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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

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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.



ADL, activities of daily living, AOR, adjusted odds ratio, ARC, applied research collaboration, Antidepressants, BNF, British national formulary, CI, confidence interval, Depression, Disparity, EMHAP, European mental health action plan, European, GDP, gross domestic product, GHQ-12, 12-item general health questionnaire, GNI, gross national income per capita, GP, general practitioner, HSE, health survey for England, IAPT, improving access to psychological therapies, IMD, index of multiple deprivation, NHS, National Health Service, NIHR, National Institute for Health Research, OR, odds ratio, SHARE, survey of health, ageing and retirement in Europe, STROBE, strengthening the reporting of observational studies in epidemiology, UK, United Kingdom, USA, United States of America, WHO, World Health Organization

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The Lancet Regional Health - Europe

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Medical Research Council (MC_PC_17213)
Medical Research Council (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).