Open Access Open Badges Research article

Factors associated with quality of services for marginalized groups with mental health problems in 14 European countries

Diogo Costa12*, Aleksandra Matanov3, Reamonn Canavan4, Edina Gabor5, Tim Greacen6, Petra Vondráčková7, Ulrike Kluge8, Pablo Nicaise9, Jacek Moskalewicz10, José Manuel Díaz–Olalla11, Christa Straßmayr12, Martijn Kikkert13, Joaquim JF Soares14, Andrea Gaddini15, Henrique Barros12 and Stefan Priebe3

Author Affiliations

1 Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Alameda Prof Hernani Monteiro, 4200-319 Porto, Portugal

2 Institute of Public Health, University of Porto, Porto, Portugal

3 Unit for Social and Community Psychiatry, Queen Mary University of London, London, United Kingdom

4 Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland

5 National Institute for Health Development, Budapest, Hungary

6 Laboratoire de recherche, Etablissement public de santé Maison Blanche, Paris, France

7 Department of Addictology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic

8 Clinic for Psychiatry and Psychotherapy, Charite, University Medicine Berlin, CCM, Berlin, Germany

9 Institute of Health and Society (IRSS), Université Catholique de Louvain, Bruxelles, Belgium

10 Institute of Psychiatry and Neurology, Warsaw, Poland

11 Madrid Salud, Madrid, Spain

12 Ludwig Boltzmann Institute for Social Psychiatry, Vienna, Austria

13 Arkin Institute for Mental Health Care, Amsterdam, The Netherlands

14 Department of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden

15 Laziosanità ASP–Public Health Agency, Lazio Region, Rome, Italy

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BMC Health Services Research 2014, 14:49  doi:10.1186/1472-6963-14-49

Published: 3 February 2014



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