Prevalence of mental illness in primary care and its association with deprivation and social fragmentation at the small-area level in England

Abstract

BackgroundWe aimed to spatially describe mental illness prevalence in England at small-area geographical level, as measured by prevalence of depression, severe mental illness (SMI) and antidepressant prescription volume in primary care records, and how much of their variation was explained by deprivation, social fragmentation and sociodemographic characteristics.MethodsInformation on prevalence of depression and SMI was obtained from the Quality and Outcomes Framework (QOF) administrative dataset for 2015/16 and the national dispensing dataset for 2015/16. Linear regression models were fitted to examine ecological associations between deprivation, social fragmentation, other sociodemographic characteristics and mental illness prevalence.ResultsMental illness prevalence varied within and between regions, with clusters of high prevalence identified across England. Our models explained 33.4–68.2% of variability in prevalence, but substantial variability between regions remained after adjusting for covariates. People in socially cohesive and socially deprived areas were more likely to be diagnosed with depression, while people in more socially fragmented and more socially deprived areas were more likely to be diagnosed with SMI.ConclusionsOur findings suggest that to tackle mental health inequalities, attention needs to be targeted at more socially deprived localities. The role of social fragmentation warrants further investigation, and it is possible that depression remains undiagnosed in more socially fragmented areas. The wealth of routinely collected data can provide robust evidence to aid optimal resource allocation. If comparable data are available in other countries, similar methods could be deployed to identify high prevalence clusters and target funding to areas of greater need.

Incidence and prevalence of primary care antidepressant prescribing in children and young people in England, 1998–2017: A population-based cohort study

“…A previous study reported that for people of all ages in England, the prevalence of antidepressant prescriptions was lowest in London and highest in the North East of England [24]. We also found the lowest incident prescription rates in London; however, the North East was the next lowest area for adolescents.…”

“…Our study has good face validity because we found similar trends to those published elsewhere. For example, we found that after adjustment for GP practice clustering and region, CYP living in more deprived areas are more likely to receive antidepressant prescriptions compared with those in the less deprived areas, which has previously been shown for children and adolescents [15,16] and adults [24] in the UK. Although the unadjusted results showed lower antidepressant prescribing in adolescents living in the most deprived quintile (S2 Fig), this was due to the lower prescribing and large proportion of people living in the most deprived quintile in London.…”

“…Increased prescribing of antidepressants could indicate a greater awareness and recognition of mental health and related issues and a willingness to seek help in the form of being diagnosed and/or treated. There is some evidence that in people of all ages, antidepressant prescribing varies by region [24] and between different ethnic groups in England [25,26]. Previous studies showing that CYP living in more deprived areas are more likely to receive antidepressant prescriptions have not taken region or ethnicity into account [15,16].…”

“…There could be differences in antidepressant prescribing patterns between CYP and adults, including initiating prescribing and the number of prescriptions because of the length of time people stay on antidepressants affecting the prevalence analysis, that account for this difference. Our study examined prescriptions, whilst Grigoroglou and colleagues [24] used dispensing data, so differences in whether patients filled their prescriptions may also exist.…”

The prevalence of psychological distress and relationships with social fragmentation and isolation: a geospatial study and survey in rural Australia

“…When deriving the K10 score, items 3 and 6 were recoded to "none of the time" if the response to the previous question was also "none of the time", as per the standard interpretation [20]. Using previous Australian thresholds for likelihood of a clinical case, K10 scores were categorised into low (10)(11)(12)(13)(14)(15), moderate (16)(17)(18)(19)(20)(21)(22)(23)(24)(25) and high (26-50) groups [21].…”