The EU referendum and mental health in the short term: a natural experiment using antidepressant prescriptions in England

Abstract

BackgroundPrevious research has highlighted the impact of economic conditions and uncertainty on physical and mental health. The unexpected result of the Brexit referendum in 2016 triggered high levels of economic uncertainty.ObjectiveTo examine whether prescriptions for antidepressants increased after the referendum result, benchmarking them against other drug classes.MethodsWe used GP practice prescribing data to compile the number of defined daily doses per capita every month in each of the 326 voting areas in England over the period 2011–2016. We used a difference-in-differences (DID) approach to identify the effects of Brexit on antidepressant prescriptions, compared with trends in a control group (antigout and iron preparations) that were unlikely to be associated with uncertainty and depression.ResultsAntidepressant prescribing continued to increase after the referendum but at a slower pace. Therapeutic classes used as controls showed a decrease. The DID approach shows that there was a relative increase of 13.4% in antidepressants compared with other therapeutic classes (DID coeff: 0.134; 95% CI 0.093 to 0.174).ConclusionOur results are open to different interpretations and should be treated with caution. This relative increase in antidepressant prescribing after the referendum may be attributed to increased uncertainty for certain parts of the population, but does not rule out an improvement in mood for others. Alternatively, some other factor—for example, distraction, might have contributed to a decrease in the control therapeutic classes. A possible policy implication is that programmes for the promotion of mental health may need to be intensified during periods of uncertainty.

Brexit and European doctors’ decisions to leave the United Kingdom: a qualitative analysis of free-text questionnaire comments

“…Our results also show support for previous research suggesting that Brexit may result in psychological distress [ 28 ], feeling of national rejection and loss of nationality [ 28 , 31 ], and fear of losing the recognition of qualifications earned elsewhere [ 31 , 32 ]. Our findings related to perceived strain on working relationships are especially concerning as doctors continue to address the COVID-19 pandemic, because a poor clinical working environment has not only been linked to negative mental health and well-being consequences for staff [ 19 , 20 ], but also quality of care [ 21 ] and patient safety and outcomes [ 22 , 23 ].…”

“…This invites the question as to whether the same association could be applied to political circumstances which may affect doctors’ personal well-being and happiness. Indeed, it has been suggested that Brexit may have led to some degree of psychological distress from the uncertainty of immigration status, ability to work, feeling of national rejection and the economic implications of Brexit [ 28 ].…”

The effect of the Brexit Referendum Result on Subjective Well-being

“…First, using data from the Eurobarometer between 2015–2019, we consider the referendum as the ‘event’ of a quasi‐experiment and apply a difference‐in‐differences approach, to identify its effects on subjective well‐being of individuals in the United Kingdom compared to those in a control group of other European countries, which are not exposed to the treatment (referendum). A previous study on the Brexit referendum result uses a narrower outcome measure, physician antidepressant prescriptions (Vandoros et al., 2018); which, as the authors acknowledge, is not as informative in determining the well‐being implications for society as whole and does not capture any changes in mood or mental health of people who do not take antidepressants. There have also been reports of individuals that have been experiencing mental health issues following the referendum (Katshu, 2019; The Independent, 2017).…”

No evidence of increase in suicide in Greece during the first wave of Covid-19

“…Financial hardship is associated with mental health problems, [6][7][8] and events at the national level can also affect mental health and wellbeing. [9][10] Increased suicide rates are often observed during recessions or times of rising unemployment, [11][12][13][14][15] although some studies have found little or no evidence of a positive link between recessions and suicide. [16][17][18] Economic uncertainty has risen to unprecedented levels during the Covid-19 pandemic, [19][20] and previous evidence suggests that economic uncertainty is associated with increased suicide rates.…”