Antidepressant prescribing inequalities in people with comorbid depression and type 2 diabetes: A UK primary care electronic health record study

Aims: To compare the likelihood of being prescribed an antidepressant in depressed individuals with and without type 2 diabetes. Methods: We performed a matched cohort study using primary care record data from the UK Clinical Practice Research Datalink. We used multivariable logistic regression to compare antidepressant prescribing during the first five years of starting oral antidiabetic medication to a comparison group without type 2 diabetes, matched based on GP practice, age and sex. We performed subgroup analyses stratified by sex, age and ethnicity. Results: People with type 2 diabetes and depression were 75% less likely to be prescribed an antidepressant compared to people with depression alone (odds ratio (OR) 0.25, 95% confidence interval (CI) 0.25 to 0.26). This difference was greater in males (OR 0.23, 95% CI, 0.22 to 0.24), people older than 56 years (OR 0.23, 95% CI, 0.22 to 0.24), or from a minoritised ethnic background (Asian OR 0.14, 95% CI 0.12–0.14; Black OR 0.12, 95% CI 0.09–0.14). Conclusions: There may be inequalities in access to antidepressant treatment for people with type 2 diabetes, particularly those who are male, older or from minoritised ethnic backgrounds.