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Research project: CPRD How has the GP management of depression changed in the last 10 years?

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GPs are prescribing more and more antidepressants, and it has been suggested that depression is increasing, particularly since the economic recession in 2008. This study looks at GP recording of depression over 10 years to see if depression has been increasing in incidence, or if people are being treated more frequently, or for longer. It also looks at the effects of NICE guidelines on depression and the depression indicators in the GP contract quality and outcomes framework (QOF) pay for performance scheme, on rates of diagnosis and treatment.

Aim: To determine how the GP management of depression has changed in England since 2003, exploring the effects of the recession, NICE guidelines, and the Quality and Outcomes Framework (QOF).

Research questions: Have antidepressant prescriptions increased because of an increase in the number of people treated, in particular since the economic recession, or because GPs are prescribing longer courses of treatment, in line with NICE guidance? Did prescribing and referral patterns change following the introduction of symptom questionnaires incentivised through the QOF? Was treatment appropriately targeted towards patients with higher symptom scores at diagnosis and follow-up?

Methods: Descriptive study using routinely collected data on 297,000 patients diagnosed with depression between April 2003 and March 2013, from 142 English practices contributing to the Clinical Practice Research Datalink (CPRD) for the whole period. Their records will be examined to determine numbers and length of antidepressant prescriptions, and psychology and psychiatry referrals. We will exclude patients prescribed antidepressants for other indications and people with psychotic diagnoses including bipolar disorder. Diagnoses will be categorised as first-ever or recurrent, allowing estimation of changes in the incidence as well as prevalence of depression. We will conduct time series analyses to look for changes in diagnosis and treatment rates after the recession of 2008, after the QOF incentivised severity questionnaires were introduced in 2006, and after the NICE Depression guidelines of 2004 and 2009. Logistic regression will be used to determine relationships between symptom questionnaire scores, prescriptions, and referrals, controlling for other relevant factors including demographics and physical comorbidities.


Chief Investigator: Professor Tony Kendrick


Duration: 2014-2015


Funder: NIHR School for Primary Care Research


CONTACT for the study:



Related research groups

Primary Care, Population Sciences and Medical Education
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