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dc.contributor.authorChen, Shanquan
dc.contributor.authorFord, Tamsin
dc.contributor.authorJones, Peter
dc.contributor.authorCardinal, Rudolf
dc.description.abstractBACKGROUND 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.
dc.description.sponsorshipUK National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) East of England, NIHR Cambridge Biomedical Research Centre (BRC-1215-20014).
dc.rightsAttribution 4.0 International
dc.sourcenlmid: 101777707
dc.sourceessn: 2666-7762
dc.subjectADL, activities of daily living
dc.subjectAOR, adjusted odds ratio
dc.subjectARC, applied research collaboration
dc.subjectBNF, British national formulary
dc.subjectCI, confidence interval
dc.subjectEMHAP, European mental health action plan
dc.subjectGDP, gross domestic product
dc.subjectGHQ-12, 12-item general health questionnaire
dc.subjectGNI, gross national income per capita
dc.subjectGP, general practitioner
dc.subjectHSE, health survey for England
dc.subjectIAPT, improving access to psychological therapies
dc.subjectIMD, index of multiple deprivation
dc.subjectNHS, National Health Service
dc.subjectNIHR, National Institute for Health Research
dc.subjectOR, odds ratio
dc.subjectSHARE, survey of health, ageing and retirement in Europe
dc.subjectSTROBE, strengthening the reporting of observational studies in epidemiology
dc.subjectUK, United Kingdom
dc.subjectUSA, United States of America
dc.subjectWHO, World Health Organization
dc.titlePrevalence, 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
prism.publicationNameThe Lancet Regional Health - Europe
dc.contributor.orcidChen, Shanquan [0000-0002-4724-4892]
dc.contributor.orcidFord, Tamsin Jane [0000-0001-5295-4904]
dc.contributor.orcidJones, Peter [0000-0002-0387-880X]
dc.contributor.orcidCardinal, Rudolf [0000-0002-8751-5167]
pubs.funder-project-idMedical Research Council (MC_PC_17213)
pubs.funder-project-idMedical Research Council (MR/W014386/1)

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Attribution 4.0 International
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