Trends in treatment for patients with depression in general practice in Norway, 2009–2015: nationwide registry-based cohort study (The Norwegian GP-DEP Study)

Abstract

Background Depression is highly prevalent, but knowledge is scarce as to whether increased public awareness and strengthened government focus on mental health have changed how general practitioners (GPs) help their depressed patients. This study aimed to examine national time trends in GP depression care and whether trends varied regarding patient gender, age, and comorbidity. Methods Nationwide registry-based cohort study, Norway. The study population comprised all residents aged 20 years or older with new depression diagnoses recorded in general practice, 2009–2015. We linked reimbursement claims data from all consultations in general practice for depression with information on demographics and antidepressant medication. The outcome was type(s) of GP depression care during 12 months from the date of diagnosis: (long) consultation, talking therapy, antidepressant drug treatment, sickness absence certification, and referral to secondary mental health care. Covariates were patient gender, age, and comorbidity. The data are presented as frequencies and tested with generalized linear models. Results We included 365,947 new depression diagnoses. Mean patient age was 44 years (SD = 16), 61.9 % were women, 41.2 % had comorbidity. From 2009 to 2015, proportions of patients receiving talking therapy (42.3–63.4 %), long consultations (56.4–71.8 %), and referral to secondary care (16.6–21.6 %) increased, while those receiving drug treatment (31.3–25.9 %) and sick-listing (58.1–50 %) decreased. The trends were different for gender (women had a greater increase in talking therapy and a smaller decrease in sick-listing, compared to men), age (working-aged patients had a smaller increase in talking therapy, a greater increase in long consultations, and a smaller decrease in antidepressant drug use, compared to older patients) and comorbidity (patients with mental comorbidity had a smaller increase in talking therapy and a greater increase in long consultations, compared to those with no comorbidity and somatic comorbidity). Conclusions The observed time trends in GP depression care towards increased provision of psychological treatment and less drug treatment and sick-listing were in the desired direction according to Norwegian health care policy. However, the large and persistent differences in treatment rates between working-aged and older patients needs further investigation.

Patient experiences with depression care in general practice: a qualitative questionnaire study

“…According to a Norwegian study from 2019 and an Australian study from 2017 [ 25 , 35 ] on patient-reported depression treatment in general practice, many depressed patients prefer other forms of treatment than antidepressants. Our study supports these findings, and another Norwegian study found that the proportion of patients receiving antidepressant treatment decreased in the period 2009–2015 [ 8 ]. However, our study also suggests that one of the reasons patients do not want antidepressants is that they do not want such treatment in the absence of follow-up.…”

“…According to earlier international studies more than 90% of patients consulting for depression were treated by GPs alone [ 7 ]. Today, 20% of patients with a new diagnosis of depression in Norway are referred to specialised care [ 8 ]. In addition, an increasing proportion of patients probably seeks help from private therapists or from community-based low-threshold services, although there is no official statistics on the extent to which these services are being used.…”

Practice characteristics influencing variation in provision of depression care in general practice in Norway; a registry-based cohort study (The Norwegian GP-DEP study)

“…Long GP-patient relationship (9–14 years) was more common among patients 40 years and older, while short GP-patient relationship (1–2 years) was more common among those younger than 40 years. It has been documented that referral rates to specialist health care among older patients in Norway and the UK were lower than for younger patients [ 24 , 25 ]. Our analysis was adjusted for patients’ age, we also performed stratified analyzes by age, which gave similar estimates in both strata.…”

Comparison of depression care provided in general practice in Norway and the Netherlands: registry-based cohort study (The Norwegian GP-DEP study)

“…For each prescription of an antidepressant drug, NorPD provided information on date of dispensing and generic drug information (Anatomical Therapeutic Chemical (ATC) code). Data sources and variables have been described previously [ 10 ].…”

“…Most antidepressants are prescribed by GPs [ 2 , 3 ], but the prescribing levels vary considerably between countries [ 4 – 8 ]. Recent studies indicate trends towards less drug treatment in the Netherlands, UK, and Norway [ 7 , 9 , 10 ], while treatment rates remained stable in the US [ 8 ]. The number of GP contacts for depression increased in the Netherlands [ 4 , 9 ] but was unchanged in Norway [ 10 ].…”