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However, formal estimates of their actual representation in routine clinical settings are scarce. This study applied a representation quotient approach to identify and quantify age-related disparities in outpatient psychotherapy utilization in Germany.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed data from 13,635 adult patients who initiated cognitive-behavioral therapy between 2018 and 2023 at 29 university outpatient clinics. Using a representation quotient approach, we compared the observed proportions of young-old adults (65\u201374\u2009years) and old-old adults (\u226575\u2009years) with prevalence-stratified population age distributions. The robustness of the results was investigated by extensive sensitivity analyses, including alternative prevalence assumptions and adjustments for long-term care needs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Even under conservative assumptions, young-old adults only accounted for about 25% and old-old adults for about 13% of their expected proportion. In contrast, young working-age adults (18\u201334\u2009years) were particularly overrepresented in the sample. Underrepresentation of older adults was most pronounced among patients with post-traumatic stress disorder, eating disorders, and dysthymia, less pronounced among patients with generalized anxiety disorder, and not significant among patients with pain disorders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study demonstrates the utility of representation quotients for systematically identifying and quantifying age-related disparities in psychotherapy utilization based on routine care data. Our analyses of large-scale data from university outpatient clinics in Germany revealed a marked underrepresentation of older adults in this setting. These findings highlight the need to improve access to, and utilization of, psychotherapeutic services for older adults.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12913-025-13714-5","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T11:44:36Z","timestamp":1764071076000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Quantifying age-related disparities in outpatient psychotherapy utilization: a representation quotient analysis of routine data from 29 university clinics in Germany"],"prefix":"10.1186","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1806-9589","authenticated-orcid":false,"given":"Nicolas","family":"Wrede","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1247-0099","authenticated-orcid":false,"given":"Marlena 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