{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T03:09:21Z","timestamp":1785467361592,"version":"3.56.0"},"reference-count":50,"publisher":"Cambridge University Press (CUP)","issue":"9","license":[{"start":{"date-parts":[[2017,10,11]],"date-time":"2017-10-11T00:00:00Z","timestamp":1507680000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Psychol. Med."],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0033291717003014_sec_a1\"><jats:title>Background<\/jats:title><jats:p>We do not know how primary care treatment of depression varies by age across both psychotropic medication and psychological therapies.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291717003014_sec_a2\" sec-type=\"methods\"><jats:title>Methods<\/jats:title><jats:p>Cohort study including 19 710 people aged 55+ with GP recorded depression diagnoses and 26 276 people with recorded depression symptoms during the period 2009\u20132013, from 373 General Practices in The Health Improvement Network (THIN) database in England. Main outcomes were initiation of treatment with anti-depressants, anxiolytics, hypnotics, anti-psychotic drugs, referrals to psychological therapies within 6 months of onset.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291717003014_sec_a3\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>Treatment rates with antidepressants are high for those recorded with new depression diagnoses (87.1%) or symptoms of depression (58.7%). Treatment in those with depression diagnoses varies little by age. In those with depressive symptoms there was a J-shaped pattern with reduced antidepressant treatment in those in their 60s and 70s followed by increased treatment in the oldest age groups (85+ years), compared with those aged 55\u201359 years. Other psychotropic drug prescribing (hypnotics\/anxiolytics, antipsychotics) all increase with increasing age. Recorded referrals for psychological therapies were low, and decreased steadily with increasing age, such that women aged 75\u201379 years with depression diagnoses had around six times lower odds of referral (OR 0.17, 95% CI 0.1\u20130.29) than those aged 55\u201359 years, and men aged 80\u201384 years had around seven times lower (OR 0.14, 95% CI 0.05\u20130.36).<\/jats:p><\/jats:sec><jats:sec id=\"S0033291717003014_sec_a4\" sec-type=\"conclusion\"><jats:title>Conclusions<\/jats:title><jats:p>The oldest age groups with new depression diagnoses and symptoms have fewer recorded referrals to psychological therapies, and higher psychotropic drug treatment rates in primary care. This suggests potential inequalities in access to psychological therapies.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s0033291717003014","type":"journal-article","created":{"date-parts":[[2017,10,11]],"date-time":"2017-10-11T03:14:42Z","timestamp":1507691682000},"page":"1504-1513","source":"Crossref","is-referenced-by-count":32,"title":["Sociodemographic inequalities in the management of depression in adults aged 55 and over: an analysis of English primary care data"],"prefix":"10.1017","volume":"48","author":[{"given":"K.","family":"Walters","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Falcaro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Freemantle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"King","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y.","family":"Ben-Shlomo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2017,10,11]]},"reference":[{"key":"S0033291717003014_ref5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2012.11.053"},{"key":"S0033291717003014_ref8","doi-asserted-by":"publisher","DOI":"10.1080\/01634372.2013.811144"},{"key":"S0033291717003014_ref42","doi-asserted-by":"publisher","DOI":"10.2307\/1403146"},{"key":"S0033291717003014_ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.maturitas.2014.05.027"},{"key":"S0033291717003014_ref38","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2014.1763"},{"key":"S0033291717003014_ref43","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2009.165"},{"key":"S0033291717003014_ref9","doi-asserted-by":"publisher","DOI":"10.1046\/j.1532-5415.2003.51555.x"},{"key":"S0033291717003014_ref14","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.112.118307"},{"key":"S0033291717003014_ref6","unstructured":"Centre HaSCI (2012). Prescriptions Dispensed in the Community, Statistics for England \u2013 2001\u20132011. Health and Social Care Information Centre. www.hscic.gov.uk"},{"key":"S0033291717003014_ref2","first-page":"251","article-title":"Generalisability of The Health Improvement Network (THIN) database: demographics, chronic disease prevalence and mortality rates","volume":"19","author":"Blak","year":"2011","journal-title":"Informatics in Primary Care"},{"key":"S0033291717003014_ref24","volume-title":"British National Formulary","year":"2013"},{"key":"S0033291717003014_ref36","unstructured":"National Institute for Health and Care Excellence (NICE) (2009, updated April 2016). Clinical Guideline 90, Depression in Adults : Recognition and Management. https:\/\/www.nice.org.uk\/guidance\/cg90\/chapter\/1-Guidance (last accessed 08.06.17)."},{"key":"S0033291717003014_ref37","doi-asserted-by":"publisher","DOI":"10.1097\/01.JGP.0000308883.64832.ed"},{"key":"S0033291717003014_ref30","unstructured":"Lubian K , Weich S , Stansfeld S , Bebbington P , Brugha T , Spiers N , McManus S , Cooper C (2016). Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2014. Chapter 3: Mental Health Treatment and Service Use. Published September 29, 2016 http:\/\/content.digital.nhs.uk\/catalogue\/PUB21748 (last accessed 11.11.16)."},{"key":"S0033291717003014_ref20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2010.09.005"},{"key":"S0033291717003014_ref41","unstructured":"Royal College of Psychiatrists (2013). Report of the Second Round of the National Audit of Psychological Therapies (NAPT) 2013. Healthcare Quality Improvement Partnership: London. http:\/\/www.rcpsych.ac.uk\/workinpsychiatry\/qualityimprovement\/nationalclinicalaudits\/psychologicaltherapies\/psychologicaltherapies.aspx (last accessed 02.09.16)."},{"key":"S0033291717003014_ref28","doi-asserted-by":"publisher","DOI":"10.1002\/pds.1115"},{"key":"S0033291717003014_ref1","doi-asserted-by":"publisher","DOI":"10.1002\/gps.4443"},{"key":"S0033291717003014_ref3","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1046\/j.1365-2532.1994.1130177.x","article-title":"What are the read codes?","volume":"11","author":"Booth","year":"1994","journal-title":"Health Libraries Review"},{"key":"S0033291717003014_ref44","first-page":"639","article-title":"A systematic review of amnestic and non-amnestic mild cognitive impairment induced by anticholinergic, antihistamine, GABAergic and opioid drugs","volume":"29","author":"Tannenbaum","year":"2012","journal-title":"Drugs and Aging"},{"key":"S0033291717003014_ref4","first-page":"171","article-title":"Feasibility study and methodology to create a quality-evaluated database of primary care data","volume":"12","author":"Bourke","year":"2004","journal-title":"Informatics in Primary Care"},{"key":"S0033291717003014_ref11","doi-asserted-by":"publisher","DOI":"10.1002\/pds.1770"},{"key":"S0033291717003014_ref12","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2011.139873"},{"key":"S0033291717003014_ref13","unstructured":"Department for Communities and Local Government (2010). 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