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

Published online by Cambridge University Press:  11 October 2017

K. Walters ,
M. Falcaro ,
N. Freemantle ,
M. King  and
Y. Ben-Shlomo
K. Walters*
Affiliation:
Research Department of Primary Care & Population Health, University College London (UCL), Rowland Hill St, London, UK
M. Falcaro
Affiliation:
Research Department of Primary Care & Population Health, University College London (UCL), Rowland Hill St, London, UK
N. Freemantle
Affiliation:
Research Department of Primary Care & Population Health, University College London (UCL), Rowland Hill St, London, UK
M. King
Affiliation:
Division of Psychiatry, UCL, Sixth Floor Maple House, 147 Tottenham Court Rd, London, UK
Y. Ben-Shlomo
Affiliation:
School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol, UK
*
Author for correspondence: Dr Kate R Walters, BMBS MSc Ph.D., E-mail: [email protected]
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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.

Keywords

Depressionolder peopleprimary caretreatment
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 9 , July 2018 , pp. 1504 - 1513
Copyright
Copyright © Cambridge University Press 2017 

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