{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T02:12:33Z","timestamp":1793931153451,"version":"4.8.0"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100006764","name":"Technische Universit\u00e4t Berlin","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006764","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Res Health Serv Reg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Depression is associated with a substantial health and economic burden and shows pronounced regional variation in Germany. While socioeconomic and urban\u2013rural differences in depression prevalence and service use are well documented, less is known about how regional socioeconomic deprivation and urbanization relate to healthcare utilization after accounting for multimorbidity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We analyzed nationwide claims data from a large German sickness fund including adults with diagnosed depression (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u20091,083,319). Healthcare utilization in 2023 was measured as healthcare costs, days of sickness absence, any outpatient mental health specialist contact, and outpatient psychotherapy use. Multilevel regression models with individuals nested within 96 spatial planning regions were estimated, adjusting for age, sex, and multimorbidity using the PopGrouper. Regional socioeconomic deprivation was measured using the German Index of Socioeconomic Deprivation, and urbanization was classified as urban, semi-urban, or rural. Proportional variance component analyses quantified explained regional heterogeneity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Higher regional socioeconomic deprivation was significantly associated with more days of sickness absence (adjusted mean: 34.1 days in the least vs. 40.1 days in the most deprived regions) and a lower likelihood of receiving outpatient psychotherapy (17.9% vs. 16.3%). No significant associations were observed between deprivation and healthcare costs or mental health specialist contacts. Urban regions were associated with higher healthcare costs (2,284\u20ac vs. 2,188\u20ac) and more frequent mental health specialist contacts (15.6% vs. 13.5%). Overall regional clustering was modest but most pronounced for mental health specialist contacts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Regional socioeconomic deprivation is linked to higher sickness absence due to depression. Regional inequalities in access to mental health services are small but largely unexplained by deprivation, urbanization, and multimorbidity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s43999-026-00092-6","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T07:55:27Z","timestamp":1780991727000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Regional variation in healthcare utilization among patients with depression in Germany: a multilevel analysis with PopGrouper-based multimorbidity adjustment"],"prefix":"10.1007","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9279-6509","authenticated-orcid":false,"given":"Anika","family":"Kreutzberg","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6537-075X","authenticated-orcid":false,"given":"Chrissa","family":"Tsatsaronis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1705-6524","authenticated-orcid":false,"given":"Wilm","family":"Quentin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4961-9130","authenticated-orcid":false,"given":"Reinhard","family":"Busse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"On behalf of the PopGroup consortium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"92_CR1","volume-title":"World mental health today: latest data","author":"WHO","year":"2025","unstructured":"WHO (2025) World mental health today: latest data. 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Versorgungsatlas","author":"M Erhart","year":"2012","unstructured":"Erhart M, von Stillfried D (2012) Analyse regionaler Unterschiede in der Pr\u00e4valenz und Versorgung depressiver St\u00f6rungen auf Basis vertrags\u00e4rztlicher Abrechnungsdaten \u2013 Teil 1 Pr\u00e4valenz. Versorgungsatlas. Zentralinstitut f\u00fcr die kassen\u00e4rztliche Versorgung in Deutschland, Berlin"},{"key":"92_CR4","volume-title":"Faktencheck Gesundheit. Regionale Unterschiede in der Gesundheitsversorgung","author":"H Melchior","year":"2014","unstructured":"Melchior H, Schulz H, H\u00e4rter M (2014) Faktencheck Gesundheit. Regionale Unterschiede in der Gesundheitsversorgung. 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Ethics approval was not required for the PopGroup project or this specific study. The analysis follows the ethical principles outlined in the German Good Practice in Secondary Data Analysis (GPS) guidelines and in the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors have no competing interests to declare that are relevant to the content of this article.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"8"}}