This long read describes the health care use of people with depression and/or anxiety across primary and secondary care prior to the coronavirus (COVID-19) pandemic. We highlight the broader health needs of these patients, and longstanding variation in use of health care by level of socioeconomic deprivation.
In England, almost three-quarters of people with depression and/or anxiety have at least one other physical or mental health-related long-term condition while almost a third have three or more other long-term conditions. Chronic pain is particularly prevalent among people with depression and/or anxiety (30.7% – almost double the rate seen in the general population), as are hypertension and irritable bowel syndrome.
People with depression and/or anxiety are more likely to have additional long-term conditions if they live in areas of higher socioeconomic deprivation. Among people aged 45–64 years, 72% of people with depression and/or anxiety in the least deprived areas of England had at least one additional long-term condition, compared with 86% in the most deprived areas.
People with depression and/or anxiety have more primary care consultations if they have additional long-term conditions, as would be expected. This group are also prescribed more medications, including more mental health-related medications. When the data are analysed by deprivation, the story becomes more complex.
People with depression and/or anxiety living in more deprived areas are prescribed more medications, which might suggest they have a higher level of clinical need. However, they do not receive more primary care consultations than people with depression and/or anxiety in less deprived areas, despite their potentially higher level of need.
Unplanned secondary health care use (A&E visits and emergency hospital admissions) is higher for people with depression and/or anxiety living in more deprived areas, yet planned secondary health care use (elective hospital admissions and outpatient appointments) is not higher. This suggests that, despite their complex needs, people in the most deprived areas are not receiving as good care as those in the least deprived areas. It is unclear whether this is due to problems with the availability or suitability of services in more deprived areas, or differences in treatment-seeking behaviours.
People with depression and/or anxiety use secondary health care for mental health needs relatively rarely. Nevertheless, we found evidence that they are more likely to use unplanned secondary health care relating to mental health if they live in more deprived areas. We do not see this pattern with deprivation for planned secondary mental health care use.
Further research is needed into the inequalities highlighted by this analysis. These are important at any time, yet the COVID-19 pandemic has made the issues more acute. The latest estimates are that up to 10 million people in England have additional mental health needs as a direct consequence of the pandemic. Resources must be targeted appropriately, particularly to primary care services in deprived areas to help meet the needs of people with mental health conditions.