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Med."],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:title>Abstract<\/jats:title>\n\t  <jats:sec id=\"S0033291725101694_sec1\">\n\t    <jats:title>Background<\/jats:title>\n\t    <jats:p>Despite growing healthcare coverage, disparities in access to and outcomes of psychiatric care persist, even in countries with universal healthcare. How socioeconomic status (SES), travel time, and social support individually and jointly affect psychiatric clinical trajectories remains largely unexplored.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S0033291725101694_sec2\" sec-type=\"methods\">\n\t    <jats:title>Methods<\/jats:title>\n\t    <jats:p>We analyze electronic health records (EHRs) from patients diagnosed with bipolar disorder, major depressive disorder, or schizophrenia at Cl\u00ednica San Juan de Dios Manizales. Using zero-inflated and standard negative binomial regression, we quantify the effects of SES, travel time, and family\/social support on utilization, clinical outcomes, and symptoms of mania, psychosis, and suicidality. A mixed-effects model examines how care-seeking patterns affect visit-to-visit variability in outcomes.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S0033291725101694_sec3\" sec-type=\"results\">\n\t    <jats:title>Results<\/jats:title>\n\t    <jats:p>Among 21,095 patients, utilization is lower for those with low SES (rate ratio [RR] 0.92, 95% CI: 0.90\u20130.95, <jats:italic>p<\/jats:italic>\u00a0=\u00a01.27e\u221210) and longer travel times (RR 0.94, 95% CI: 0.93\u20130.95, <jats:italic>p<\/jats:italic>\u00a0=\u00a01.19e\u221253). Patients with low SES are more likely to have severe symptoms (e.g., delusions: RR 1.28, 95% CI: 1.20\u20131.37, <jats:italic>p<\/jats:italic>\u00a0=\u00a02.57e\u221215) and require hospitalization (RR 1.10, 95% CI: 1.05\u20131.15, <jats:italic>p<\/jats:italic>\u00a0=\u00a01.94e\u221204), suggesting they primarily seek care when critical. Longer travel differentially affects those with low SES. However, the relationship between SES and adverse outcomes is less pronounced when living with family (e.g., hospitalizations: LRT, <jats:italic>\u03c7<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a047.08, df\u00a0=\u00a03, <jats:italic>p<\/jats:italic>\u00a0=\u00a03.35e\u221210). Frequent outpatient care is associated with lower odds of hospitalization, suicidality, and other symptoms.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S0033291725101694_sec4\" sec-type=\"conclusions\">\n\t    <jats:title>Conclusions<\/jats:title>\n\t    <jats:p>Findings demonstrate use of EHRs to model patient outcomes, the important role of social support, and need for improved healthcare accessibility.<\/jats:p>\n\t  <\/jats:sec>","DOI":"10.1017\/s0033291725101694","type":"journal-article","created":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T10:25:46Z","timestamp":1760351146000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":4,"title":["Socioeconomic and geographic disparities in psychiatric outcomes under Colombia\u2019s universal healthcare system"],"prefix":"10.1017","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-8348-8550","authenticated-orcid":false,"given":"Greta","family":"Gerdes","sequence":"first","affiliation":[{"name":"University of California Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Song","sequence":"additional","affiliation":[{"name":"University of California Los Angeles"},{"name":"Northwestern University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan K.","family":"Service","sequence":"additional","affiliation":[{"name":"University of California Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3853-436X","authenticated-orcid":false,"given":"Ana M.","family":"Ramirez-Diaz","sequence":"additional","affiliation":[{"name":"University of California Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana M.","family":"Diaz-Zuluaga","sequence":"additional","affiliation":[{"name":"University of California Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Arias","sequence":"additional","affiliation":[{"name":"University of Antioqu\u00eda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1071-6307","authenticated-orcid":false,"given":"Mauricio","family":"Casta\u00f1o-Ramirez","sequence":"additional","affiliation":[{"name":"Universidad de Caldas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas A.","family":"Crossley","sequence":"additional","affiliation":[{"name":"University of Antioqu\u00eda"},{"name":"University of Oxford"},{"name":"Pontificia Universidad Cat\u00f3lica de Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Lopez-Jaramillo","sequence":"additional","affiliation":[{"name":"University of Antioqu\u00eda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelson B.","family":"Freimer","sequence":"additional","affiliation":[{"name":"University of California Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3327-7837","authenticated-orcid":false,"given":"Loes M.","family":"Olde Loohuis","sequence":"additional","affiliation":[{"name":"University of California Los Angeles"},{"name":"University of California Los Angeles"},{"name":"University of California Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2025,10,13]]},"reference":[{"key":"S0033291725101694_r44","first-page":"e165","article-title":"Mental health in the Americas: An overview of the treatment gap","volume":"42","author":"Kohn","year":"2018","journal-title":"Revista Panamericana de Salud Publica = Pan American Journal of Public Health"},{"key":"S0033291725101694_r72","doi-asserted-by":"publisher","DOI":"10.1038\/s43856-024-00441-x"},{"key":"S0033291725101694_r21","doi-asserted-by":"publisher","DOI":"10.1037\/0278-6133.23.2.207"},{"key":"S0033291725101694_r80","volume-title":"). 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