Does primary care level psychotherapy associate with later use of long-term psychotherapy – longitudinal register-based cohort study among Finnish occupationally active individuals

BACKGROUND: One key question for current psychotherapy research is how limited resources should be used efficiently to optimise treatment pathways. We examined how primary care level (PCL) psychotherapy, a history of mental disorder, and sociodemographic factors are associated with the later probability of receiving long-term rehabilitative psychotherapy. METHODS: This longitudinal observational cohort study based on a register data from the Gaps in Mental Health-Related Work Disability and Treatment Outcomes (GapMind) project, which combines data from national registers (Statistics Finland and the Social Insurance Institution of Finland) and the largest occupational health service (OHS) provider in Finland. The study population comprised Finnish occupationally active individuals aged 15-65 (N = 1,261,320). Data on the use of PCL psychotherapy in the OHS between 2019 and 2020 were combined with data on age, gender, socioeconomic status, education, history of mental disorders (including psychotropic medication purchases, sickness absences, pensions, and use of OHS due to mental disorders), and somatic disabling comorbidities and four-model logistic regression analyses were conducted. The primary outcome was the use of long-term psychotherapy during 2020-2022. RESULTS: Participation in PCL psychotherapy (OR 7.05-15.51) and a history of mental disorders (OR 1.67-4.25) were associated with a higher probability of receiving subsequently long-term rehabilitative psychotherapy. Higher age, female gender, and higher socioeconomic status were also associated with an elevated likelihood of engaging in long-term rehabilitative psychotherapy. CONCLUSIONS: Participation in PCL psychotherapy, and various clinical and sociodemographic factors were associated with an increased probability of receiving later long-term psychotherapy. These findings may support healthcare systems in leveraging this information to better anticipate the need for long-term psychotherapy.