Patient-reported depression treatment and future treatment preferences: an observational study in general practice

Hetlevik, Øystein; Garre-Fivelsdal, Gina Dorothea; Bjorvatn, Bjørn; Hjörleifsson, Stefán; Ruths, Sabine

doi:10.1093/fampra/cmz026

Cited by 12 publications

(6 citation statements)

References 31 publications

(39 reference statements)

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“…A survey among patients in GP waiting rooms in Norway showed that lower educational level was associated with greater preference for medication. 35 The association between educational level and drug treatment found in our study among women only, may suggest that highly educated women are more skeptical to medication in general. This may apply particularly to younger women since older women in the study population were less educated.…”

Section: Comparison With Existing Literaturementioning

confidence: 54%

General practitioners’ drug treatment for depression by patients’ educational level: registry-based study

et al. 2020

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Background: Antidepressant drugs are often prescribed in general practice. Evidence is conflicting on how patient education influences antidepressant treatment. Aim: To investigate the association between educational attainment and drug treatment in adult patients with a new depression diagnosis, and how gender and age influence the association. Design and setting: Nationwide registry-based cohort study, Norway, 2014-2016. Method: The study comprised all residents of Norway born before 1996 and alive in 2015. We obtained information on all new depression diagnoses in general practice in 2015 (Primary Care Database) and data on all dispensed depression medication (Norwegian Prescription Database) 12-months after the date of diagnosis. Independent variables were education, gender, and age. Associations with drug treatment were estimated using a Cox proportional hazard model, for genders separately. Results: Out of 49,967 patients with new depression (61.6% women), 15,678 were dispensed drugs (30.4% women, 33.0% men). Highly educated women were less likely to receive medication (Hazard Ratio (HR) =0.93, 95% CI (0.88 – 0.98)) than women with low education. No such differences appeared among men. Women aged 20-29 were more likely to be treated with drugs than those aged 30-59, and women aged 70+ were more likely to receive drugs (HR=1.65, (1.54 – 1.77)) than those aged 20-29. The pattern was similar but less pronounced for men. Conclusion: Educational differences in antidepressant therapy among women may reflect different treatment approaches that clinicians should be aware of to avoid unintended variation. Reasons for this variation and consequences for quality of treatment should be

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Section: Comparison With Existing Literaturementioning

confidence: 54%

General practitioners’ drug treatment for depression by patients’ educational level: registry-based study

et al. 2020

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“…A survey among patients in GP waiting rooms in Norway showed that lower educational level was associated with greater preference for medication. 34 The association between educational level and drug treatment found in the present Hansen AB et al BJGP Open 2021; DOI: 10.3399/BJGPO-2020-0122 study among women only, may suggest that highly educated women are more sceptical towards medication in general. This may apply particularly to younger women since older women in the study population were less educated.…”

Section: Comparison With Existing Literaturementioning

confidence: 65%

GPs’ drug treatment for depression by patients’ educational level: registry-based study

et al. 2021

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BackgroundAntidepressant drugs are often prescribed in general practice. Evidence is conflicting on how patient education influences antidepressant treatment.AimTo investigate the association between educational attainment and drug treatment in adult patients with a new depression diagnosis, and to what extent sex and age influence the association.Design & settingA nationwide registry-based cohort study was undertaken in Norway from 2014–2016.MethodThe study comprised all residents of Norway born before 1996 and alive in 2015. Information was obtained on all new depression diagnoses in general practice in 2015 (primary care database) and data on all dispensed depression medication (Norwegian Prescription Database [NorPD]) 12 months after the date of diagnosis. Independent variables were education, sex, and age. Associations with drug treatment were estimated using a Cox proportional hazard model and performed separately for sex.ResultsOut of 49 967 patients with new depression (61.6% women), 15 678 were dispensed drugs (30.4% women, 33.0% men). Highly educated women were less likely to receive medication (hazard ratio [HR] = 0.93; 95% confidence interval [CI] = 0.88 to 0.98) than women with low education. No such differences appeared among men. Women aged 20–29 years were more likely to be treated with drugs than those aged 30–59 years, and women aged ≥70 years were more likely to receive drugs (HR = 1.65; 95% CI = 1.54 to 1.77) than those aged 20–29 years. The pattern was similar but less pronounced for men.ConclusionEducational differences in antidepressant therapy among women may reflect different treatment approaches that clinicians should be aware of to avoid unintended variation. Reasons for this variation and consequences for quality of treatment should be explored.

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“… 54 , 55 Nonetheless, observational data of 28,498 patients referred for psychotherapy showed that patients with long-term somatic illnesses had similar outcomes compared to those without somatic comorbidity, excepted those with musculoskeletal condition, chronic obstructive pulmonary disease, and diabetes, considering that cases with somatic comorbidity needed more therapy sessions to achieve the same results. 56 , 57 …”

Section: Epidemiologymentioning

confidence: 99%

The Frail Depressed Patient: A Narrative Review on Treatment Challenges

Aprahamian¹,

Borges²,

Hanssen³

et al. 2022

CIA

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Although the public importance of frailty is widely acknowledged by the World Health Organization, physical frailty is still largely neglected in geriatric mental health care. Firstly in this narrative review, we summarize the knowledge on the epidemiology of the association between depression and frailty, whereafter implications for treatment will be discussed. Even though frailty and depression have overlapping diagnostic criteria, epidemiological studies provide evidence for distinct constructs which are bidirectionally associated. Among depressed patients, frailty has predictive validity being associated with increased mortality rates and an exponentially higher fall risk due to antidepressants. Nonetheless, guidelines on the treatment of depression neither consider frailty for risk stratification nor for treatment selection. We argue that frailty assessment enables clinicians to better target the pharmacological and psychological treatment of depression as well as the need for interventions targeting primarily frailty, for instance, lifestyle interventions and reduction of polypharmacy. Applying a frailty informed framework of depression treatment studies included in a meta-analysis reveals that the benefit–harm ratio of antidepressants given to frail depressed patients can be questioned. Nonetheless, frail-depressed patients should not withhold antidepressants as formal studies are not available yet, but potential adverse effects should be closely monitored. Dopaminergic antidepressants might be preferable when slowness is a prominent clinical feature. Psychotherapy is an important alternative for pharmacological treatment, especially psychotherapeutic approaches within the movement of positive psychology, but this approach needs further study. Finally, geriatric rehabilitation, including physical exercise and nutritional advice, should also be considered. In this regard, targeting ageing-related abnormalities underlying frailty that may also be involved in late-life depression such as low-grade inflammation might be a promising target for future studies. The lack of treatment studies precludes firm recommendations, but more awareness for frailty in mental health care will open a plethora of alternative treatment options to be considered.

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Patient-reported depression treatment and future treatment preferences: an observational study in general practice

Cited by 12 publications

References 31 publications

General practitioners’ drug treatment for depression by patients’ educational level: registry-based study

General practitioners’ drug treatment for depression by patients’ educational level: registry-based study

GPs’ drug treatment for depression by patients’ educational level: registry-based study

The Frail Depressed Patient: A Narrative Review on Treatment Challenges

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