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Country-level health care spending, public attitudes impact antidepressant use

Analysis of a large general population survey indicated antidepressant use significantly varied among European countries and was influenced by country-level health care spending and public attitudes towards mental illness.

“Prescribing of antidepressants in Europe increased by an average of 20% per year between 2000 and 2010. However, the quantity of antidepressant prescribing varies widely between countries, with 6.4 times as many antidepressants prescribed per person in Iceland than in Estonia in 2010,” study researcher Dan Lewer, BSc, of King’s College London, and colleagues wrote. “Little is known about the reasons for the inter-country variation in antidepressant use. Variations in treatment-seeking, availability of providers, spending on health care services and other differences between health care systems are likely important factors. Societal attitudes towards mental illness may also play a role, as is the case for help-seeking for mental health problems.”

To assess associations between country-level health care spending, public attitudes towards mental illness and antidepressant use, researchers analyzed data from the Eurobarometer 2010, a cross-sectional survey of residents of 27 European Union Member States, for approximately 26,800 individuals.

Overall, 7.2% of study participants reported taking antidepressants in the past year. The prevalence of antidepressant use varied among countries, ranging from 2.7% in Greece to 15.7% in Portugal.

Multivariable regression analysis indicated individuals were more likely to take antidepressants if they had higher Mental Health Inventory-5 scores, were female, were aged more than 40 years, were unemployed or a homemaker, considered themselves to be of a lower social class or reported difficulty paying their bills.

Further, individuals were more likely to take antidepressants if they lived in a country that spent more on health care, where residents were more likely to consider people with mental illness dangerous or where residents were less likely to think people with mental illness never recover or have themselves to blame for their illness.

Fifty-eight percent of the antidepressant users reported regular use of antidepressants, ranging from 19% in Bulgaria to 89% in Sweden.

Individuals were more likely to take antidepressants regularly if they resided in a country that spent more on health care per capita, where residents were more likely to think people with mental illness were unpredictable and where residents were less likely to consider people with mental illness never recover.

“Some of the wide variation in antidepressant use across Europe is explained by differences in health care spending and attitudes towards mental illness. Health care spending in this study is likely a proxy for many variables, including availability of medical care, training of health care staff and affordability of drugs,” Lewer and colleagues wrote. “Our study shows that health care spending is strongly associated with regularity of antidepressant use. In addition, attitudes towards people with mental illness are associated with both use and regularity of use. Policy aiming to achieve appropriate prescribing and use of antidepressants will need to consider individual and societal attitudes as well as medical practices.” – by Amanda Oldt

Disclosure: Lewer reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.