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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cam.depositDate2022-03-14
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cam.orpheus.successTue Apr 12 08:22:45 BST 2022 - Embargo updated*
datacite.ispreviousversionof.handlehttps://www.repository.cam.ac.uk/handle/1810/336860
dc.contributor.authorChen, Shanquan
dc.contributor.authorFord, Tamsin Jane
dc.contributor.authorJones, Peter
dc.contributor.authorCardinal, Rudolf
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]
dc.date.accessioned2022-03-14T19:46:31Z
dc.date.available2022-03-14T19:46:31Z
dc.date.issued2022-06
dc.date.updated2022-03-14T13:35:31Z
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. 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).
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.identifier.doi10.17863/CAM.82407
dc.identifier.eissn2666-7762
dc.identifier.issn2666-7762
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/334968
dc.publisherElsevier BV
dc.publisher.departmentDepartment of Psychiatry
dc.rightsAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
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.
dc.typeArticle
prism.publicationNameLancet Reg Health Eur
pubs.licence-display-nameApollo Repository Deposit Licence Agreement
pubs.licence-identifierapollo-deposit-licence-2-1
rioxxterms.typeJournal Article/Review
rioxxterms.versionAM
rioxxterms.versionofrecord10.1016/j.lanepe.2022.100368
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