Social inequalities in antidepressant treatment and mortality: a longitudinal register study.
BACKGROUND
Despite an increased prevalence of depression among people of low socio-economic position, it remains unclear whether their treatment with antidepressants appropriately matches their increased need compared with people from more affluent backgrounds. This study examined socio-economic differences in antidepressant prescriptions and mortality related to depressive disorders.


METHODS
A longitudinal register study of 17947 male and 47458 female local government employees with linked information on socio-economic indicators (education and occupational status) and data on antidepressant use and mortality associated with depressive disorder (suicide, alcohol-related deaths) during the years 1994 to 2000.


RESULTS
In men, antidepressant treatment was less common among low educational groups than among high educational groups (OR 0.87, 95% CI 0.76-0.99) and a corresponding difference was seen between occupational statuses (OR for manual v. upper non-manual 0.72, 95% CI 0.62-0.84). In women, socio-economic position was not associated with antidepressant use. However, both among the men and women, employees with low socio-economic position had increased risk for mental-health-related mortality, as indicated by suicides, deaths from alcohol-related causes, and all-cause mortality.


CONCLUSIONS
These data suggest a mismatch in the treatment of depression relative to apparent clinical need, with the lowest levels of treatment concentrated in the lower socio-economic groups, despite evidence of their increased prevalence of depression and suicide.
Kivimäki
Mika
M
International Institute for Health and Society, Department of Epidemiology and Public Health, University College London, UK. mika.kivimaki@ttl.fi
Gunnell
David
D
Lawlor
Debbie A
DA
Davey Smith
George
G
Pentti
Jaana
J
Virtanen
Marianna
M
Elovainio
Marko
M
Klaukka
Timo
T
Vahtera
Jussi
J
D000328:Adult; D019973:Alcohol-Related Disorders / Q000401:mortality; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002423:Cause of Death; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000188:drug therapy* / Q000401:mortality*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D005387:Finland; D006801:Humans; D009111:Local Government; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment / Q000706:statistics & numerical data; D012042:Registries; D018570:Risk Assessment; D012737:Sex Factors; D012959:Socioeconomic Factors; D013405:Suicide / Q000706:statistics & numerical data
D000928:Antidepressive Agents