Factors Influencing Psychotherapists' Willingness to Treat Spinal Cord Injury Patients: Insights from Germany

Introduction

Individuals with spinal cord injury (SCI) often face a higher prevalence of mental health issues compared to the general population. Despite this, they encounter significant barriers when accessing outpatient psychotherapy. Understanding the factors that influence therapists' willingness to treat this population is crucial for improving mental healthcare equity.

Methods

A cross-sectional online survey was conducted among licensed outpatient psychotherapists in Southern Germany. The survey targeted therapists registered with the Association of Statutory Health Insurance Physicians who had an email address or an online contact form. A total of 677 complete datasets were analyzed. Logistic regression was used to examine the associations between therapists' willingness to accept a hypothetical therapy request from an individual with SCI and nine potential influencing factors, including personal, emotional, and organizational variables.

Results

The study identified six variables significantly associated with therapists' willingness. Therapists who agreed to provide home-based therapy had higher odds of being willing [OR = 2.28, 95% CI [1.50, 3.46], p <0.001], as did those who reported a stronger feeling of preparedness [OR = 1.83, 95% CI [1.51, 2.21], p <0.001] and greater field experience [OR = 1.34, 95% CI [1.11, 1.61], p = 0.002]. Conversely, older age [OR = 0.83, 95% CI [0.74, 0.92], p < 0.001], higher levels of emotional response [OR = 0.82, 95% CI [0.68, 0.99], p = 0.040], and workload concerns [OR = 0.73, 95% CI [0.55, 0.95], p = 0.020] were associated with lower willingness.

Discussion

The willingness to provide psychotherapy for individuals with SCI is influenced by both modifiable factors (e.g., training, preparedness, home visit policies) and non-modifiable factors (e.g., age). These findings underscore the importance of disability-specific education and structural adjustments to reduce access barriers. Although this study was limited to Southern Germany, similar challenges have been reported in other countries, suggesting a broader issue across healthcare systems.

Conclusion

This study highlights the need for targeted interventions to improve psychological care for individuals with SCI. By addressing both provider-related and systemic barriers, healthcare systems can work towards more inclusive and accessible mental health services. Future research should continue to explore these factors to develop effective strategies for enhancing mental healthcare equity for individuals with spinal cord injuries. ? **Source:** https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2025.1704099/full