Royal College of Psychiatrists

Perinatal Section - Daksha Emson Prize 2012

Review of diagnoses of depression, history of self harm & antidepressant usage in NHS Greater Glasgow and Clyde resident ‘bookers’

Dr Selena Gleadow WareLecturer in Mental Health, College of Medicine, University of Malawi; Dr Julie LanganClinical Lecturer in Psychiatry & Honorary Specialist Trainee (ST4) General Adult Psychiatry, University Of Glasgow; Mr Paul Burton Information Manager, Information Services, NHS Greater Glasgow & Clyde

and Dr John O’DowdConsultant Public Health Physician, Children & Maternity Section, Public Health Services, NHS Greater Glasgow & Clyde

Aims

Our aims were toreviewrecent and currentusage of antidepressants in NHS Greater Glasgow and Clyde (NHSGG&C) resident women attending their first antenatal appointment (“bookers”); todescribe patterns of antidepressant prescription by medication type andsocioeconomic deprivation and todescribe recording of diagnosis relating to depression and self harm and its relationship to medication use and socioeconomic deprivation.

Methods

All NHSGG&C resident women attendingtheir first antenatal appointment between 1st April 2011 and 30thJune 2012 were included.

Antidepressant medication use was determined bymedication history on the primary care electronic system (Scottish Clinical Interface (SCI Store)) referral madeto the maternity hospital. Socioeconomic deprivation was assigned using SIMD (Scottish Index of Multiple Deprivations) quintiles (1 being the most disadvantaged). Rates of depression and self harm were estimated by analysingrelated entries on the referral.

Results

17,878 women attended their first antenatal appointment. The majority(42.6%) belonged to themost deprived socioeconomic group (SIMD quintile 1).

321 (1.8%)had been prescribed antidepressant medications either concurrently with their referral or recently but prior totheir referral. Of those antidepressants prescribed, 81.2% were SSRIs and 11.6% were tricyclics.

Rates of antidepressant prescription were higher in the most deprived quintile(2.6%)compared to the least deprived quintile(1.0%).

Higher rates of depression and self harm were observed inwomen from the most deprived quintile (12.8% and 5.0% respectively)compared to the least deprived (9.2% and 2.4% respectively).

Conclusions

A history of depression or self harm and evidence of antidepressantprescribing appear more frequently on referrals of women residing in areas of greater socioeconomic deprivation.

Whilst analysis of these data revealed lower than expected usage of antidepressant medication, it indicates interesting socioeconomic trends in diagnosis and medication use. Given the implications of perinatal mental illness on maternal and infant outcomes, this area warrants further investigation.