001* |
Other therapy only | 0.76 | 0.70–0.82 | <0.001* | 0.71 | 0.65–0.78 | <0.001 | 0.73 | 0.67–0.80 | <0.001* |
Comorbidity Axis I (ref: no) | |||||||||
Total group | 0.45 | 0.43–0.47 | <0.001* | 0.41 | 0.39–0.43 | <0.001 | 0.42 | 0.40–0.44 | <0.001* |
Psychotherapy only | 0.46 | 0.42–0.50 | <0.001* | 0.42 | 0.39–0.45 | <0.001 | 0.43 | 0.39–0.46 | <0.001* |
Medication only | 0.46 | 0.40–0.53 | <0.001* | 0.43 | 0.37–0.50 | <0.001 | 0.43 | 0.37–0.50 | <0.001* |
Psychotherapy and medication | 0.52 | 0.47–0.57 | <0.001* | 0.46 | 0.42–0.50 | <0.001 | 0.46 | 0.42–0.50 | <0.001* |
Other therapy only | 0.36 | 0.32–0.41 | <0.001* | 0.35 | 0.31–0.39 | <0.001 | 0.36 | 0.32–0.41 | <0.001* |
Comorbidity Axis II (ref: no) | |||||||||
Total group | 0.58 | 0.54–0.62 | <0.001* | 0.47 | 0.44–0.51 | <0.001 | 0.47 | 0.44–0.51 | <0.001* |
Psychotherapy only | 0.57 | 0.50–0.64 | <0.001* | 0.46 | 0.41–0.52 | <0.001 | 0.46 | 0.41–0.52 | <0.001* |
Medication only | 0.62 | 0.51–0.76 | <0.001* | 0.52 | 0.42–0.63 | <0.001 | 0.52 | 0.42–0.63 | <0.001* |
Psychotherapy and medication | 0.54 | 0.47–0.62 | <0.001* | 0.44 | 0.39–0.51 | <0.001 | 0.44 | 0.39–0.51 | <0.001* |
Other therapy only | 0.63 | 0.53–0.74 | <0.001* | 0.51 | 0.43–0.61 | <0.001 | 0.52 | 0.44–0.61 | <0.001* |
Comorbidity Axis III (ref: no) | |||||||||
Total group | 0.86 | 0.83–0.97 | 0.001* | 0.89 | 0.85–0.92 | <0.001 | 0.89 | 0.86–0.93 | 0.02 |
Psychotherapy only | 0.91 | 0.86–0.97 | 0.005* | 0.91 | 0.86–0.97 | 0.005 | 0.92 | 0.86–0.98 | 0.007* |
Medication only | 0.81 | 0.73–0.90 | <0.001* | 0.86 | 0.77–0.95 | <0.001 | 0.86 | 0.77–0.95 | <0.001* |
Psychotherapy and medication | 0.78 | 0.73–0.85 | 0.001* | 0.83 | 0.77–0.90 | <0.001 | 0.83 | 0.77–0.90 | <0.001* |
Other therapy only | 0.88 | 0.81–0.96 | 0.002* | 0.0.91 | 0.83–0.99 | <0.001 | 0.0.91 | 0.83–0.98 | <0.001* |
Comorbidity Axis IV (ref: no) | |||||||||
Total group | 0.92 | 0.88–1.06 | 0.37 | – | – | – | – | – | – |
Psychotherapy only | 0.99 | 0.92–1.09 | 0.99 | – | – | – | – | – | – |
Medication only | 0.86 | 0.75–0.98 | 0.02 | – | – | – | – | – | – |
Psychotherapy and medication | 1.06 | 0.96–1.18 | 0.27 | 1.13 | 1.02–1.26 | 0.02 | 1.13 | 1.02–1.26 | 0.02 |
Other therapy only | 0.79 | 0.72–0.86 | <0.001* | 0.85 | 0.77–0.93 | 0.02 | 0.87 | 0.79–0.95 | 0.003* |
Treatment closed in collaboration (ref: drop out of treatment) | |||||||||
Total group | 0.94 | 0.91–0.98 | 0.004* | 0.93 | 0.89–0.96 | <0.001 | 0.94 | 0.90–0.98 | <0.001* |
Psychotherapy only | 0.96 | 0.90–1.03 | 0.22 | – | – | – | – | – | – |
Medication only | 1.05 | 0.94–1.16 | 0.40 | – | . | – | – | – | – |
Psychotherapy and medication | 0.83 | 0.77–0.90 | <0.001* | 0.83 | 0.77–0.90 | <0.001 | 0.83 | 0.77–0.90 | <0.001* |
Other therapy only | 1.04 | 0.96–0.1.13 | 0.35 | – | – | – | – | – | – |
Duration treatment (ref: >1000 min) | |||||||||
Total group | |||||||||
5–250 min | 1.34 | 1.27–1.41 | <0.001* | 1.19 | 1.13–1.26 | <0.001* | |||
251–500 min | 1.21 | 1.16–1.28 | <0.001* | 1.11 | 1.06–1.17 | <0.001* | |||
501–750 min | 1.11 | 1.05–1.18 | <0.001* | 1.04 | 0.99–1.10 | 0.14 | |||
751–1000 min | 1.24 | 1.17–1.31 | <0.001* | 1.18 | 1.11–1.25 | <0.001* | |||
Psychotherapy only | |||||||||
5–250 min | 1.43 | 1.30–1.57 | <0.001* | 1.26 | 1.15–1.39 | <0.001* | |||
251–500 min | 1.25 | 1.15–1.35 | <0.001* | 1.14 | 1.05–1.24 | 0.001 | |||
501–750 min | 1.09 | 1.09–1.19 | 0.05 | 1.006 | 0.92–1.10 | 0.89 | |||
751–1000 min | 1.33 | 1.33–1.45 | <0.001* | 1.24 | 1.14–1.36 | <0.001* | |||
Medication only | |||||||||
5–250 min | 1.14 | 0.99–1.31 | 0.08 | 1.02 | 0.88–1.18 | 0.75 | |||
251–500 min | 1.13 | 0.98–1.30 | 0.10 | 1.00 | 0.87–1.15 | 0.99 | |||
501–750 min | 1.30 | 1.11–1.51 | 0.001* | 1.21 | 1.04–1.41 | 0.02 | |||
751–1000 min | 1.16 | 0.98–1.38 | 0.09 | 1.12 | 0.94–1.33 | 0.20 | |||
Psychotherapy and medication | |||||||||
5–250 min | 0.87 | 0.73–1.04 | 0.12 | 0.81 | 0.68–0.96 | 0.02 | |||
251–500 min | 1.11 | 0.99–1.23 | 0.07 | 1.04 | 0.93–1.16 | 0.47 | |||
501–750 min | 1.06 | 0.95–1.18 | 0.31 | 1.004 | 0.90–1.12 | 0.95 | |||
751–1000 min | 1.32 | 1.19–1.45 | <0.001* | 1.26 | 1.13–1.39 | <0.001* | |||
Other therapy only | |||||||||
5–250 min | 1.90 | 1.68–2.16 | <0.001* | 1.67 | 1.47–1.89 | <0.001* | |||
251–500 min | 1.66 | 1.47–1.88 | <0.001* | 1.53 | 1.34–1.73 | <0.001* | |||
501–750 min | 1.50 | 1.30–1.72 | <0.001* | 1.43 | 1.24–1.64 | <0.001* | |||
751–1000 min | 1.27 | 1.07–1.50 | 0.006* | 1.26 | 1.06–1.49 | 0.008* |