Presentation (CTI)

OBJECTIVES: Depression is a major public health challenge in England, with GP-recorded prevalence rising from 7.3% in 2014 to over 13.3% in 2022. Although NHS talking therapies guidelines recommend treatment initiation within 18 weeks, evidence on real-world care pathways and associated healthcare resource utilisation (HCRU) is limited. This study aimed to characterise time to treatment initiation, describe HCRU patterns in adults with newly diagnosed depression, and identify factors associated with treatment delays.
METHODS: A retrospective cohort study was conducted using Clinical Practice Research Datalink (CPRD) Aurum, covering over 13 million patients in England. Time to first recorded treatment (pharmacological or psychological) was analysed using Kaplan-Meier estimations. HCRU outcomes, including GP consultations, secondary care, and emergency attendances, were assessed in the 12 months before and after diagnosis. Multivariable Cox regression examined predictors of delayed treatment, including age, sex, socioeconomic deprivation, and comorbidities.
RESULTS: Among 187,432 adults with incident depression, median time to treatment initiation was 67 days, with 34.6% untreated at 12 months. Antidepressants were the most common first-line therapy (38.3%), followed by talking therapy alone (18.1%). A marked socioeconomic gradient was observed: patients in the most deprived quintile were 28% less likely to initiate treatment than those in the least deprived (HR 0.72, 95% CI 0.69-0.75). GP consultations increased by 75% post-diagnosis, and A&E attendance rates were 2.8 times higher in the 12 months post-diagnosis compared with the preceding year, suggesting high unmet need.
CONCLUSIONS: Significant treatment delays and increased HCRU follow depression diagnosis in England. Persistent socioeconomic inequalities in treatment access highlight the need for targeted service improvements and have important implications for healthcare planning, resource allocation and health equity.