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Social inequalities in antidepressant treatment and mortality: a longitudinal register study

  • MIKA KIVIMÄKI (a1) (a2), DAVID GUNNELL (a3), DEBBIE A. LAWLOR (a3), GEORGE DAVEY SMITH (a3), JAANA PENTTI (a1), MARIANNA VIRTANEN (a1), MARKO ELOVAINIO (a4), TIMO KLAUKKA (a5) and JUSSI VAHTERA (a2)...

Abstract

Background. Despite an increased prevalence of depression among people of low socio-economic position, it remains unclear whether their treatment with antidepressants appropriately matches their increased need compared with people from more affluent backgrounds. This study examined socio-economic differences in antidepressant prescriptions and mortality related to depressive disorders.

Method. A longitudinal register study of 17947 male and 47458 female local government employees with linked information on socio-economic indicators (education and occupational status) and data on antidepressant use and mortality associated with depressive disorder (suicide, alcohol-related deaths) during the years 1994 to 2000.

Results. In men, antidepressant treatment was less common among low educational groups than among high educational groups (OR 0·87, 95% CI 0·76–0·99) and a corresponding difference was seen between occupational statuses (OR for manual v. upper non-manual 0·72, 95% CI 0·62–0·84). In women, socio-economic position was not associated with antidepressant use. However, both among the men and women, employees with low socio-economic position had increased risk for mental-health-related mortality, as indicated by suicides, deaths from alcohol-related causes, and all-cause mortality.

Conclusions. These data suggest a mismatch in the treatment of depression relative to apparent clinical need, with the lowest levels of treatment concentrated in the lower socio-economic groups, despite evidence of their increased prevalence of depression and suicide.

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Corresponding author

Finnish Institute of Occupational Health, Topeliuksenkatu 41 aA, FI-00250 Helsinki, Finland. (Email: mika.kivimaki@ttl.fi)

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