{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T13:24:45Z","timestamp":1792416285290,"version":"4.4.0"},"reference-count":50,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T00:00:00Z","timestamp":1765497600000},"content-version":"unspecified","delay-in-days":345,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Epidemiol Psychiatr Sci"],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S2045796025100309_sec1a\">\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>In England, psychological therapies provided in primary care are recommended as first-line treatment for people living with mild-to-moderate dementia experiencing depression or anxiety. It is known that people living with dementia experience more barriers to accessing therapy than people without dementia, but such inequalities in terms of rates of access to primary care services are yet to be characterised.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2045796025100309_sec2b\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective, observational study of linked electronic healthcare records, the national database of the National Health Service (NHS) Talking Therapies for anxiety and depression programme was used to compare pathways to accessing therapy between 6623 people living with dementia and 4 825 489 without dementia between 2012 and 2019. Outcomes included access to an assessment, to therapy and reasons for discharge. Primary analyses used a propensity-score matched cohort to compare outcomes. Exact matching was used for the NHS service entity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2045796025100309_sec3c\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The prevalence of dementia in the study cohort was lower than the prevalence of dementia in a representative population, based on an estimation of prevalence in people with mild-to-moderate age over 35 (0.23% in our study vs 3.82% in previous research). Compared to people without dementia, people living with dementia were less likely to access an assessment (odds ratio [OR] = 0.60; 95% confidence interval [CI]: 0.55\u20130.65), to subsequently receive therapy (OR =\u00a00.67; 95% CI: 0.61\u20130.73) and more likely to be discharged because services were deemed not suitable before having an assessment (relative rate ratio [RRR]\u00a0=\u00a04.90; 95% CI: 4.20\u20135.72) and starting therapy (RRR\u00a0=\u00a02.74; 95% CI: 2.24\u20133.35). Female gender, social deprivation, Asian ethnicity and less common dementia subtypes (such as frontotemporal dementia) were also associated with poorer access rates and a higher likelihood of services being deemed not suitable. Involvement of care partners in the referral process was associated with better access rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2045796025100309_sec4d\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Pathways to accessing primary care psychological therapy services must be made more accessible for people living with dementia. Better access could be achieved by increasing referrer awareness and training for staff within services to promote access for people living with dementia (especially for groups under-represented in services), better understanding how to involve care partners in the process, as well as when specialist support might be more suited in secondary care. More granularity in the medical coding of rarer dementia diagnoses in electronic health records would also allow for better statistically powered research for these groups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/s2045796025100309","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T06:17:01Z","timestamp":1765520221000},"source":"Crossref","is-referenced-by-count":2,"title":["Characterising inequalities in accessing primary care psychological therapies services for people living with dementia: the example of NHS talking therapies in England"],"prefix":"10.1017","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7212-1835","authenticated-orcid":false,"given":"Celine","family":"El Baou","sequence":"first","affiliation":[{"name":"UCL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rob","family":"Saunders","sequence":"additional","affiliation":[{"name":"UCL"},{"name":"UCL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2281-0907","authenticated-orcid":false,"given":"Joshua Eusty Jonathan","family":"Buckman","sequence":"additional","affiliation":[{"name":"UCL"},{"name":"Camden & Islington NHS Foundation Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Richards","sequence":"additional","affiliation":[{"name":"UCL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Cooper","sequence":"additional","affiliation":[{"name":"Queen Mary University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Marchant","sequence":"additional","affiliation":[{"name":"UCL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roopal","family":"Desai","sequence":"additional","affiliation":[{"name":"UCL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgia","family":"Bell","sequence":"additional","affiliation":[{"name":"UCL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Fearn","sequence":"additional","affiliation":[{"name":"UCL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Pilling","sequence":"additional","affiliation":[{"name":"UCL"},{"name":"Camden & Islington NHS Foundation Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikki","family":"Zimmermann","sequence":"additional","affiliation":[{"name":"UCL Queen Square Institute of Neurology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie","family":"Mansfield","sequence":"additional","affiliation":[{"name":"UCL Queen Square Institute of Neurology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Crutch","sequence":"additional","affiliation":[{"name":"UCL Queen Square Institute of Neurology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilie V.","family":"Brotherhood","sequence":"additional","affiliation":[{"name":"UCL Queen Square Institute of Neurology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amber","family":"John","sequence":"additional","affiliation":[{"name":"UCL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Stott","sequence":"additional","affiliation":[{"name":"UCL"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2025,12,12]]},"reference":[{"key":"S2045796025100309_ref18","first-page":"30","article-title":"World alzheimer report 2021: Journey through the diagnosis of dementia","volume":"2022","author":"Gauthier","year":"2021","journal-title":"Alzheimer\u2019s Disease International"},{"key":"S2045796025100309_ref17","doi-asserted-by":"publisher","DOI":"10.1002\/alz.14332"},{"key":"S2045796025100309_ref4","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001885"},{"key":"S2045796025100309_ref19","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(21)00395-3"},{"key":"S2045796025100309_ref33","doi-asserted-by":"publisher","DOI":"10.1002\/gps.4502"},{"key":"S2045796025100309_ref37","doi-asserted-by":"publisher","DOI":"10.1017\/S1754470X20000306"},{"key":"S2045796025100309_ref40","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2012.11.007"},{"key":"S2045796025100309_ref43","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-021-03661-w"},{"key":"S2045796025100309_ref47","doi-asserted-by":"publisher","DOI":"10.1111\/resp.12312"},{"key":"S2045796025100309_ref16","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(23)00291-2"},{"key":"S2045796025100309_ref28","doi-asserted-by":"publisher","DOI":"10.1002\/gps.5556"},{"key":"S2045796025100309_ref29","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-018-21243-x"},{"key":"S2045796025100309_ref36","unstructured":"NICE, (2018) Dementia: assessment, management and support for people living with dementia and their carers. https:\/\/www.nice.org.uk\/guidance\/ng97 (accessed 5 December 2025 )."},{"key":"S2045796025100309_ref41","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2021.06.084"},{"key":"S2045796025100309_ref20","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18020686"},{"key":"S2045796025100309_ref22","doi-asserted-by":"publisher","DOI":"10.1016\/j.maturitas.2016.07.019"},{"key":"S2045796025100309_ref27","doi-asserted-by":"publisher","DOI":"10.3928\/0048-5713-20020901-06"},{"key":"S2045796025100309_ref9","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291721004773"},{"key":"S2045796025100309_ref12","first-page":"393","article-title":"Inequalities in receipt of mental and physical healthcare in people with dementia in the UK","volume":"46","author":"Cooper","year":"2016","journal-title":"Age and Ageing"},{"key":"S2045796025100309_ref10","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-clinpsy-050817-084833"},{"key":"S2045796025100309_ref34","unstructured":"National Collaborating Centre for Mental Health (2025) NHS talking therapies for anxiety and depression manual."},{"key":"S2045796025100309_ref25","unstructured":"Improving Access to Psychological Therapies Dataset Nhs Digital 2021b. [Online]. Available: https:\/\/digital.nhs.uk\/data-and-information\/data-collections-and-data-sets\/data-sets\/improving-access-to-psychological-therapies-data-set (accessed 20 October 2025 )."},{"key":"S2045796025100309_ref2","doi-asserted-by":"publisher","DOI":"10.1002\/gps.5074"},{"key":"S2045796025100309_ref24","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.12792"},{"key":"S2045796025100309_ref13","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-015-0329-3"},{"key":"S2045796025100309_ref8","doi-asserted-by":"publisher","DOI":"10.1017\/S2045796021000342"},{"key":"S2045796025100309_ref5","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-020290"},{"key":"S2045796025100309_ref15","unstructured":"Dementia Fact Sheet World Health Organisation 2023. [Online]. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/dementia (accessed 5 December 2025) ."},{"key":"S2045796025100309_ref31","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-018-8762-6"},{"key":"S2045796025100309_ref35","unstructured":"The NHS Long Term Plan Implementation Framework Department of Health 2019. [Online]. NHS. Available: https:\/\/www.england.nhs.uk\/2019\/01\/long-term-plan\/ (accessed 20 October 2025 )."},{"key":"S2045796025100309_ref23","unstructured":"Hospital Episode Statistics (HES) Analysis Guide Nhs Digital 2019. [Online]. NHS Digital. Available: https:\/\/digital.nhs.uk\/data-and-information\/data-tools-and-services\/data-services\/hospital-episode-statistics\/users-uses-and-access-to-hospital-episode-statistics (accessed 20 October 2025 )."},{"key":"S2045796025100309_ref38","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(10)70299-4"},{"key":"S2045796025100309_ref39","doi-asserted-by":"publisher","DOI":"10.1007\/s40615-021-00993-x"},{"key":"S2045796025100309_ref7","doi-asserted-by":"publisher","DOI":"10.1186\/s12982-016-0053-z"},{"key":"S2045796025100309_ref26","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291722002537"},{"key":"S2045796025100309_ref30","unstructured":"Linked HES-ONS Mortality Data Nhs Digital 2023. [Online]. Available: https:\/\/digital.nhs.uk\/data-and-information\/data-tools-and-services\/data-services\/linked-hes-ons-mortality-data (accessed 20 October 2025 )."},{"key":"S2045796025100309_ref3","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2022.101692"},{"key":"S2045796025100309_ref14","unstructured":"DCB0011: Mental Health Services Data Set Nhs Digital 2021a. [Online]. Available: https:\/\/digital.nhs.uk\/data-and-information\/information-standards\/governance\/latest-activity\/standards-and-collections\/dcb0011-scci0011-mental-health-services-data-set-archive (accessed 20 October 2025 )."},{"key":"S2045796025100309_ref32","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.12r07757"},{"key":"S2045796025100309_ref45","doi-asserted-by":"publisher","DOI":"10.1002\/gps.5419"},{"key":"S2045796025100309_ref21","doi-asserted-by":"publisher","DOI":"10.1080\/13607863.2017.1408772"},{"key":"S2045796025100309_ref42","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.10.1092"},{"key":"S2045796025100309_ref44","doi-asserted-by":"publisher","DOI":"10.1093\/arclin\/acy084"},{"key":"S2045796025100309_ref48","doi-asserted-by":"publisher","DOI":"10.1002\/gps.5113"},{"key":"S2045796025100309_ref46","doi-asserted-by":"publisher","DOI":"10.1080\/13607863.2022.2107176"},{"key":"S2045796025100309_ref6","doi-asserted-by":"publisher","DOI":"10.3389\/fepid.2023.1095236"},{"key":"S2045796025100309_ref49","unstructured":"World Health Organisation, (2025) Posterior cortical atrophy ICD-11 code. [Online]. Available: https:\/\/icd.who.int\/browse\/2024-01\/mms\/en#377572273 (accessed 5 December 2025 )."},{"key":"S2045796025100309_ref50","unstructured":"World Health Organization (2021) Global status report on the public health response to dementia."},{"key":"S2045796025100309_ref11","doi-asserted-by":"publisher","DOI":"10.1017\/S1041610220001118"},{"key":"S2045796025100309_ref1","doi-asserted-by":"publisher","DOI":"10.1002\/cpp.2674"}],"container-title":["Epidemiology and Psychiatric Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S2045796025100309","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T06:17:06Z","timestamp":1765520226000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S2045796025100309\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":50,"alternative-id":["S2045796025100309"],"URL":"https:\/\/doi.org\/10.1017\/s2045796025100309","relation":{},"ISSN":["2045-7960","2045-7979"],"issn-type":[{"value":"2045-7960","type":"print"},{"value":"2045-7979","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025]]},"article-number":"e60"}}