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Social inequalities in antidepressant treatment

Published online by Cambridge University Press:  16 April 2020

A. Bocquier
Affiliation:
Observatoire régional de la santé, Paca/UMR 912 SESSTIM/Aix Marseille université, 13006Marseille, France
S. Cortaredona
Affiliation:
Observatoire régional de la santé, Paca/UMR 912 SESSTIM/Aix Marseille université, 13006Marseille, France
H. Verdoux
Affiliation:
Observatoire régional de la santé, Paca/UMR 912 SESSTIM/Aix Marseille université, 13006Marseille, France Inserm U657, Bordeaux University, 33000Bordeaux, France
P. Verger
Affiliation:
Observatoire régional de la santé, Paca/UMR 912 SESSTIM/Aix Marseille université, 13006Marseille, France

Abstract

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Purpose

We studied the relation between individual and neighborhood socioeconomic characteristics and the probability of:

  • – new long-duration antidepressant treatment;

  • – early antidepressant discontinuation.

Methods

We followed two cohorts of inhabitants of Marseille (aged 18–64 years) covered by the National Health Insurance Fund (NHIF) for 2.5 years. In the first cohort (316,412 individuals in 2008), we studied new long-duration antidepressant treatments (≥ 4 antidepressants prescription claims within 6 months after the index claim, and none in the 6 months before). The second cohort was restricted to the 14,518 individuals with a new episode of antidepressant treatment prescribed by a private GP in 2008–2009 to study early treatment discontinuation: < 4 antidepressant prescription claims in the 6 months following the index claim. We developed a deprivation index at the neighborhood level (census block) and used multivariate multilevel logistic models adjusted for consultations with GPs and psychiatrists. In the second cohort, analyses were further adjusted on GPs characteristics.

results

First cohort: the probability of new long-duration antidepressant treatments was negatively associated with both individual low income and neighborhood deprivation. Second cohort: low income, and prescribers’ clientele composition (high proportion of disadvantaged patients) were independently associated with an increased risk of early discontinuation. A significant interaction was found between low income and gender.

Conclusions

Our results add further evidence supporting the existence of inequalities in antidepressant treatment at both the individual, GP and neighborhood levels, and that these inequalities occur principally during the processes of care. Inequalities in antidepressant continuation are more pronounced among women. Further research is warranted to improve our understanding of their mechanisms.

Type
Session thématique: Le DSM-5 – les principales nouveautés
Copyright
Copyright © European Psychiatric Association 2013

References

Further reading

Andersen, IThielen, KNygaard, EDiderichsen, F.Social inequality in the prevalence of depressive disorders. J Epidemiol Community Health 2009;63:575581.10.1136/jech.2008.082719CrossRefGoogle ScholarPubMed
Bocquier, ACortaredona, SVerdoux, H, et al. Social inequalities in new antidepressant treatment: a study at the individual and neighborhood levels. Ann Epidemiol 2013;23:99105.10.1016/j.annepidem.2012.12.008CrossRefGoogle ScholarPubMed
Mair, CDiez Roux, AVGalea, S.Are neighbourhood characteristics associated with depressive symptoms? A review of evidence. J Epidemiol Community Health 2008;62:940946.Google ScholarPubMed
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