Does the density of the health workforce predict adolescent health? A cross-sectional, multilevel study of 38 countries

Kira E. Riehm, Eric Latimer, Amlie Quesnel-Valle, Gonneke W.J.M. Stevens, Genevive Garipy, Frank J. Elgar*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background Scant evidence exists on the relation between the availability of health professionals and adolescent health, and whether the size of the health workforce equally benefits adolescents across socioeconomic strata. Methods We conducted a cross-sectional analysis of adolescent health in 38 countries. Data from 218 790 adolescents were drawn from the 2013/2014 Health Behavior in School-aged Children survey. We used multilevel regression analyses to examine the association between the density of the health workforce and psychosomatic and mental health symptoms with differences in country wealth and income inequality controlled. Results A higher density of psychologists was associated with better self-reported mental health in adolescents (P = 0.047); however, this finding was not robust to sensitivity analyses. The densities of physicians and psychiatrists were not significantly associated with better adolescent psychosomatic or mental health. Cross-level interactions between the health workforce and socioeconomic status did not relate to health, indicating that larger health workforces did not reduce socioeconomic differences in adolescent health. Conclusions This study found that adolescents in countries with a higher density of health providers do not report better psychosomatic or mental health. Other social or structural factors may play larger roles in adolescent health.

Original languageEnglish
Pages (from-to)E35-E43
JournalJournal of Public Health (United Kingdom)
Volume41
Issue number1
Early online date1 Mar 2019
DOIs
Publication statusPublished - 2019

Funding

K.E.R. was supported by a Frederick Banting and Charles Best Canada Graduate Scholarship from the Canadian Institutes of Health Research and the National Institute of Mental Health (NIMH) Psychiatric Epidemiology Training Program (5T32MH014592-39; PI: Zandi, Peter). FJE was supported by a Canadian Institutes for Health Research operating grant (MOP-133519). G.G. was supported by a Canadian Institutes for Health Research postdoctoral fellowship. AQV holds the Canada Research Chair in Policies and Health Inequalities. FJE holds the Canada Research Chair in Social Inequalities in Child Health.

Keywords

  • Health services
  • Mental health
  • Young people

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