title: A longitudinal study of educational differences in antidepressant use before and after hospital care for depression.
abstract: Despite social inequalities in depression various studies report small or even reversed social gradients for antidepressant treatment, suggesting unmet need for treatment among those with low social position. However, few studies assess need for treatment or compare longitudinal antidepressant use patterns between socioeconomic groups.
  
  
  
  We used a nationally representative register cohort of Finnish adults with hospital care for depression in 1998-2007 (n = 7249). We compared the prevalence of any use and daily use of antidepressants across educational groups in consecutive 3-month periods up to 5 years before admission and 5 years after discharge, adjusting for important confounders.
  
  
  
  We found no educational differences in any antidepressant use in the 5 years leading to hospital care for depression but a 3-4 percentage-point higher prevalence among those with high education in the 3-month periods immediately preceding and following hospital care for depression. Furthermore, decline in the prevalence of antidepressant use after discharge was more rapid in low education resulting in a significant 4-6 percentage-point higher prevalence among the highly educated lasting until 2.5 years after discharge. Daily use was significantly more common among the highly educated for a year before admission, immediately after discharge and for 2.5 years thereafter, the excess being 3-8 percentage-points.
  
  
  
  Our results suggest rather equitable access to antidepressant treatment at the time of evident need, i.e. immediately after discharge from hospital care for depression. However, early discontinuation of treatment as well as below guideline use of antidepressants were more common among the low educated.
authors.affiliation: Department of Social Research, Population Research Unit, University of Helsinki, Helsinki, Finland heta.moustgaard@helsinki.fi.
authors.forename: Heta
authors.initials: H
authors.lastname: Moustgaard
authors.affiliation: Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Kaisla
authors.initials: K
authors.lastname: Joutsenniemi
authors.affiliation: Department of Social Research, Population Research Unit, University of Helsinki, Helsinki, Finland.|Laboratory of Population Health, Max Planck Institute for Demographic Research, Rostock, Germany.|Centre for Health Equity Studies (CHESS), Stockholm University and Karolinska Institutet, Stockholm, Sweden.
authors.forename: Pekka
authors.initials: P
authors.lastname: Martikainen
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000188:drug therapy*; D004363:Drug Utilization; D004522:Educational Status; D005260:Female; D005387:Finland; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors
chemical_list: D000928:Antidepressive Agents