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Research

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

Anneli Borge Hansen, Valborg Baste, Oystein Hetlevik, Inger Haukenes, Tone Smith-Sivertsen and Ruths Sabine
BJGP Open 24 November 2020; BJGPO.2020.0122. DOI: https://doi.org/10.3399/BJGPO.2020.0122
Anneli Borge Hansen
1 Research Unit for General Practice, NORCE Norwegian Research Centre AS, Bergen, Norway
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  • For correspondence: ahan@norceresearch.no
Valborg Baste
2 Research Unit for General Practice, NORCE Norwegian Research Centre AS, Bergen, Norway
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Oystein Hetlevik
3 Department of Global Public Health and Primary Care, University of Bergen Department of Medicine, Bergen, Norway
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Inger Haukenes
4 Research Unit for General Practice, NORCE Norwegian Research Centre AS, Bergen, Norway
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Tone Smith-Sivertsen
5 Research Unit for General Practice, NORCE Norwegian Research Centre AS, Bergen, Norway
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Ruths Sabine
6 Department of Global Public Health and Primary Care, University of Bergen Department of Medicine, Bergen, Norway
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Abstract

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

  • Mental health
  • Depression
  • Patient groups
  • Family medicine
  • Research methods
  • Large database research
  • Received July 10, 2020.
  • Accepted July 30, 2020.
  • Copyright © 2020, The Authors

This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/)

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Accepted Manuscript
General practitioners’ drug treatment for depression by patients’ educational level: registry-based study
Anneli Borge Hansen, Valborg Baste, Oystein Hetlevik, Inger Haukenes, Tone Smith-Sivertsen, Ruths Sabine
BJGP Open 24 November 2020; BJGPO.2020.0122. DOI: 10.3399/BJGPO.2020.0122

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Accepted Manuscript
General practitioners’ drug treatment for depression by patients’ educational level: registry-based study
Anneli Borge Hansen, Valborg Baste, Oystein Hetlevik, Inger Haukenes, Tone Smith-Sivertsen, Ruths Sabine
BJGP Open 24 November 2020; BJGPO.2020.0122. DOI: 10.3399/BJGPO.2020.0122
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Keywords

  • Mental health
  • Depression
  • Patient groups
  • family medicine
  • Research methods
  • Large database research

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