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A data linkage study of the effects of the Great Recession and austerity on antidepressant prescription usage

Lookup NU author(s): Dr Niall CunninghamORCiD, Professor Clare BambraORCiD



This is the authors' accepted manuscript of an article that has been published in its final definitive form by Oxford University Press, 2021.

For re-use rights please refer to the publisher's terms and conditions.


ABSTRACT: Background International literature shows that the impacts of unemployment and loss of income (including reductions in state welfare expenditures) during the Great Recession (2007/2008) worsened population mental health. However, most research relies on self-reported health measures and ecological designs. This individual-level longitudinal study examines how regional economic trends and austerity related to depression using administrative prescription data for a very large and representative population sample. Methods: Records from a sample of the Scottish Longitudinal Study (N=86,500) were linked to monthly primary care antidepressant prescriptions (2009-2015). Regional economic trends were characterised by annual full-time employment data (2004-2014). Economic impact of austerity was measured via annual income lost per working age adult due to welfare reforms (2010-2015). Sequence analysis identified new cases of anti-depressant use, and group-based trajectory modelling classified regions into similar economic trajectories. Multi-level logistic regression examined relationships between regional economic trends and new antidepressant prescriptions. Structural equation mediation analysis assessed the contributory role of welfare reforms. Results: Employed individuals living in regions not recovering post-recession had the highest risk of beginning a new course of antidepressants (AOR 1.23; 95%CI 1.08-1.38). Individuals living in areas with better recovery trajectories had the lowest risk. Mediation analyses showed that50% (95% CI 7-61%) of this association was explained by the impact of welfare benefit reforms on average incomes. Conclusion: Following the Great Recession, local labour market decline and austerity measures were associated with growing antidepressant usage, increasing regional inequalities in mental health in Scotland. The study evidences the impact of austerity on health inequalities and suggests that economic conditions and welfare policies impact on population health. Reducing the burden of mental ill-health primarily requires action on the social determinants.

Publication metadata

Author(s): Cherrie M, Curtis S, Baranyi G, Cunningham N, Dibben C, Bambra C, Pearce J

Publication type: Article

Publication status: Published

Journal: European Journal of Public Health

Year: 2021

Volume: 31

Issue: 2

Pages: 297-303

Print publication date: 01/04/2021

Online publication date: 07/02/2021

Acceptance date: 21/12/2020

Date deposited: 03/01/2021

ISSN (print): 1101-1262

ISSN (electronic): 1464-360X

Publisher: Oxford University Press


DOI: 10.1093/eurpub/ckaa253


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