eprintid: 1573728 rev_number: 38 eprint_status: archive userid: 608 dir: disk0/01/57/37/28 datestamp: 2017-10-26 13:57:05 lastmod: 2021-11-17 23:41:02 status_changed: 2017-10-26 13:57:05 type: article metadata_visibility: show creators_name: Walters, KR creators_name: Falcaro, M creators_name: Freemantle, N creators_name: King, M creators_name: Ben-Schlomo, Y title: Socio-demographic inequalities in the management of depression in adults aged 55 and over: an analysis of English primary care data ispublished: pub divisions: UCL divisions: B02 divisions: C07 divisions: D79 divisions: C09 divisions: D65 divisions: H20 divisions: D12 divisions: G20 keywords: Depression, older people, primary care, treatment. note: © Cambridge University Press 2017. This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. abstract: We do not know how primary care treatment of depression varies by age across both psychotropic medication and psychological therapies. Cohort study including 19 710 people aged 55+ with GP recorded depression diagnoses and 26 276 people with recorded depression symptoms during the period 2009–2013, from 373 General Practices in The Health Improvement Network (THIN) database in England. Main outcomes were initiation of treatment with anti-depressants, anxiolytics, hypnotics, anti-psychotic drugs, referrals to psychological therapies within 6 months of onset. Treatment rates with antidepressants are high for those recorded with new depression diagnoses (87.1%) or symptoms of depression (58.7%). Treatment in those with depression diagnoses varies little by age. In those with depressive symptoms there was a J-shaped pattern with reduced antidepressant treatment in those in their 60s and 70s followed by increased treatment in the oldest age groups (85+ years), compared with those aged 55–59 years. Other psychotropic drug prescribing (hypnotics/anxiolytics, antipsychotics) all increase with increasing age. Recorded referrals for psychological therapies were low, and decreased steadily with increasing age, such that women aged 75–79 years with depression diagnoses had around six times lower odds of referral (OR 0.17, 95% CI 0.1–0.29) than those aged 55–59 years, and men aged 80–84 years had around seven times lower (OR 0.14, 95% CI 0.05–0.36). The oldest age groups with new depression diagnoses and symptoms have fewer recorded referrals to psychological therapies, and higher psychotropic drug treatment rates in primary care. This suggests potential inequalities in access to psychological therapies. date: 2018-07 date_type: published publisher: Cambridge University Press official_url: http://doi.org/10.1017/S0033291717003014 oa_status: green full_text_type: other language: eng primo: open primo_central: open_green article_type_text: Article verified: verified_manual elements_id: 1421095 doi: 10.1017/S0033291717003014 lyricists_name: Falcaro, Milena lyricists_name: Freemantle, Nicholas lyricists_name: King, Michael lyricists_name: Walters, Katherine lyricists_id: MFALC34 lyricists_id: NDRFR82 lyricists_id: MBKIN92 lyricists_id: KWALT44 actors_name: Walters, Katherine actors_id: KWALT44 actors_role: owner full_text_status: public publication: Psychological Medicine volume: 48 number: 9 pagerange: 1504-1513 issn: 0033-2917 citation: Walters, KR; Falcaro, M; Freemantle, N; King, M; Ben-Schlomo, Y; (2018) Socio-demographic inequalities in the management of depression in adults aged 55 and over: an analysis of English primary care data. Psychological Medicine , 48 (9) pp. 1504-1513. 10.1017/S0033291717003014 <https://doi.org/10.1017/S0033291717003014>. Green open access document_url: https://discovery-pp.ucl.ac.uk/id/eprint/1573728/1/PsycholMed_Age_depression_revised_abstract_090917.docx document_url: https://discovery-pp.ucl.ac.uk/id/eprint/1573728/3/Psychol%20Med%20Age_ineq_dep_Table1_final_090917.docx document_url: https://discovery-pp.ucl.ac.uk/id/eprint/1573728/5/PsycholMed_Ageineq_Tables2-5_final_revised_090917.docx document_url: https://discovery-pp.ucl.ac.uk/id/eprint/1573728/7/PsycholMed_Agedepression_supptable1_revised_090917.docx