Evidence map›Paper›PMID 41291652›Full record

ArticleBMC health services research2025

Quantifying age-related disparities in outpatient psychotherapy utilization: a representation quotient analysis of routine data from 29 university clinics in Germany.

Nicolas Wrede, Marlena L Itz, Anne Katrin Risch, Hanna Christiansen, Tina In-Albon, Jürgen Hoyer, Tania M Lincoln, Wolfgang Lutz, Jürgen Margraf, Julian Rubel and 32 more

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Article in BMC health services research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1citing papers in PubMed
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1 · What the graph read from it

What it found

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3 · Its place in the literature

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1 citing paper in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

42 authors.

Nicolas Wrede *Department of Counseling and Clinical Intervention, Friedrich Schiller University Jena, Institute of Psychology, Humboldtstraße 11, 07743, Jena, Germany. nicolas.wrede@uni-jena.de.ORCID http://orcid.org/0000-0002-1806-9589
Marlena L Itz *Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, University Hospital Jena, Jena, Germany.ORCID http://orcid.org/0000-0002-1247-0099
Anne Katrin RischDepartment of Counseling and Clinical Intervention, Friedrich Schiller University Jena, Institute of Psychology, Humboldtstraße 11, 07743, Jena, Germany.
Hanna ChristiansenClinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany.ORCID http://orcid.org/0000-0002-8104-0711
Tina In-AlbonClinical Child and Adolescent Psychology and Psychotherapy, University of Mannheim, Mannheim, Germany.ORCID http://orcid.org/0000-0002-2070-8458
Jürgen HoyerClinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.ORCID http://orcid.org/0000-0002-1697-6732
Tania M LincolnClinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany.ORCID http://orcid.org/0000-0002-6674-2440
Wolfgang LutzClinical Psychology and Psychotherapy, Department of Psychology, Trier University, Trier, Germany.ORCID http://orcid.org/0000-0002-5141-3847
Jürgen MargrafGerman Center for Mental Health (DZPG), Partner Site, Bochum/Marburg, Germany.ORCID http://orcid.org/0000-0001-5207-7016
Julian RubelPsychotherapy Research & Clinical Psychology, Department of Psychology, Osnabrück University, Osnabrück, Germany.ORCID http://orcid.org/0000-0002-9625-6611
Rudolf StarkPsychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany.ORCID http://orcid.org/0000-0003-4299-5280
Julia VeltenMental Health Research and Treatment Center, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany.ORCID http://orcid.org/0000-0002-6822-767X
Katja WerheidClinical Neuropsychology & Psychotherapy, Bielefeld University, Bielefeld, Germany.ORCID http://orcid.org/0000-0001-8087-5752
Ulrike WillutzkiClinical Psychology and Psychotherapy, Department of Psychology and Psychotherapy, University Witten/Herdecke, Witten/Herdecke, Germany.ORCID http://orcid.org/0000-0002-0149-4554
Georg W AlpersDepartment of Psychology, School of Social Sciences and Otto Selz Institute, University of Mannheim, Mannheim, Germany.ORCID http://orcid.org/0000-0001-9896-5158
Stephan BartholdyDepartment of Psychology, Clinical Psychology and Psychotherapy, University Greifswald, Greifswald, Germany.ORCID http://orcid.org/0000-0002-1532-410X
Elisa-Maria BergerOutpatient Department of Psychotherapy, Johannes Gutenberg-University, Mainz, Germany.
Eva-Lotta BrakemeierDepartment of Psychology, Clinical Psychology and Psychotherapy, University Greifswald, Greifswald, Germany.ORCID http://orcid.org/0000-0001-9589-3697
Monika EquitDepartment of Clinical Psychology and Psychotherapy, Saarland University, Saarbrücken, Germany.ORCID http://orcid.org/0000-0002-7213-5962
Lydia FehmDepartment of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.ORCID http://orcid.org/0000-0002-0825-8466
Thomas ForkmannDepartment of Clinical Psychology and Psychotherapy, University of Duisburg-Essen, Duisburg/Essen, Germany.ORCID http://orcid.org/0000-0001-9942-2016
Jessica FritzPsychotherapy Research & Clinical Psychology, Department of Psychology, Osnabrück University, Osnabrück, Germany.ORCID http://orcid.org/0000-0002-6342-0892
Julia GlombiewskiClinical Psychology and Psychotherapy, University of Kaiserslautern-Landau, Kaiserslautern-Landau, Germany.ORCID http://orcid.org/0000-0001-8037-398X
Jens HeiderClinical Psychology and Psychotherapy, University of Kaiserslautern-Landau, Kaiserslautern-Landau, Germany.
Sylvia Helbig-LangPsychotherapie Ausbildung Hamburg, Universität Hamburg, Hamburg, Germany.
Andrea HermannPsychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany.ORCID http://orcid.org/0000-0003-3186-7777
Christiane HermannClinical Psychology and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany.ORCID http://orcid.org/0000-0001-5969-2898
Anke KirschTraining Institute for Psychotherapy, Saarbrücken, Germany.
Tim KluckenDepartment of Clinical Psychology and Psychotherapy, University of Siegen, Institute of Psychology, Siegen, Germany.ORCID http://orcid.org/0000-0003-2433-6652
Ulrike LuekenDepartment of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.ORCID http://orcid.org/0000-0003-1564-4012
Patrizia OdyniecClinical Psychology and Psychotherapy, Department of Psychology and Psychotherapy, University Witten/Herdecke, Witten/Herdecke, Germany.ORCID http://orcid.org/0000-0002-9444-7473
Anya PedersenDepartment of Clinical Psychology and Psychotherapy, Cristian-Albrechts-University Kiel, Kiel, Germany.ORCID http://orcid.org/0000-0002-5346-4234
Andre PittigTranslational Psychotherapy, Institute of Psychology, University of Göttingen, Göttingen, Germany.ORCID http://orcid.org/0000-0003-3787-9576
Babette RennebergClinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany.ORCID http://orcid.org/0000-0003-2177-3566
Anja RieselClinical Psychology and Neuroscience, Universität Hamburg, Hamburg, Germany.ORCID http://orcid.org/0000-0002-1902-6644
Almut RudolphClinical Psychology and Psychotherapy, Department of Psychology, University of Leipzig, Leipzig, Germany.ORCID http://orcid.org/0000-0002-2887-7168
Brian SchwartzClinical Psychology and Psychotherapy, Department of Psychology, Trier University, Trier, Germany.ORCID http://orcid.org/0000-0003-4695-4953
Tobias TeismannMental Health Research and Treatment Center, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany.ORCID http://orcid.org/0000-0002-6498-7356
Antonia VehlenClinical Psychology and Psychotherapy, Department of Psychology, Trier University, Trier, Germany.ORCID http://orcid.org/0000-0002-6019-3161
Michael WitthöftDepartment of Clinical Psychology and Psychotherapy, Ruhr University Bochum, Bochum, Germany.ORCID http://orcid.org/0000-0002-4928-4222
Marcella L WoudClinical Psychology and Experimental Psychopathology, University of Göttingen, Göttingen, Germany.ORCID http://orcid.org/0000-0002-4974-505X
Gabriele WilzDepartment of Counseling and Clinical Intervention, Friedrich Schiller University Jena, Institute of Psychology, Humboldtstraße 11, 07743, Jena, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAlthough mental disorders are highly prevalent among older adults, evidence suggests that they underutilize psychotherapy. However, formal estimates of their actual representation in routine clinical settings are scarce. This study applied a representation quotient approach to identify and quantify age-related disparities in outpatient psychotherapy utilization in Germany.

methodsWe analyzed data from 13,635 adult patients who initiated cognitive-behavioral therapy between 2018 and 2023 at 29 university outpatient clinics. Using a representation quotient approach, we compared the observed proportions of young-old adults (65-74 years) and old-old adults (≥75 years) with prevalence-stratified population age distributions. The robustness of the results was investigated by extensive sensitivity analyses, including alternative prevalence assumptions and adjustments for long-term care needs.

resultsEven under conservative assumptions, young-old adults only accounted for about 25% and old-old adults for about 13% of their expected proportion. In contrast, young working-age adults (18-34 years) were particularly overrepresented in the sample. Underrepresentation of older adults was most pronounced among patients with post-traumatic stress disorder, eating disorders, and dysthymia, less pronounced among patients with generalized anxiety disorder, and not significant among patients with pain disorders.

conclusionThis study demonstrates the utility of representation quotients for systematically identifying and quantifying age-related disparities in psychotherapy utilization based on routine care data. Our analyses of large-scale data from university outpatient clinics in Germany revealed a marked underrepresentation of older adults in this setting. These findings highlight the need to improve access to, and utilization of, psychotherapeutic services for older adults.

Indexed as

Ambulatory CareCognitive Behavioral TherapyHealthcare DisparitiesMental DisordersPatient Acceptance of Health CarePsychotherapyAdolescentAdultAgedAged, 80 and overAge FactorsFemaleGermanyHumansMaleMiddle AgedAccess barriersAge disparitiesMental health servicesOlder adultsPsychotherapy utilizationRepresentation quotient

Identifiers

PMID41291652
PMCPMC12670761

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