A new study suggests that adults with depression in Ireland avail more of psychiatric healthcare services and use less medication than their counterparts in several other western European countries.
The report, published in the British Journal of Psychiatry this month, examined the use of community and hospital-based healthcare services by people with depression over a six-month period. It found participants in Ireland and the UK were more likely to have used healthcare services than participants in Norway, Spain and Finland.
Irish people also reported the highest use of inpatient psychiatric facilities, which the report's authors suggested could drive up the cost of healthcare service use for the condition.
Given that outcomes of depression are similar in the countries with less hospitalisation than Ireland, the results suggest that we need to focus more on community mental health services here and reduce unnecessary stays in hospital, said Prof Patricia Casey, consultant psychiatrist at the Mater Misericordiae Hospital and professor of psychiatry at University College Dublin.
She led the Irish contribution to the research, which was carried out by the Outcomes of Depression International Network (ODIN), a multi-centre study that looks at the prevalence, risks, outcomes and effects of intervention on depression in the European Union.
The study randomly selected 14,387 participants from across the five countries and identified 427 participants, of whom 38 were in Ireland, who met criteria for depression or an adjustment disorder and could provide information about how they used healthcare services.
Irish participants reported substantial levels of contact with GP, generic, social and psychiatric services and low usage of psychotropic medication over the previous six months. But the authors suggested that the relatively high representation of inpatient psychiatric treatment in Ireland drove up the cost of service use here, which was almost double that of Norway and Finland.
The issue could be that we are keeping people in hospital unnecessarily, according to Prof Casey.
She said we should ideally shift the focus back onto community mental health services and identify the people who do need hospitalisation, but that our community services are currently under-resourced to do so. "There is a need for intervention but because we don't have adequate community services we are bringing people into hospital," she said.
"It's often a stop-gap solution when there is a crisis to admit people because we don't have adequate community facilities and it is driving up the cost."
According to Prof Casey, "We also need to revise our concept of depression and differentiate between transient periods of unhappiness triggered by a stressful event and more persistent depression that is associated with suicidal behaviour.
"People with profound or severe clinical depression do need to be in hospital. But we seem to have a habit of admitting people to hospital where they are having a short-term crisis - they may need to be in hospital for a day or so, but we tend to be keeping them in hospital - that's what the results suggest to me."
The ODIN study also found that people with depression who had a good social support network tended to access healthcare services more readily, which the authors suggested should influence intervention strategies. "Social support encourages health-seeking behaviour," said Prof Casey.
