Event Details

Speaker: Joana Pestana (PhD student in Economics, NOVA University, Portugal)

Speaker: Joana Pestana (PhD student in Economics, NOVA University, Portugal)

Discussant: Chiara Costi (PhD student in Economics, Lancaster University, UK)

Title: High antidepressant therapy prescription, do psychologists help? - Evidence from Portugal

Abstract:

Depressive disorders are one of the leading causes of ill health and disability globally and are commonly treated in primary health care (PHC) context. When consulting with their family doctor patients with depressive symptoms, may be prescribed a pharmacological treatment, referred to psychotherapy, or both. Several factors may influence this choice, namely the availability of well-integrated mental health services, patient preferences and beliefs, and the General Practitioners (GPs) preferences and habits. In this paper, we assess the variation in antidepressants´ prescription among GPs in Portugal, a country with one of the highest utilization of these drugs in Europe and a low supply of psychotherapy in primary health care. We apply multilevel modelling to explore how physician´s prescription behaviour is influenced by the clustering of GPs in PHC practices, which are part of local groupings where psychologists are based. Using longitudinal data methods we further study the heterogeneous relationship between antidepressant´s prescription and the supply of psychotherapy, adjusting for patient, practice and area characteristics.

Overall, our findings suggest that the grand majority of the adjusted variation in antidepressants use were at the physician level. However, the percentage of variation associated with the GP group practice and the local primary health care cluster were 34% and 12% respectively. This contribution was larger when compared with the prescription variation of other drugs, pointing to the importance of the primary care delivery structure in mental health care. Greater psychologist density integrated in the primary care services (psychologist per 100 000 patients) had a statistically significant and negative association with the share of patients taking antidepressants (-0.27 pp), that increases in magnitude when GPs practice in areas that were in the highest quintile of mental health services supply for the past three years.

While the variation in the use of antidepressant drugs was found to be in large part due to differences between GPs themselves, the influence exerted by peer groups and the local mental health services does have a significant impact as well. The results suggest that better psychologist supply can reduce antidepressant use. Further research needs to be conducted regarding the institutional and contextual factors that prompt physicians to harmonize their treatments strategies in supplementation or complementary for patients with depression.