Depression and anxiety are common mental disorders, experienced by around 1 in 5 of us in the UK. But the NHS has recognised that mental healthcare services need improvement and will be investing substantially more money in this area over the next 4 years.
We know that generally, patients coming to the NHS for treatment are increasingly likely to have several medical conditions that they are dealing with. This is also likely to be true for patients with depression or anxiety, but the number of depressed or anxious patients with additional medical conditions is not well understood and neither are their healthcare needs.
We will describe how many patients with common mental disorders (depression or anxiety) are dealing with additional long-term conditions and whether there are certain groups of patients that are more likely to be affected (e.g. older people or those in more deprived areas). We will describe how additional conditions and other characteristics affect which types of NHS services patients with common mental disorders are using, and how often they use them.
As the NHS invests more money in improving mental health services, it is important to understand the needs of patients with common mental disorders and the way in which they are using the NHS. This includes understanding how additional long-term conditions can affect the health needs of these patients, so that it is possible target improvements appropriately.
Objectives: In its long-term plan, the NHS committed to improving mental health services and growing investment in mental health services. Plans for mental health services should recognise that patients are presenting to the National Health Service with increasing levels of multimorbidity. Multiple conditions, along with socioeconomic deprivation, are associated with higher levels of some types of health care use. This study aims to support mental health service providers and commissioners to understand how health service needs for people with a common mental disorder (CMD) vary by level of deprivation and number of additional conditions.
This study will estimate: the prevalence of additional long-term conditions among adults with CMD, by age, sex, deprivation, and time. It will describe the use of primary and secondary health care and patient outcomes (mortality, readmissions, and ambulatory care sensitive admissions) for adults with CMD by number of additional conditions and socioeconomic deprivation.
Methods and data analysis:
This descriptive study is based on adults (18+ years) with CMD identified by diagnosis or treatment in primary care using CPRD. We will estimate the prevalence of 0, 1, and 2+ additional long-term conditions (based on a list of validated codes for 35 conditions) using repeat cross-sectional samples drawn each year from 2008/09 to 2017/18, by age, sex and Index of Multiple Deprivation (IMD) quintile.
For the most up-to-date sample where follow-up data is available (2015/16), we will describe levels of primary and secondary care utilisation (as captured in HES) over a two-year follow-up period (2015/16 to 2017/18) according to the number of additional long-term conditions they have and their IMD quintile, with adjustment for age and sex.
We will estimate the age-sex-adjusted proportion who had a hospital admission for an ambulatory care sensitive condition, had a hospital readmission within 30 days, or died within the follow-up period and all-cause mortality by number of additional long-term conditions they have and their IMD quintile.
Our primary outcomes are
A) all-cause primary and secondary care utilisation
number and duration of primary care consultations;
number of prescribed products;
number of outpatient visits;
number of emergency department visits;
number and duration of hospital admissions.
B) All-cause patient outcomes
ambulatory care sensitive admissions;
30-day hospital readmissions;
all-cause mortality.
Our secondary outcomes are mental health-related primary and secondary care utilisation
number of prescribed psychiatric products;
number of referrals to mental health services;
number of mental health-related outpatient visits;
number of mental health-related emergency dept visits;
number and duration of mental health-related hospital admissions.
Sarah Deeny - Chief Investigator - The Health Foundation
Richard Welpton - Corresponding Applicant - The Health Foundation
Karen Hodgson - Collaborator - The Health Foundation
Mai Stafford - Collaborator - The Health Foundation
Will Parry - Collaborator - The Health Foundation
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation