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Factors associated with quality of services for marginalized groups with mental health problems in 14 European countries
Institute of Public Health, University of Porto, Porto, Portugal.
Unit for Social and Community Psychiatry, Queen Mary University of London, London, United Kingdom.
Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland.
National Institute for Health Development, Budapest, Hungary.
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2014 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Art. no. 49- p.Article in journal (Refereed) Published
Abstract [en]


Different service characteristics are known to influence mental health care delivery. Much less is

known about the impact of contextual factors, such as the socioeconomic circumstances, on the provision of care

to socially marginalized groups.

The objectives of this work were to assess the organisational characteristics of services providing mental health care

for marginalized groups in 14 European capital cities and to explore the associations between organisational

quality, service features and country-level characteristics.


617 services were assessed in two highly deprived areas in 14 European capital cities. A Quality Index of

Service Organisation (QISO) was developed and applied across all sites. Service characteristics and country level

socioeconomic indicators were tested and related with the Index using linear regressions and random intercept

linear models.


The mean (standard deviation) of the QISO score (minimum = 0; maximum = 15) varied from 8.63 (2.23) in

Ireland to 12.40 (2.07) in Hungary. The number of different programmes provided was the only service characteristic

significantly correlated with the QISO (p < 0.05). The national Gross Domestic Product (GDP) was inversely

associated with the QISO. Nearly 15% of the variance of the QISO was attributed to country-level variables, with

GDP explaining 12% of this variance.


Socioeconomic contextual factors, in particular the national GDP are likely to influence the

organisational quality of services providing mental health care for marginalized groups. Such factors should be

considered in international comparative studies. Their significance for different types of services should be explored

in further research.


Mental health services, Quality index of service organization, Socially marginalized groups,

Multi-level analysis

Place, publisher, year, edition, pages
2014. Art. no. 49- p.
Keyword [en]
Mental health services, Quality index of service organization, Socially marginalized groups, Multi-level analysis
National Category
Medical and Health Sciences
URN: urn:nbn:se:miun:diva-21274DOI: 10.1186/1472-6963-14-49ISI: 000331182700001ScopusID: 2-s2.0-84893183735OAI: diva2:695253
Available from: 2014-02-10 Created: 2014-02-10 Last updated: 2016-10-20Bibliographically approved

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