title: Changes in rates of recorded depression in English primary care 2003-2013: Time trend analyses of effects of the economic recession, and the GP contract quality outcomes framework (QOF).
abstract: BACKGROUND
  Depression may be increasing, particularly since the economic recession. Introduction of quality outcomes framework (QOF) performance indicators may have altered GP recording of depression.
  
  
  METHODS
  Time trend analyses of GP recording of depression before and after the recession (from April 2008), and the QOF (from April 2006) were conducted on anonymised consultation data from 142 English practices contributing to the Clinical Practice Research Datalink, April 2003-March 2013.
  
  
  RESULTS
  293,596 patients had computer codes for depressive diagnoses or symptoms in the 10 years. Prevalence of depression codes fell from 44.6 (95% CI 44.2, 45.0) per 1000 person years at risk (PYAR) in 2003/2004 to 38.0 (37.7, 38.3) in 2008/2009, rising to 39.5 (39.2, 39.9) in 2012/2013. Incidence of first-ever depression codes fell from 11.9 (95% CI 11.7, 12.1) per 1000 PYAR in 2003/2004 to 9.5 (9.3, 9.7) in 2008/2009, rising to 10.0 (9.8, 10.2) in 2012/1203. Prevalence increased in men but not women following the recession, associated with increased unemployment. Following introduction of the QOF, GPs used more non-QOF-qualifying symptom or other codes than QOF-qualifying diagnostic codes for new episodes.
  
  
  CONCLUSIONS
  Clinical data recording is probably incomplete. Participating practices were relatively large and not representative across English regions.
  
  
  CONCLUSIONS
  Rates of recorded depression in English general practices were falling prior to the economic recession but increased again subsequently, among men, associated with increased unemployment. GPs responded to the QOF by switching from diagnostic to symptom codes, removing most depressed patients from the denominator for measuring GP performance in assessing depression.
authors.affiliation: Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST, UK. Electronic address: A.R.Kendrick@Southampton.ac.uk.
authors.forename: Tony
authors.initials: T
authors.lastname: Kendrick
authors.affiliation: Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST, UK.
authors.forename: Beth
authors.initials: B
authors.lastname: Stuart
authors.affiliation: Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST, UK.
authors.forename: Colin
authors.initials: C
authors.lastname: Newell
authors.affiliation: Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST, UK.
authors.forename: Adam W A
authors.initials: AW
authors.lastname: Geraghty
authors.affiliation: Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Moore
mesh_terms: D003863:Depression / Q000453:epidemiology*; D057172:Economic Recession; D004739:England / Q000453:epidemiology; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*
keywords: Depression; Economic recession; Pay for performance; Prevalence; Primary care; QOF