AbstractsMedical & Health Science

Depression is a leading cause of disability worldwide. At worst, it may lead to frequent hospitalisation and even premature death. The risk of suicide is particularly high among the depressed. This study assessed whether social and economic resources protect depressed patients from psychiatric hospital admission and premature mortality. The study also aimed to establish the role of alcohol and the rapidly increased antidepressant treatment of depression in these outcomes. The study used large, longitudinal register samples of the Finnish adult population, combining information from various administrative registers. Depression was assessed from psychiatric hospital care and antidepressant purchases. Treatment and depression outcomes were assessed in 1-10-year follow-ups. The results indicate that at least in a population already in contact with the healthcare system, antidepressant treatment and depression outcomes vary only modestly according to social factors. However, material aspects of socioeconomic position such as a low income, not owning a home and being unemployed increased the risk of hospital admission for depression by 20-40 per cent among those with previous depression treatment, even after controlling for baseline depression severity and psychiatric comorbidity, whereas education and occupational social class were unrelated to admission risk. Having no partner and living without co-resident children also increased the admission risk. None of the social factors studied buffered against excess mortality among the depressed. Educational differences in the prevalence of antidepressant use before and after hospital care for depression were small and mostly limited to the period after discharge. Antidepressant use immediately after discharge was slightly less common among those with a low level of education, but educational differences increased thereafter as antidepressant use decreased more rapidly among this group. Differences in daily antidepressant use that met treatment guidelines were more pronounced than those for any antidepressant use, suggesting a need for improving treatment adequacy and adherence particularly among patients with a low level of education. The study established the central role of excessive alcohol consumption as a pathway to depression mortality. Alcohol-related causes accounted for about half of the excess mortality of depressed men and around a third of depressed women. Improving the detection and management of substance use problems would thus be critical for reducing depression mortality. Increased antidepressant sales do not seem to have prevented female suicides. However, among men an increase in the proportion of antidepressant users receiving minimally adequate treatment reduced non-alcohol-related suicides. The results suggest that increased adequacy of antidepressant treatment has been more central in reducing suicide rates than the mere increase in per-capita antidepressant sales or prevalence of antidepressant use. Masennus on yleinen mielenterveyden häiriö, joka…