Inequalities in unmet mental healthcare needs in emerging adulthood: A survey-registry linked study

Background

Anxiety and depression are common in emerging adulthood with consequences for everyday life and future prospects. Equality in access to care is thus important. This study explores social inequalities in estimated unmet care needs tied to anxiety and depression.

Methods

The study analyses 3336 individuals from the Swedish Futura01 cohort born in 2001. Occurrence of anxiety and depression was measured in the 2024 survey (at age 23) by screening tools (GAD-7≥10 and/or PHQ-8≥10). Mental healthcare use was identified in linked registry data during 12 months post-survey as diagnoses in specialized care (ICD-10: F32, F33, F34.1 & F40-F44) and/or psychotropic medication (ATC: N05, N06A). Unmet care needs were estimated as occurrence without subsequent care use. Information on social group came from registers, i.e. parental education, family occupational class, family income, country of birth, type of residential area and sex. Unadjusted and fully adjusted logistic regression models were computed.

Results

While inequalities were present in occurrence, there were few differences in healthcare use (with less care use among foreign-born and males). Hence, estimated unmet care needs were socially patterned by parental education (upper sec≤2y vs tertiary≥3y: OR 1.77, CI 1.41-2.22); occupational class (manual vs higher non-manual: OR 1.49, CI 1.22-1.82); family income (3rd vs 1st quartile: OR 1.49, CI 1.17-1.88; 4th vs 1st quartile: OR 1.89, CI 1.49-2.39); country of birth (foreign- vs Swedish-born: OR 1.89, CI 1.44-2.49; foreign-born parents vs Swedish born: OR 1.80, CI 1.38-2.34); and sex (women vs men: OR 1.54, CI 1.30-1.82). In the full model, the patterning remained but residential area (small town vs large city: OR 0.73, CI 0.57-0.93) reached statistical significance while occupational class became insignificant.

Conclusions

The estimated unmet care needs tied to anxiety and depression showed clear social gradients, indicating inequalities in access to care.

Key messages

• The estimated unmet healthcare needs for anxiety and depression were unequally distributed between social groups in emerging adulthood.

• The results from this survey-registry linked Swedish cohort study indicate social inequalities in access to mental healthcare among young adults.