title: Does depression diagnosis and antidepressant prescribing vary by location? Analysis of ethnic density associations using a large primary-care dataset.
abstract: BACKGROUND
  Studies have linked ethnic differences in depression rates with neighbourhood ethnic density although results have not been conclusive. We looked at this using a novel approach analysing whole population data covering just over one million GP patients in four London boroughs.
  
  
  METHODS
  Using a dataset of GP records for all patients registered in Lambeth, Hackney, Tower Hamlets and Newham in 2013 we investigated new diagnoses of depression and antidepressant use for: Indian, Pakistani, Bangladeshi, black Caribbean and black African patients. Neighbourhood effects were assessed independently of GP practice using a cross-classified multilevel model.
  
  
  RESULTS
  Black and minority ethnic groups are up to four times less likely to be newly diagnosed with depression or prescribed antidepressants compared to white British patients. We found an inverse relationship between neighbourhood ethnic density and new depression diagnosis for some groups, where an increase of 10% own-ethnic density was associated with a statistically significant (p < 0.05) reduced odds of depression for Pakistani [odds ratio (OR) 0.81, 95% confidence interval (CI) 0.70-0.93], Indian (OR 0.88, CI 0.81-0.95), African (OR 0.88, CI 0.78-0.99) and Bangladeshi (OR 0.94, CI 0.90-0.99) patients. Black Caribbean patients, however, showed the opposite effect (OR 1.26, CI 1.09-1.46). The results for antidepressant use were very similar although the corresponding effect for black Caribbeans was no longer statistically significant (p = 0.07).
  
  
  CONCLUSIONS
  New depression diagnosis and antidepressant use was shown to be less likely in areas of higher own-ethnic density for some, but not all, ethnic groups.
authors.affiliation: Division of Health & Social Care Research,Faculty of Life Sciences & Medicine,King's College London,Addison House,Guy's Campus,London,UK.
authors.forename: P
authors.initials: P
authors.lastname: Schofield
authors.affiliation: Institute of Psychiatry, Psychology & Neuroscience,King's College London,UK.
authors.forename: J
authors.initials: J
authors.lastname: Das-Munshi
authors.affiliation: Centre for Primary Care and Public Health,Queen Mary University of London,UK.
authors.forename: R
authors.initials: R
authors.lastname: Mathur
authors.affiliation: Centre for Primary Care and Public Health,Queen Mary University of London,UK.
authors.forename: P
authors.initials: P
authors.lastname: Congdon
authors.affiliation: Centre for Primary Care and Public Health,Queen Mary University of London,UK.
authors.forename: S
authors.initials: S
authors.lastname: Hull
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D044383:Black People; D066264:Datasets as Topic; D003866:Depressive Disorder / Q000188:drug therapy* / Q000208:ethnology*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008131:London / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D012044:Regression Analysis; D012111:Residence Characteristics; D044465:White People; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents
keywords: Antidepressants; depression; ethnicity