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Treatment of depression in primary care

Socio-economic status, clinical need and receipt of treatment

Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry

IRWIN NAZARETH, PhD

Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London

LOUISE MORGAN, PhD

Dr Foster Ltd, London

MICHAEL KING, PhD

Department of Mental Health Sciences, Royal Free and University College Medical School, London

Correspondence: Professor Scott Weich, Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK. Email: s.weich{at}warwick.ac.uk

Declaration of interest None. Funding detailed in Acknowledgements.

Background Depression is prevalent, costly and often undertreated.

Aims To test the hypothesis that people with low socio-economic status are least likely to receive and adhere to evidence-based treatments for depression, after controlling for clinical need.

Method Individuals with an ICD–10 depressive episode in the past12 months (n=866) were recruited from 7271 attendees in 36 general practices in England and Wales. Depressive episodes were identified using the12-month Composite International Diagnostic Interview. Treatment receipt and adherence were assessed by structured interview, and rated using evidence-based criteria.

Results We identified 332 individuals (38.3%) who received and adhered to evidence-based treatment. There were few socio-economic differences in treatment allocation. Although those without educational qualifications were least likely to receive psychological treatments (OR = 0.55,95% CI 0.34–0.89, P = 0.02), this association was not statistically significant after adjusting for depression severity.

Conclusions We found no evidence of inverse care in the treatment of moderate and severe depression in primary care in England and Wales.

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BJP 2007 191: 5. [Full Text]