Depression is a common mental health problem. People with depression often misuse alcohol (perhaps as self-treatment), and conversely, those who abuse alcohol are often depressed. It is therefore important to recognise harmful drinking in those who are depressed, both to limit the poor health outcomes linked to excessive drinking and to help with the management of mental illness. In the UK most depression is managed by general practitioners, so screening for potential alcohol abuse in depressed people in primary care could be one way to determine (and therefore help) these vulnerable people. Indeed national guidelines from the National Institute of Health and Care Excellence from 2010 recommend alcohol screening for depressed people in primary care. However, it is unclear if this guidance is being followed. Our study therefore aims to use information from electronic health records to describe alcohol screening in depressed patients, and determine whether there are specific groups of depressed people (i.e. younger/older, men/women, etc) who are not being screened appropriately. We will also use information from hospital admissions, to investigate the whether routine alcohol-use screening in depressed people protects against future hospital admissions. This will provide useful information as to whether screening guidelines are followed in GP practices, determine whether there are any patient groups who are not being screened, and determine whether screening works in terms of reducing hospital admissions.
In 2019 NICE guidelines recommended screening for alcohol-use in depressed primary care patients. This is important as depression and harmful alcohol use frequently occur together leading to increased morbidity and mortality. Identifying harmful drinking at an early stage through screening presents an opportunity for brief interventions aimed at reducing the impact of risky drinking and improving patient outcomes. However, it is unclear whether these guidelines are being followed in primary care. Additionally, the association between alcohol screening in primary care and outcomes such as hospitalisation rates is unknown.
This study aims to use UK primary care data from the Clinical Practice Research Datalink (CPRD) to identify depressed patients and describe the levels of alcohol screening within this population. We will describe the characteristics of screened and unscreened patients, and use linked Hospital Episode Statistics (HES) data to explore the association between alcohol screening and one-year hospital admissions. We will use Poisson regression to calculate rate ratios comparing the rate of hospital admissions in those who were and were not screened adjusting for a priori confounders such as age and sex.
This study will provide useful information about alcohol screening in depressed patients in UK primary care and investigate the effect this may have on hospital admissions. Understanding these issues is imperative for assessing whether improvements in alcohol screening in vulnerable patients can be made.
Alcohol screening status (descriptive analysis only)
All cause hospital admissions
Emily Herrett - Chief Investigator - London School of Hygiene & Tropical Medicine ( LSHTM )
Emily Herrett - Corresponding Applicant - London School of Hygiene & Tropical Medicine ( LSHTM )
Elizabeth Adesanya - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Elizabeth Crellin - Collaborator - The Health Foundation
Kathryn Mansfield - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Sarah Cook - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
HES Admitted Patient Care;Patient Level Index of Multiple Deprivation