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Sociodemographic inequalities in the management of depression in adults aged 55 and over: an analysis of English primary care data

  • K. Walters (a1), M. Falcaro (a1), N. Freemantle (a1), M. King (a2) and Y. Ben-Shlomo (a3)...
Abstract
Background

We do not know how primary care treatment of depression varies by age across both psychotropic medication and psychological therapies.

Methods

Cohort study including 19 710 people aged 55+ with GP recorded depression diagnoses and 26 276 people with recorded depression symptoms during the period 2009–2013, from 373 General Practices in The Health Improvement Network (THIN) database in England. Main outcomes were initiation of treatment with anti-depressants, anxiolytics, hypnotics, anti-psychotic drugs, referrals to psychological therapies within 6 months of onset.

Results

Treatment rates with antidepressants are high for those recorded with new depression diagnoses (87.1%) or symptoms of depression (58.7%). Treatment in those with depression diagnoses varies little by age. In those with depressive symptoms there was a J-shaped pattern with reduced antidepressant treatment in those in their 60s and 70s followed by increased treatment in the oldest age groups (85+ years), compared with those aged 55–59 years. Other psychotropic drug prescribing (hypnotics/anxiolytics, antipsychotics) all increase with increasing age. Recorded referrals for psychological therapies were low, and decreased steadily with increasing age, such that women aged 75–79 years with depression diagnoses had around six times lower odds of referral (OR 0.17, 95% CI 0.1–0.29) than those aged 55–59 years, and men aged 80–84 years had around seven times lower (OR 0.14, 95% CI 0.05–0.36).

Conclusions

The oldest age groups with new depression diagnoses and symptoms have fewer recorded referrals to psychological therapies, and higher psychotropic drug treatment rates in primary care. This suggests potential inequalities in access to psychological therapies.

Copyright
Corresponding author
Author for correspondence: Dr Kate R Walters, BMBS MSc Ph.D., E-mail: k.walters@ucl.ac.uk
References
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Benraad, CE et al. (2016) Geriatric characteristics in randomised controlled trials on antidepressant drugs for older adults: a systematic review. International Journal of Geriatric Psychiatry 31, 9901003. doi: 10.1002/gps.4443.
Blak, BT et al. (2011) Generalisability of The Health Improvement Network (THIN) database: demographics, chronic disease prevalence and mortality rates. Informatics in Primary Care 19, 251255.
Booth, N (1994) What are the read codes? Health Libraries Review 11, 177182.
Bourke, A, Dattani, H and Robinson, M (2004) Feasibility study and methodology to create a quality-evaluated database of primary care data. Informatics in Primary Care 12, 171177.
Calati, R et al. (2013) Antidepressants in elderly: metaregression of double-blind, randomized clinical trials. Journal of Affective Disorders 147, 18.
Centre HaSCI (2012) Prescriptions Dispensed in the Community, Statistics for England – 2001–2011. Health and Social Care Information Centre. www.hscic.gov.uk
Collard, RM et al. (2012) Prevalence of frailty in community-dwelling older persons: a systematic review. Journal of the American Geriatrics Society 60, 14871492.
Corcoran, J et al. (2013) Depression in older adults: a meta-synthesis. Journal of Gerontological Social Work. 56, 509534.
Crystal, S et al. (2003) Diagnosis and treatment of depression in the elderly medicare population: predictors, disparities, and trends. Journal of the American Geriatrics Society 51, 17181728. http://www.csdmruk.imshealth.com/ (last accessed 02.09.16).
Cuijpers, P et al. (2014) Managing depression in older age: psychological interventions. Maturitas 79, 160169.
Davé, S and Petersen, I (2009) Creating medical and drug code lists to identify cases in primary care databases. Pharmacoepidemiology and Drug Safety 18, 704707.
de Lusignan, S et al. (2012) Referral to a new psychological therapy service is associated with reduced utilisation of healthcare and sickness absence by people with common mental health problems: a before and after comparison. Journal of Epidemiology & Community Health 66, e10.
Department for Communities and Local Government (2010) The English indices of deprivation 2010. http://www.communities.gov.uk/publications/corporate/statistics/indices2010 (last accessed 02.09.16).
Diniz, BS et al. (2013) Late-life depression and risk of vascular dementia and Alzheimer's disease: systematic review and meta-analysis of community-based cohort studies. British Journal of Psychiatry 202, 329335.
Douglas, IJ and Smeeth, L (2008) Exposure to antipsychotics and risk of stroke: self-controlled case series study. British Medical Journal 337, a1227.
Durrleman, S and Simon, R (1989) Flexible regression models with cubic splines. Statistics in Medicine 8, 551561.
Gould, RL, Coulson, MC and Howard, RJ (2012) Cognitive behavioral therapy for depression in older people: a meta-analysis and meta-regression of randomized controlled trials. Journal of the American Geriatrics Society 60, 18171830.
Harman, JS, Edlund, MJ and Fortney, JC (2004) Disparities in the adequacy of depression treatment in the United States. Psychiatric Services 55, 13791385.
Harman, JS, Veazie, PJ and Lyness, JM (2006) Primary care physician office visits for depression by older Americans. Journal of General Internal Medicine 21, 926930.
Harris, T et al. (2012) Antidepressant prescribing in older primary care patients in community and care home settings in England and Wales. Journal of the American Medical Directors Association 13, 4147.
Horsfall, L, Walters, K and Petersen, I (2013) Identifying periods of acceptable computer usage in primary care research databases. Pharmacoepidemiology and Drug Safety 22, 6469.
Huber, PJ (1967) The behaviour of maximum likelihood estimators under non-standard conditions. In Proceedings of the fifth Berkeley Symposium on Mathematical Statistics and Probability. University of California Press: Berkeley, USA, pp. 221–233.
Jeong, HG et al. (2013) Role of severity and gender in the association between late-life depression and all-cause mortality. International Psychogeriatrics 25, 677684.
Joint Formulary Committee (2013) British National Formulary, 66th edn. BMJ Group and Pharmaceutical Press: London.
Kessler, RC et al. (2005) Prevalence and treatment of mental disorders, 1990 to 2003. New England Journal of Medicine 352, 25152523.
King, M et al. (2008) Prevalence of common mental disorders in general practice attendees across Europe. The British Journal of Psychiatry 192, 362367.
Kok, RM, Nolen, WA and Heeren, TJ (2012) Efficacy of treatment in older depressed patients: a systematic review and meta-analysis of double-blind randomized controlled trials with antidepressants. Journal of Affective Disorders 41, 103115.
Lewis, JD et al. (2005) The relationship between time since registration and measured incidence rates in the General Practice Research Database. Pharmacoepidemiology and Drug Safety 14, 443451.
Lewis, JD et al. (2007) Validation studies of the health improvement network (THIN) database for pharmacoepidemiology research. Pharmacoepidemiology and Drug Safety 16, 393401.
Lubian, K et al. (2016) Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2014. Chapter 3: Mental Health Treatment and Service Use. Published September 29, 2016 http://content.digital.nhs.uk/catalogue/PUB21748 (last accessed 11.11.16).
Luppa, M et al. (2010) Age- and gender-specific prevalence of depression in latest-life – systematic review and meta-analysis. Journal of Affective Disorders 136, 212221.
Marston, L et al. (2014) Prescribing of antipsychotics in UK primary care: a cohort study. BMJ Open 4, e006135.
Mitchell, AJ, Rao, S and Vaze, A (2010) Do primary care physicians have particular difficulty identifying late-life depression? A meta-analysis stratified by age. Psychotherapy and Psychosomatics 79, 285294.
Mitchell, AJ, Vaze, A and Rao, S (2009) Clinical diagnosis of depression in primary care: a meta-analysis. The Lancet 374, 609619.
Murray, J et al. (2006) Primary care professionals’ perceptions of depression in older people: a qualitative study. Social Science & Medicine 63, 13631373.
National Institute for Health and Care Excellence (NICE) (2009, updated April 2016). Clinical Guideline 90, Depression in Adults : Recognition and Management. https://www.nice.org.uk/guidance/cg90/chapter/1-Guidance (last accessed 08.06.17).
Nelson, JC, Delucchi, K and Schneider, LS (2008) Efficacy of second generation antidepressants in late-life depression: a meta analysis of the evidence. American Journal of Geriatric Psychiatry 16, 558567.
Olfson, M, King, M and Schoenbaum, M (2015) Benzodiazepine use in the United States. JAMA Psychiatry 72, 136142.
Parsaik, AK et al. (2016) Mortality associated with anxiolytic and hypnotic drugs—A systematic review and meta-analysis. Australian and New Zealand Journal of Psychiatry 50, 520533.
Rait, G et al. (2009) Recent trends in the incidence of recorded depression in primary care. British Journal of Psychiatry 195, 520524.
Royal College of Psychiatrists (2013) Report of the Second Round of the National Audit of Psychological Therapies (NAPT) 2013. Healthcare Quality Improvement Partnership: London. http://www.rcpsych.ac.uk/workinpsychiatry/qualityimprovement/nationalclinicalaudits/psychologicaltherapies/psychologicaltherapies.aspx (last accessed 02.09.16).
Royall, RM (1986) Model robust confidence intervals using maximum likelihood estimators. International Statistical Reviews 54, 221226.
Serfaty, MA et al. (2009) Clinical effectiveness of individual cognitive behavioral therapy for depressed older people in primary care: a randomized controlled trial. Archives of General Psychiatry 66, 13321340.
Tannenbaum, C et al. (2012) A systematic review of amnestic and non-amnestic mild cognitive impairment induced by anticholinergic, antihistamine, GABAergic and opioid drugs. Drugs and Aging 29, 639658.
Thorlund, K et al. (2015) Comparative efficacy and safety of selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors in older adults: a network meta-analysis. Journal of the American Geriatrics Society 63, 10021009.
Unützer, J et al. (2000) Care for depression in HMO patients aged 65 and older. Journal of the American Geriatrics Society 48, 871878.
White, J et al. (2015) Severity of depressive symptoms as a predictor of mortality: the English longitudinal study of ageing. Psychological Medicine 45, 27712779.
Whiteford, HA et al. (2013) Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. The Lancet 382, 15751586.
Xing, D et al. (2014) Association between use of benzodiazepines and risk of fractures: a meta-analysis. Osteoporosis International 25, 105120.
Zeger, SL, Liang, K-Y and Albert, PS (1988) Models for longitudinal data: a generalized estimating equation approach. Biometrics 44, 10491060.
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Psychological Medicine
  • ISSN: 0033-2917
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