Background: The European Mental Health Action Plan (EMHAP) 2013-2020 promoted community-based mental health services. One potential success indicator is the provision of antidepressant medication to those needing it.
Methods: Public data from two surveys (Health Survey for England, UK; Survey of Health, Ageing and Retirement in Europe) covered 19 European countries across EMHAP phases one (2011-2015) and two (2015-2018). People screening positive for depressive symptoms by self-report were included. The primary outcome was antidepressant use: using country-specific weighted regression models, we estimated temporal trends and subgroup disparities in antidepressant receipt, with secondary analysis by country-level measures including healthcare expenditure.
Findings: Across 37,250 participants, after controlling for age, sex, wealth, and physical disability, antidepressant use (amongst those screening positive) increased significantly in 14/19 countries, with the smallest increase being in Slovenia (adjusted OR[AOR] for trend=1.68[1.20-2.36]) and the highest increase being in Germany (AOR for trend=10.07[7.54-13.46]) and Austria (AOR for trend=10.07[7.32-13.74]). The overall proportion using antidepressants was positively associated with national health expenditure (coefficient=5.43[1.62-9.25]), but not with gross national income per capita or the number of psychiatrists, general practitioners, or psychiatric hospital beds. In 15/19 countries, antidepressants were used less by ≥65-year-olds than 50-64-year-olds, with the smallest differential reported in Luxembourg (AOR=0.70[0.49, 0.98]) and the highest in Germany (AOR=0.28[0.21, 0.37]); this disparity widened in 12/15 countries. Men used antidepressants less than women in 8/19 countries, across phases. In 13/19 countries, people with physical disability were more likely to receive antidepressants, with the smallest gap in Italy (AOR=1.42[1.12-1.80]) and the largest in Israel (AOR=2.34[1.46-3.74]); this disparity narrowed in 5/13 countries. Disparity by wealth was found in 8/19 countries, but its temporal trend varied.
Interpretation: Usage of antidepressants by those with depressive symptoms has increased, with wide variation between countries and subgroups. Disparities across age, sex, and disability should prompt further research.
Funding: Medical Research Council (grants MC_PC_17213 and MR/W014386/1), UK National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) East of England, NIHR Cambridge Biomedical Research Centre (BRC-1215-20014).
Keywords: ADL, activities of daily living; AOR, adjusted odds ratio; ARC, applied research collaboration; Antidepressants; BNF, British national formulary; CI, confidence interval; Depression; Disparity; EMHAP, European mental health action plan; European; GDP, gross domestic product; GHQ-12, 12-item general health questionnaire; GNI, gross national income per capita; GP, general practitioner; HSE, health survey for England; IAPT, improving access to psychological therapies; IMD, index of multiple deprivation; NHS, National Health Service; NIHR, National Institute for Health Research; OR, odds ratio; SHARE, survey of health, ageing and retirement in Europe; STROBE, strengthening the reporting of observational studies in epidemiology; UK, United Kingdom; USA, United States of America; WHO, World Health Organization.
© 2022 The Author(s).