Treatment of depression in primary care. Socio-economic status, clinical need and receipt of treatment.
BACKGROUND
Depression is prevalent, costly and often undertreated.


OBJECTIVE
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.


METHODS
Individuals with an ICD-10 depressive episode in the past 12 months (n=866) were recruited from 7271 attendees in 36 general practices in England and Wales. Depressive episodes were identified using the 12-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.
Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK. s.weich@warwick.ac.uk
Scott
S
Weich
Irwin
I
Nazareth
Louise
L
Morgan
Michael
M
King
D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003695:Delivery of Health Care / Q000592:standards*; D003866:Depressive Disorder / Q000628:therapy*; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011320:Primary Health Care / Q000379:methods; D012959:Socioeconomic Factors; D014852:Wales
D000928:Antidepressive Agents