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GPs go forth

GP consultations for depression have risen since financial crisis hit

Rates of depression have risen since the financial crash of 2008, particularly among working-age men, according to an analysis of general practice records.

The increase, which was linked to rising male unemployment, was mainly seen in the poorest areas of the country - and marks a reversal of falling rates of depression seen in the years preceding the economic downturn.

Researchers led by Professor Tony Kendrick, professor of primary care in medicine at the University of Southampton, studied GP records of depression before and after the recession, using anonymised data from 142 practices contributing to the Clinical Practice Research Datalink between 2003 and 2013.

The overall rate of depression - recorded through either diagnostic or symptom codes - fell by 15% between 2003 and 2008, but then rose again, by 4%, up to the end of March 2013.

Looking more closely, the researchers found the increase after the recession was only statistically significant in men, not in women - and that this increase correlated with a rise in unemployment since 2008, according to Office of National Statistics data.

Furthermore, the increase in depression was only seen in the most socioeconomically deprived areas. Rates of depression flatlined after 2008 in all but the lowest quintile of deprivation, in which they rose significantly.

Professor Kendrick told Pulse the increase in depression rates explained some - but not all - of the rise in antidepressant use recorded by the Health Survey for England. That data showed GP prescriptions of antidepressants had rocketed - by around 50% - since 2008, with one in 10 people now prescribed them overall, rising to nearly one in five among women from the poorest groups.

Professor Kendrick said: ‘[Our study] helps to explain the rise in prescribing - but it doesn’t account for all of it. That may be because each patient is getting more prescriptions. One of the things we want to now do is look at the length of treatment - we think they are getting longer courses.’

Professor Kendrick added that his group will also look at how changes in the way GPs record depression may reflect different treatment patterns - the study found GPs are increasingly moving towards symptom rather than diagnostic codes for depression, such that less than half of patients with symptoms were on the QOF register of depression.

J Affect Disord 2015; 180: 68-78

Readers' comments (7)

  • The big elephant in the room is that citalopram prescribing does NOT equal true depression prevalence I am afraid.

    It equals for some clinicians an easy, direct, hassle free and convenient way to terminate the consultation and give the customer precisely what they wanted and came in for (because all their friends are seemingly popping the pills too after their Friday night out on the tiles). This is the sad reality. It is the medicated, branded, quick fix, "I want a drug" culture that Government and Public Health England have permitted.

    Putting a mild-moderate "depressed" female who broke up with their boyfriend after having a stressful 10 hour job on a plane to Malta for £50 with RyanAir maybe the most cost-EFFECTIVE and curing option.

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  • Clearly as a practice manager you have never actually tried to persuade most depressed middle aged men to actually take the damn antidepressant.
    Stick to your own technical area.

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  • ESA and housing benefit pays more than job seekers for those with low employment prospects.
    This is not blame on those people - they have made a rational choice, conscious or otherwise.

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  • Vinci Ho

    It depends on what you believe:
    If you believe that the economy has really improved that much under this government with low unemployment rate without looking at poverty at work , clearly this 'rise' in cases of depression can be 'explained' bybclinicians being too 'casual' in prescribing antidepressants . The truth is I have genuinely seen more cases ,more severe cases of depression in last few years . Their backgrounds were more complex as well. Not only antidepressants but also talking and cognitive behavioural therapy are necessary in these cases.
    The bottom line is one can argue that one can always forget about the empathy and tell them ,'get on with your life!' Remember somebody talked about 'emotional resilience' not too long ago.
    I only believe the gap difference between the rich and the poor has been widened a lot and it has manifested itself in various ways . Gina coefficient , Palmar ratio etc of this country is high whether you want to believe in statistics or not.....

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  • particularly among working-age men AND GPs.....

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  • This is the expansion of the "want" not "need" generation.

    For prescribed antidepressant replace with "free" pick me up to supplement the illicit "recreational" drugs more and more people are taking as part of their "normal" daily life because it is no longer frowned upon in fact it is so socially accepted now that it may as well be legalised.

    It won't be long before these patients are coming in for their "free" repeat prescription for cannabis and Heroin!! (oh some already do - methadone!!)

    The worlds gone mad!!

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  • @2.09 other GP - You should not need to 'persuade' patients with capacity to take chemicals. Pill pushing seems a paramount obsession of some robotic other GPs.

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