People with depression are “stagnating” in the UK healthcare system, according to research that suggests many wait years to be diagnosed and then often receive suboptimal treatment.
The research, led by scientists at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London, aimed to assess how real-world care for depression compared with best practice and painted a bleak picture that sees huge numbers go undiagnosed and those with very serious illness are not referred on for specialist care quickly enough.
The paper concluded that “substantial and concerning” gaps in the provision of care meant that, for some, illness persists longer than it should.
“The effective treatment of depression is one of the country’s biggest health challenges that we face right now,” said Prof Allan Young, of King’s College and a senior author of the paper. “High rates of missed diagnosis mean that vast swaths of the population cannot get the help that they need, while a lack of follow-ups and access to more specialist care often means that those experiencing severe depression are stuck stagnating on a pathway that is not treating them as effectively as it should.”
The study set out to identify gaps in treatment of depression across Europe, with a focus on six individual countries, including the UK, by reviewing evidence from academic papers, databases and from experts in the field. The research suggested that only half of the approximately 30 million people in Europe living with depression are diagnosed. In the UK, researchers found evidence of an eight-year average wait between a person showing initial symptoms and them first contacting a health professional, with some studies finding rates of untreated depression as high as 77%.
In the UK, antidepressants and psychological therapies are both offered as first-line treatments and have been shown to be roughly equally effective. Evidence suggests that people often benefit most when they get both treatments simultaneously. However, the latest work suggests that people are given medication at about twice the rate of psychological treatment such as cognitive behavioural therapy (CBT).
It is known that about one in five people will not respond to first-line treatments, but the study found a referral rate to secondary care of as low as 5%-6% in some studies. This, the authors said, suggests many may be “stagnating” in primary care, not getting better, but not getting more specialist help either.
The idea that mental health services are extremely stretched is not new, but Dr Rebecca Strawbridge, of King’s and first author, said “it was pretty much across the board worse than we expected”.
The paper, published in the journal European Psychiatry, includes recommendations for how services could be improved for those with depression, including longer appointments with a GP, to ensure that people can be properly diagnosed, increasing treatment provision so that the “right” treatment is available to each patient and better follow-up so doctors know how patients have responded. But the authors note: “We cannot serve those with depression better without additional funded resources and capacity.”
