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June 14, 2026Open Access

Regional variation in healthcare utilization among patients with depression in Germany: a multilevel analysis with PopGrouper-based multimorbidity adjustment

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Authors

AKAnika KreutzbergCTChrissa TsatsaronisWQWilm Quentin

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Overview

Multilevel analysis demonstrates links between regional deprivation and healthcare access for depression.

Key Points

  • This analysis aims to explore how regional socioeconomic deprivation and urbanization affect healthcare utilization among adults with depression in Germany, accounting for multimorbidity.
  • Analyzed nationwide claims data from a large German sickness fund, involving 1,083,319 adults with depression.
  • Utilized multilevel regression models with individuals nested within 96 spatial planning regions.
  • Measured healthcare utilization through costs, days of sickness absence, outpatient mental health specialist contacts, and outpatient psychotherapy use.
  • Higher regional socioeconomic deprivation correlates with increased sickness absence (34.1 days in least deprived vs. 40.1 days in most deprived).
  • Lower likelihood of receiving outpatient psychotherapy in more deprived regions (17.9% vs. 16.3%).
  • Urban areas show higher healthcare costs (2,284€ vs. 2,188€) and more mental health specialist contacts (15.6% vs. 13.5%).

Cite This Study

Kreutzberg et al. (2026) studied this question.

synapsesocial.com/papers/6a2e482cb1cc60ccdea8c727https://doi.org/10.15495/epub_ubt_00009407
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Regional variation in healthcare utilization among patients with depression in Germany: a multilevel analysis with PopGrouper-based multimorbidity adjustment2026
  2. 2Income, Educational Level, and Depressive Symptoms in a Time of Multiple Crises: Trends Revealed by High-Frequency Mental Health Surveillance in Germany, 2019–2024.2025
  3. 3Impact of Depression on Health Care Utilization and Costs among Multimorbid Patients – Results from the MultiCare Cohort Study2014 · 122 citations
  4. 4Depression or Anxiety by Region, Small-Area Deprivation, and Health Care Level in Sweden2026
  5. 5Clinical and societal burden of incident major depressive disorder: A population‐wide cohort study in Stockholm2022 · 23 citations