.2020 Jan;50(2):293-302.

doi: 10.1017/S0033291719000023. Epub 2019 Feb 12.

Prevalence of mental illness in primary care and its association with deprivation and social fragmentation at the small-area level in England

Christos Grigoroglou^{1 2}, Luke Munford^{2 3}, Roger T Webb^{2 4 5}, Nav Kapur^{2 5 6 7}, Darren M Ashcroft^{2 5 8}, Evangelos Kontopantelis^{1 2}

Affiliations

¹ Division of Population Health, Health Services Research and Primary Care, NIHR School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK.
² Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK.
³ Division of Population Health, Health Services Research and Primary Care, Centre for Health Economics, University of Manchester, Manchester, UK.
⁴ Division of Psychology and Mental Health, Centre for Mental Health and Safety, University of Manchester, Manchester, UK.
⁵ NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK.
⁶ Division of Psychology and Mental Health, Centre for Suicide Prevention, University of Manchester, Manchester, UK.
⁷ Greater Manchester Mental Health Trust.
⁸ Faculty of Biology, Medicine and Health, Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, University of Manchester, Manchester, UK.

PMID:30744718
PMCID: PMC7083582
DOI: 10.1017/S0033291719000023

Prevalence of mental illness in primary care and its association with deprivation and social fragmentation at the small-area level in England

Christos Grigoroglou et al. Psychol Med.2020 Jan.

.2020 Jan;50(2):293-302.

doi: 10.1017/S0033291719000023. Epub 2019 Feb 12.

Authors

Christos Grigoroglou^{1 2}, Luke Munford^{2 3}, Roger T Webb^{2 4 5}, Nav Kapur^{2 5 6 7}, Darren M Ashcroft^{2 5 8}, Evangelos Kontopantelis^{1 2}

Affiliations

¹ Division of Population Health, Health Services Research and Primary Care, NIHR School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK.
² Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK.
³ Division of Population Health, Health Services Research and Primary Care, Centre for Health Economics, University of Manchester, Manchester, UK.
⁴ Division of Psychology and Mental Health, Centre for Mental Health and Safety, University of Manchester, Manchester, UK.
⁵ NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK.
⁶ Division of Psychology and Mental Health, Centre for Suicide Prevention, University of Manchester, Manchester, UK.
⁷ Greater Manchester Mental Health Trust.
⁸ Faculty of Biology, Medicine and Health, Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, University of Manchester, Manchester, UK.

PMID:30744718
PMCID: PMC7083582
DOI: 10.1017/S0033291719000023

Abstract

Background: We aimed to spatially describe mental illness prevalence in England at small-area geographical level, as measured by prevalence of depression, severe mental illness (SMI) and antidepressant prescription volume in primary care records, and how much of their variation was explained by deprivation, social fragmentation and sociodemographic characteristics.

Methods: Information on prevalence of depression and SMI was obtained from the Quality and Outcomes Framework (QOF) administrative dataset for 2015/16 and the national dispensing dataset for 2015/16. Linear regression models were fitted to examine ecological associations between deprivation, social fragmentation, other sociodemographic characteristics and mental illness prevalence.

Results: Mental illness prevalence varied within and between regions, with clusters of high prevalence identified across England. Our models explained 33.4-68.2% of variability in prevalence, but substantial variability between regions remained after adjusting for covariates. People in socially cohesive and socially deprived areas were more likely to be diagnosed with depression, while people in more socially fragmented and more socially deprived areas were more likely to be diagnosed with SMI.

Conclusions: Our findings suggest that to tackle mental health inequalities, attention needs to be targeted at more socially deprived localities. The role of social fragmentation warrants further investigation, and it is possible that depression remains undiagnosed in more socially fragmented areas. The wealth of routinely collected data can provide robust evidence to aid optimal resource allocation. If comparable data are available in other countries, similar methods could be deployed to identify high prevalence clusters and target funding to areas of greater need.

Keywords: Antidepressant prescribing; depression; deprivation; mental illness; severe mental illness; social fragmentation.

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Figures

**Fig. 1.**
Prevalence of depression in England (2015/16 LSOA level).

**Fig. 2.**
Prevalence of severe mental illness in England (2015/16 LSOA level).

See this image and copyright information in PMC

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Prevalence of mental illness in primary care and its association with deprivation and social fragmentation at the small-area level in England

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Prevalence of mental illness in primary care and its association with deprivation and social fragmentation at the small-area level in England

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