Research Article: Socioeconomic determinants affecting the access and utilization of depression care services in immigrants: A population-based study

Date Published: March 13, 2019

Publisher: Public Library of Science

Author(s): Sohyun Jeong, Cinoo Kang, Hyemin Cho, Hee-Jin Kang, Sunmee Jang, Monika R. Asnani.


It is imperative to address the health problems faced by immigrants in their destination countries in light of the current magnitude of migration processes worldwide. We aimed to evaluate the socioeconomic determinants of healthcare utilization in immigrants with depression.

A population-based cohort comprising all immigrants who were eligible for National Health Insurance coverage (permanent residents, marriage immigrants, and naturalized citizens) using the National Health Insurance Claims Database in 2011–2013 was established. Cases were defined as immigrants with new-onset depression. Controls were new-onset Korean patients with depression matched by age, sex, and Charlson comorbidity index in a 1:2 ratio. Appropriateness of care (AOC) was defined as visiting a clinic for depression management at least 3 times in the first 12 weeks and 4 times thereafter until 12 months post-cohort entry.

A total of 2,378 immigrants and 4,756 matched Korean patients were identified. Of the immigrants, 30.0% achieved AOC, in contrast to 38.7% of Koreans (p < .0001). Adjusting for possible covariates, AOC was less likely for immigrants (adjusted OR (aOR), 0.760; 95% CI: 0.670–0.863). Medical Aid (aOR, 2.309; 95% CI, 1.479–3.610), rural residence (aOR, 1.536; 95% CI, 1.054–2.237), the presence of a psychiatric comorbidity (aOR, 1.912; 95% CI, 1.484–2.463), and visiting a psychiatrist (aOR, 2.387; 95% CI, 1.821–3.125) were associated with an increased likelihood of AOC in immigrants. Socioeconomic determinants included insurance type (Medical Aid and National Health Insurance), place of residence, psychiatric comorbid status, doctor specialty, easy access to medical services (clinic-based), and a SSRI-based treatment regimen. Those predictors should be taken into account when developing healthcare strategies for immigrants.

Partial Text

In the current age of rapid globalization, immigration has exerted significant effects on nations and people globally [1]. The number of international migrants has consistently increased, reaching 258 million in 2017 (a 40% increase compared to the number of 173 million in 2000), and over 60% of international migrants reside in Asia (80 million) and Europe (78 million) [2]. The number of immigrants in Korea reached 2 million in 2016, accounting for 4.0% of the Korean population [3], which reflects a rapid doubling from 2007 [3, 4]. The main country of origin of immigrants in Korea is China, followed by Vietnam and Thailand [3]. The steep increase of immigration to Korea began in the late 1980s, with labor immigration accounting for the majority of migrants, followed by marriage immigration starting in the early 1990s and the immigration of international students starting in 2015; as a result, Korea has become a highly diverse society. The proportion of immigrants and their offspring was 3.4% of the total Korean population in 2015. The Korean government has been providing language education, family consultations, cultural adaptation programs, and diverse policies to support immigrants and to promote their smooth assimilation into Korean society [5].

This is the first population-based study including all immigrants in Korea that assessed the characteristics and determinants associated with access to and utilization of depression care services. The Korean NHI program is a model in which the payments come from a government-run insurance body that all citizens pay into, prorated by income and assets. Since we utilized NHI claims data, which only include insurance-covered medical services, we included permanent residents, marriage immigrants, and naturalized immigrants who are eligible to receive benefits under the NHI program. Eligible subjects can receive the same medical services, as long as they pay their copayments and medical expenses.

Determinants associated with improved healthcare utilization of depression management in immigrants were insurance type (Medical Aid), place of residence (rural site), psychiatric comorbidities (comorbid status), doctor specialty (psychiatrist) and SSRI-based treatment regimens. When developing and introducing a healthcare strategy for immigrants, these findings should be taken into account.




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