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Antidepressant prescribing rose in England after EU referendum

Mental health provision ought to be strengthened during future periods of uncertainty

Louise Prime

Thursday, 22 November 2018

Increased uncertainty about the future might have lain behind the rise in antidepressant prescribing in England after the EU referendum in 2016, researchers have suggested in the Journal of Epidemiology & Community Health. They proposed in their research report* that mental health provision ought to be strengthened during such periods in future.

Because, they said, previous research has highlighted the impact of economic conditions and uncertainty on physical and mental health – and the “unexpected result of the Brexit referendum in 2016 triggered high levels of economic uncertainty” – they wanted to investigate whether or not prescriptions for antidepressants increased after the referendum result, compared with other drug classes as a benchmark.

Using data from the GP prescribing database, published by NHS Digital, for the monthly number of presentations of each drug prescribed by every practice in England and then dispensed, they calculated the number of defined daily doses per capita every month in each of the 326 voting areas in England over the period 2011–16. They then used a "difference-in-differences" (DID) approach to identify the effects of Brexit on antidepressant prescriptions, compared with prescribing trends for control medicines (antigout and iron preparations) that they believed were unlikely to be associated with uncertainty and depression.

They found that antidepressant prescribing continued to increase after the referendum, although at a slower pace, against a decrease in prescribing for the control therapeutic classes. Their DID approach revealed a relative increase of 13.4% in antidepressants compared with other therapeutic classes.

The study authors noted: “Our findings are open to different interpretations and should be treated with caution.”

They explained: “The relative increase may reflect an increase in psychological distress, triggered by uncertainty relating to the results of the Brexit referendum. Alternatively, one could focus on the decrease in the control groups. This might perhaps be attributed to patient distraction in the aftermath of the referendum, regardless of whether they perceived it as a positive or negative development. Patients might thus have neglected to visit their GP or pharmacy, as distraction has been documented as a non-adherence factor.”

However, they also pointed out that their findings did not seem to differ between pro-remain and pro-leave areas.

They concluded: “Finally, our study suggests that major political and economic shocks may have unanticipated consequences on population health, even before they directly affect employment, business or migration patterns. This suggests that the anticipation of change may in itself be a risk factor for the use of antidepressants…

“A possible policy implication is that programmes for the promotion of mental health may need to be intensified during periods of uncertainty.”

*Vandoros S, Avendano M, Kawachi I. The EU referendum and mental health in the short term: a natural experiment using antidepressant prescriptions in England. J Epidemiol Community Health Published Online First: 21 November 2018. doi: 10.1136/jech-2018-210637.

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