Characterising the depression pathway in secondary care: a UK-based epidemiological study of patient characteristics, comorbidities, and treatments

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Abstract
BACKGROUND Depression is a disabling disorder with variable outcomes. In severe cases treatment is provided by specialist mental health care services, yet there is a lack of real-world evidence demonstrating how depression is managed within these settings, and consequently, a limited understanding of how to improve care for this population. AIMS We examine the characteristics of patients receiving secondary mental healthcare for depressive disorders within a UK National Health Service (NHS) provider, and the treatments they receive. We investigate when patients receive treatments, and what predicts the use of specific treatments, improvement, and duration with services, with the aim of comparing real-world care to that advised by national guidelines. METHODS A retrospective cohort study was conducted using de-identified electronic patient records of patients with depression referred to Cambridgeshire and Peterborough NHS Foundation Trust (serving a population ∼0·86 million), between January 2013 and June 2021. ANOVA models examined predictor variables of improvement and duration of care, while survival analyses explored treatment initiation rates and predictors of which treatments were used. RESULTS 9,083 patients met the study’s inclusion criteria. Almost half of those with depression had additional psychiatric diagnoses, reflecting the complexity of cases in secondary care. Treatment within secondary care was associated with improvements in both depressive and overall symptoms. Patients with a greater degree of psychiatric co-morbidity and those with lower socio-economic status indicators presented with greater overall illness severity at baseline, were more likely to be admitted into hospital, spent longer with services, and improved less than the average. Treatment patterns differed across age groups, sex/gender, socio-economic status, and psychiatric comorbidities. Some nationally recommended further-line treatments appeared to be under-used. CONCLUSIONS Treatment gaps in further-line treatments for depression exist, highlighting key areas for service improvement. Future work should target patients with complex needs and those who are socio-economically deprived.

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