Disuguaglianze socio-economiche e utilizzazione dei servizi psichiatrici. Uno studio multicentrico italiano.

Introduction: Previous studies conducted in a community-based psychiatric service showed an inverse association between socio-economic status (SES) and services utilization for some group of patients. In general, literature reported evidence for an association between SES and both objective and subjective mental health outcomes and there is a need for a greater understanding of the factors related with psychiatric services utilization to improve allocation of economic resources. Objectives: The main aim of this study was to assess how the utilization of community-based psychiatric services in Italy varies according to the SES of the area of residence, adjusted for spatial proximity and patients’ socio-demographic and clinical characteristics. Methods: All patients with ICD-10 psychiatric diagnosis, who had at least one contact between January and June 2009 with one of three Italian Psychiatric Units (Verona, Bollate-Milan, Avellino) were included (2,759 pts.). Services were described by using the International Classification of Mental Health and the European Service Mapping Schedule. Treated prevalence and incidence and indicators of inpatient, day-care, outpatient and domiciliary service utilization were calculated by considering all contacts occurred for each patient in a period of six months. An ecological socio-economic status index was calculated from nine census variables at census block (CB) level (336,788 CBs). Patients’ clinical and socio-demographic characteristics were collected by using questionnaires and Information Systems data; spatial proximity between patients and facilities locations were measured along the street network; residential area characteristics was described by land characteristics and public services supply. These variables were considered in multilevel regression models with Poisson distribution. Results: General treated prevalence and incidence significantly increased in the more deprived census blocks in Verona, but not in the other centers and differences among category of community services resulted: an inverse association between SES and day care prevalence and outpatient prevalence in Verona and in-patient prevalence in Milan emerged. In general, number of contacts was greater for those living in more affluent CBs and considering the overall sample, the models which included all individual and ecological variables were able to explain around 20% of the variance in utilization; however differences resulted for inpatient, day care, outpatient and domiciliary services and among the three Italian Psychiatric Units, which presented different characteristics and supply of services. Conclusion: Socio-economic status conditions alongside other patients’ characteristics may be used as proxy measures to make planners aware of the local needs and to organize and evaluate mental health services. Further research in this area will help to clarify what interventions are required to improve equality access to mental health services and to refine allocation of economic resources.