People with depression are ‘stalled’ in the UK health system, according to research, which suggests they spend many years waiting to be diagnosed and then often receive sub-optimal treatment.
The research, led by scientists from the Institute of Psychiatry, Psychology and Neuroscience (IoPPN) at King’s College London, aimed to assess how real-world depression care compares with best practice and painted a grim picture that a huge number people go undiagnosed and those with very serious illness are not referred quickly enough for specialist help.
The paper concludes that “significant and worrying” gaps in care provision mean that for some the illness lasts longer than it should.
“Effective treatment of depression is one of the biggest national health challenges we are currently facing,” said Professor Alan Young of King’s College and senior author of the paper. “High rates of missed diagnosis mean huge swathes of the population are unable to get the help they need, while a lack of follow-up and access to more specialist care often means those experiencing major depression are stuck in limbo in a way that is not treating them as effectively as it should.”
The study aimed to identify gaps in depression treatment across Europe, with a focus on six individual countries, including the UK, by reviewing evidence from academic articles, databases and from experts in the field. The research suggests that only half of the estimated 30 million people in Europe living with depression are diagnosed. In the UK, researchers found evidence of an average eight-year wait between a person showing initial symptoms and their first contact with a health professional, with some studies finding rates of untreated depression as high as 77%.
In the UK, antidepressants and psychological therapies are offered as first-line treatment and have been shown to be about equally effective. Evidence suggests that people often benefit most when they receive both treatments at the same time. However, the latest work suggests that people are given medication at about twice the rate of psychological treatments such as cognitive behavioral therapy (CBT).
It is known that around one in five people will not respond to first-line treatment, but the study found that referral rates to secondary care were as low as 5%-6% in some studies. This, the authors said, suggests that many may be “stagnant” in primary care, not improving but also not receiving more specialist care.
The idea that mental health services are extremely stretched is not new, but Dr Rebecca Strawbridge, from King’s and the first author, said “it was almost worse than we expected”.
The paper, published in the journal European Psychiatry, includes recommendations on how services can be improved for those with depression, including longer GP appointments to ensure people can be correctly diagnosed, increasing the provision of treatment , so that the “right” treatment is available for every patient, and better follow-up, so that doctors know how patients have responded. But the authors note, “We cannot serve people with depression better without additional funded resources and capacity.”
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