Prevalence, progress, and subgroup disparities in pharmacological antidepressant treatment of those who screen positive for depressive symptoms: A repetitive cross-sectional study in 19 European countries.
Ford, Tamsin J
Jones, Peter B
Cardinal, Rudolf N
Lancet Reg Health Eur
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Chen, S., Ford, T. J., Jones, P. B., & Cardinal, R. N. (2022). Prevalence, progress, and subgroup disparities in pharmacological antidepressant treatment of those who screen positive for depressive symptoms: A repetitive cross-sectional study in 19 European countries.. Lancet Reg Health Eur, 17 https://doi.org/10.1016/j.lanepe.2022.100368
Background: The European Mental Health Action Plan (EMHAP) 2013-2020 promoted community-based mental health services. One potential success indicator is the provision of antidepressant medication to those needing it. Methods: Public data from two surveys (Health Survey for England, UK; Survey of Health, Ageing and Retirement in Europe) covered 19 European countries across EMHAP phases one (2011-2015) and two (2015-2018). People screening positive for depressive symptoms by self-report were included. The primary outcome was antidepressant use: using country-specific weighted regression models, we estimated temporal trends and subgroup disparities in antidepressant receipt, with secondary analysis by country-level measures including healthcare expenditure. Findings: Across 37,250 participants, after controlling for age, sex, wealth, and physical disability, antidepressant use (amongst those screening positive) increased significantly in 14/19 countries, with the smallest increase being in Slovenia (adjusted OR[AOR] for trend=1.68[1.20-2.36]) and the highest increase being in Germany (AOR for trend=10.07[7.54-13.46]) and Austria (AOR for trend=10.07[7.32-13.74]). The overall proportion using antidepressants was positively associated with national health expenditure (coefficient=5.43[1.62-9.25]), but not with gross national income per capita or the number of psychiatrists, general practitioners, or psychiatric hospital beds. In 15/19 countries, antidepressants were used less by ≥65-year-olds than 50-64-year-olds, with the smallest differential reported in Luxembourg (AOR=0.70[0.49, 0.98]) and the highest in Germany (AOR=0.28[0.21, 0.37]); this disparity widened in 12/15 countries. Men used antidepressants less than women in 8/19 countries, across phases. In 13/19 countries, people with physical disability were more likely to receive antidepressants, with the smallest gap in Italy (AOR=1.42[1.12-1.80]) and the largest in Israel (AOR=2.34[1.46-3.74]); this disparity narrowed in 5/13 countries. Disparity by wealth was found in 8/19 countries, but its temporal trend varied. Interpretation: Usage of antidepressants by those with depressive symptoms has increased, with wide variation between countries and subgroups. Disparities across age, sex, and disability should prompt further research. Funding: Medical Research Council (grants MC_PC_17213 and MR/W014386/1), UK National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) East of England, NIHR Cambridge Biomedical Research Centre (BRC-1215-20014).
Disparity, Depression, European, Antidepressants, Gdp, Gross Domestic Product, Or, Odds Ratio, Ci, Confidence Interval, Who, World Health Organization, Nihr, National Institute For Health Research, Aor, Adjusted Odds Ratio, Usa, United States Of America, Adl, Activities Of Daily Living, Gp, General Practitioner, Strobe, Strengthening The Reporting Of Observational Studies In Epidemiology, Uk, United Kingdom, Nhs, National Health Service, Imd, Index Of Multiple Deprivation, Iapt, Improving Access To Psychological Therapies, Share, Survey Of Health, Ageing And Retirement In Europe, Arc, Applied Research Collaboration, Emhap, European Mental Health Action Plan, Gni, Gross National Income Per Capita, Hse, Health Survey For England, Bnf, British National Formulary, Ghq-12, 12-Item General Health Questionnaire
UK National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) East of England, NIHR Cambridge Biomedical Research Centre (BRC-1215-20014).
Medical Research Council (MC_PC_17213)
External DOI: https://doi.org/10.1016/j.lanepe.2022.100368
This record's URL: https://www.repository.cam.ac.uk/handle/1810/336860
Attribution 4.0 International
Licence URL: https://creativecommons.org/licenses/by/4.0/