Factors associated with psycho- and pharmacotherapy initiation for common mental disorders in the general population during the COVID-19 pandemic

BackgroundHealth service utilization is influenced by perceived and evaluated health status (need factors), sociodemographic characteristics and health beliefs (predisposing factors), and personal and community resources that facilitate or hinder access to care (enabling factors). No study has simultaneously quantified how these factors directly and indirectly influence psychotherapy and pharmacotherapy initiation for common mental disorders (CMD). The COVID-19 pandemic provides an opportunity to examine these dynamics due to heightened mental health needs and strained healthcare systems. MethodsWe conducted a cross-sectional study within the French Grippenet/Covidnet cohort (n=6,944) in April 2022. Data were collected through a voluntary online questionnaire. Participants not using CMD treatments before the pandemic (n=3,297) were included. Weighted structural equation modeling was used to analyze the direct and indirect pathways to psychotherapy and pharmacotherapy initiation. ResultsPsychotherapy initiation was directly associated with perceived need (poorer self-rated mental health, negative pandemic impact) and enabling factors (employed, mindfulness/relaxation activities, over-the-counter medication). Pharmacotherapy initiation was directly associated with evaluated need (CMD symptoms, non-psychiatric chronic disease), predisposing (female), and enabling factors (over-the-counter medication). Indirectly, predisposing factors influenced treatment initiation primarily through CMD symptoms (female, younger, lower education, living with adults, adverse life event and recent difficult event), while enabling and pandemic-related factors influenced it through poorer perceived need (loneliness, urban, employed, fewer financial difficulties, less deprived area, pandemic financial decline) and CMD symptoms (loneliness, less sport, most deprived area, symptomatic COVID-19). ConclusionsThis study highlights distinct pathways to psychotherapy and pharmacotherapy initiation and provides insights to improve access to each treatment.