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A data linkage study of the effects of the Great Recession and austerity on antidepressant prescription usage

Cherrie, Mark; Curtis, Sarah; Baranyi, Gergő; Cunningham, Niall; Dibben, Chris; Bambra, Clare; Pearce, Jamie

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Mark Cherrie

Gergő Baranyi

Niall Cunningham

Chris Dibben

Clare Bambra

Jamie Pearce


Background International literature shows unemployment and income loss during the Great Recession worsened population mental health. This individual-level longitudinal study examines how regional economic trends and austerity related to depression using administrative prescription data for a large and representative population sample. Methods Records from a sample of the Scottish Longitudinal Study (N=86 500) were linked to monthly primary care antidepressant prescriptions (2009–15). Regional economic trends were characterized by annual full-time employment data (2004–14). Economic impact of austerity was measured via annual income lost per working age adult due to welfare reforms (2010–15). Sequence analysis identified new cases of antidepressant use, and group-based trajectory modelling classified regions into similar economic trajectories. Multi-level logistic regression examined relationships between regional economic trends and new antidepressant prescriptions. Structural equation mediation analysis assessed the contributory role of welfare reforms. Results Employed individuals living in regions not recovering post-recession had the highest risk of beginning a new course of antidepressants (AOR 1.23; 95% CI 1.08–1.38). Individuals living in areas with better recovery trajectories had the lowest risk. Mediation analyses showed that 50% (95% CI 7–61%) of this association was explained by the impact of welfare benefit reforms on average incomes. Conclusions Following the Great Recession, local labour market decline and austerity measures were associated with growing antidepressant usage, increasing regional inequalities in mental health. The study evidences the impact of austerity on health inequalities and suggests that economic conditions and welfare policies impact on population health. Reducing the burden of mental ill-health primarily requires action on the social determinants.

Journal Article Type Article
Online Publication Date Feb 7, 2021
Publication Date 2021-04
Deposit Date Sep 14, 2021
Publicly Available Date Sep 14, 2021
Journal European Journal of Public Health
Print ISSN 1101-1262
Electronic ISSN 1464-360X
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 31
Issue 2
Pages 297-303
Public URL
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