BACKGROUND: Depression is prevalent, costly and often undertreated. AIMS: To test the hypothesis that people with low socio-economic status are least likely to receive and adhere to evidence-based treatments for depression, after controlling for clinical need. METHOD: Individuals with an ICD-10 depressive episode in the past 12 months (n=866) were recruited from 7271 attendees in 36 general practices in England and Wales. Depressive episodes were identified using the 12-month Composite International Diagnostic Interview. Treatment receipt and adherence were assessed by structured interview, and rated using evidence-based criteria. RESULTS: We identified 332 individuals (38.3%) who received and adhered to evidence-based treatment. There were few socio-economic differences in treatment allocation. Although those without educational qualifications were least likely to receive psychological treatments (OR = 0.55,95% CI 0.34-0.89, P = 0.02), this association was not statistically significant after adjusting for depression severity. CONCLUSIONS: We found no evidence of inverse care in the treatment of moderate and severe depression in primary care in England and Wales.
BACKGROUND:Depression is prevalent, costly and often undertreated. AIMS: To test the hypothesis that people with low socio-economic status are least likely to receive and adhere to evidence-based treatments for depression, after controlling for clinical need. METHOD: Individuals with an ICD-10 depressive episode in the past 12 months (n=866) were recruited from 7271 attendees in 36 general practices in England and Wales. Depressive episodes were identified using the 12-month Composite International Diagnostic Interview. Treatment receipt and adherence were assessed by structured interview, and rated using evidence-based criteria. RESULTS: We identified 332 individuals (38.3%) who received and adhered to evidence-based treatment. There were few socio-economic differences in treatment allocation. Although those without educational qualifications were least likely to receive psychological treatments (OR = 0.55,95% CI 0.34-0.89, P = 0.02), this association was not statistically significant after adjusting for depression severity. CONCLUSIONS: We found no evidence of inverse care in the treatment of moderate and severe depression in primary care in England and Wales.