Browsing by Subject "lyhytpsykoterapia"

Objective: Untreated mental disorders result in notable costs to Finnish society, especially in the form of disability pensions. The delay of psychotherapy and psychiatric treatment has previously been associated with a higher risk of chronicity, poorer response to treatment and a higher number of recurrences. In Finland, a patient referred to psychotherapy is responsible for finding and choosing a psychotherapist that is suitable for them. Challenges in finding a psychotherapist can therefore lead to a delay of treatment. The aim of this study is to examine the following questions: 1) What is the association between guidance received by the patient when choosing a psychotherapist and the length of the delay associated with starting psychotherapy? 2) How are other factors related to the patient and the health care system associated with the delay of psychotherapy? The hypothesis for this study is that patients who receive more guidance when choosing a psychotherapist have shorter delays than patients who receive less or no guidance. Methods: The data used in this study are derived from the quality registry for psychotherapy, which is utilized by the Hospital District of Helsinki and Uusimaa (HUS) in order to monitor service voucher therapies from the first referral until the end of treatment. Guidance received by the patient was measured with one multiple choice question, in which patients picked the option that best corresponded with the method they used to choose their psychotherapist: 1) the psychotherapist was chosen independently with no guidance or with the help of a brochure, 2) the psychotherapist was chosen independently but with guidance from a health care professional regarding what kind of psychotherapist would suit the patient best (i.e. a specific approach or therapist specialization), 3) the psychotherapist was chosen together with a health care professional, 4) the psychotherapist was chosen for the patient by a health care professional. The subjects were divided into four groups based on the amount of guidance they received. Treatment delay was measured in days starting from the first referral to service voucher psychotherapy and ending at the starting date of treatment. Overall delay of psychotherapy was examined by fitting a Kaplan- Meier-curve to the entire data, as well as to each guidance group individually. The linear association between guidance and delay was examined by conducting a linear regression analysis. Associations between factors related to the patient or the health care system were assessed by conducting a stepwise multivariate regression analysis. Independent variables included in this analysis were guidance, patient age, sex, diagnosis, comorbidity, whether the patient was referred to psychotherapy from primary care or specialized care, and whether the patient was referred to short psychotherapy or long psychotherapy. Results and conclusions: Patients who received more guidance when choosing a psychotherapist had shorter delays than patients who received less or no guidance. The results of this study were in line with the hypothesis, with the exception that patients who chose their psychotherapist independently with no guidance, had shorter delays when compared to patients who chose their psychotherapist independently after receiving guidance from a health care professional. Higher age was found to be associated with shorter delays, as was belonging to the diagnosis group “bipolar disorder or schizophrenia”. Reported comorbidity and belonging to the diagnosis group “other” were associated with longer delays. Patients referred to short psychotherapy from specialized care had shorter delays than patients referred to long psychotherapy from specialized care or short psychotherapy from primary care. Overall, patients referred from specialized care had shorter delays than patients referred from primary care. The results show that by offering patients sufficient guidance when choosing a psychotherapist, delays associated with psychotherapy may be shortened and the unwanted consequences of treatment delay may be prevented. Further research is needed to identify factors associated with treatment delay and how patients referred to psychotherapy choose their psychotherapists.