Complementary and integrative medicine use in mental disorders: socioeconomic patterns and healthcare utilization in Germany.

BACKGROUND: Complementary and integrative medicine (CIM) is widely used among individuals with mental disorders, but evidence on associated out-of-pocket expenditures and socioeconomic differences in spending remains limited. METHODS: This cross-sectional study used data from the PSYKIM cross-sectional study of adults with self-reported psychiatric disorders in Germany. Associations of CIM-related out-of-pocket costs and expenditure categories with sociodemographic and clinical variables, physician awareness, subjective evaluation of CIM approaches, and health insurance status were examined descriptively and using multivariable binary and ordinal logistic regression models where appropriate. A relative financial burden measure, approximated as the ratio of CIM-related out-of-pocket expenses to available monthly income, was analyzed descriptively. RESULTS: Among 657 participants with complete cost data, 72% reported out-of-pocket CIM-related costs. Higher disposable income was associated with higher odds of reporting out-of-pocket costs (aOR = 1.19; 95% CI: 1.04-1.37) and higher expenditure categories (aOR = 1.18; 95% CI: 1.06-1.31). Physician awareness of CIM use and more positive evaluations of CIM were also associated with higher expenditures. Men had lower adjusted odds of reporting out-of-pocket costs than women (aOR = 0.44; 95% CI: 0.26-0.76), while participants with university-level qualifications more frequently reported such costs in descriptive analyses. Disease duration, psychiatric diagnosis, and health insurance status were not clearly associated with CIM-related costs. CIM use was not associated with lower use of conventional medication. CONCLUSION: CIM use among individuals with mental disorders in Germany is frequently associated with private out-of-pocket expenditures and appears to be socially patterned. The findings further suggest that CIM is primarily used as an adjunct to, rather than a substitute for, conventional psychiatric treatment. Given the cross-sectional design, these observations should be confirmed in prospective observational studies.