Prevalence and variation in antidepressant prescribing across Northern Ireland: a longitudinal administrative data linkage study for targeted support.

英国（UK）的抗抑郁药物处方率是西欧最高的，北爱尔兰（NI）的处方率明显高于英国其他地区。此外，虽然处方率每年都在攀升，但抑郁症的发病率并没有改变，有证据表明，一系列社会经济和地理因素可能是罪魁祸首。此外，大多数英国全科医生通常认为替代疗法可能更合适，如果有其他选择，他们会少开一些抗抑郁药。证据似乎普遍表明：(a)人们接受抗抑郁药的原因和全科医生开抗抑郁药的原因有很大不同，(b)这些原因的相对重要性可能因地域而异（例如，接受抗抑郁药的可能性可能因一个地区的富裕程度或现有初级保健服务的数量和邻近程度而异；以及这些服务的相关压力）。一个由经验丰富的学术研究人员和获奖的NI慈善机构Aware Defeat Depression （Aware）组成的多学科团队，旨在最大限度地利用NI的人口普查和增强处方数据库数据，针对、定制和实施对接受抗抑郁药物处方的个人的支持，并刺激整个地区的“社会处方”（一种将患者与社区内非医疗支持来源联系起来的机制）。具体而言，该研究旨在(i)提供NI中抗抑郁药处方的详细地理细分，以确定小地理水平上的处方“热点”，（ii）使用相关的人口普查数据来确定区分“热点”的人口变量（个人、社会和经济因素），（iii）确定人口变量与“热点”之间的关联是否因地理位置而异。（四）确定人们生活的长期变化（例如贫困、家庭结构、身体健康的变化）是否与抗抑郁药的使用有关；（五）通过有针对性的干预措施在整个区域促进“社会处方”。该项目将解决2015/16年ESRC战略优先领域“影响行为和告知干预”中突出的两个主要研究问题。在拟议的分析战略的基础上，项目小组的目标是绘制一幅全国地图，详细说明NI抗抑郁药处方的社会经济状况。该地图将支持非学术合作伙伴（Aware）通过以下方式开发和实施有效和协调的干预计划：(i)突出小地理层面的处方热点；（ii）使用个人、社会和经济数据生成特定于已确定热点的“风险”概况；（iii）通过纵向变化模型识别个人、社会和经济层面的“脆弱性”。项目具有交付有效且有意义的变更的潜力。与Aware的伙伴关系将确保能够立即根据调查结果采取行动。自1996年以来，Aware一直为全国数千名青少年和成年人提供强化教育和培训项目，并于2014年获得GSK IMPACT奖。这些方案的一个主要重点是教育个人了解可用于从抑郁症中恢复的积极策略。Aware将根据项目发现，在这些地区和NI中最需要的个人中定制、定位和促进“社会处方”。社会处方可能包括艺术和创造力的机会、体育活动、学习新技能、志愿服务、互助、交朋友和自助，以及就业、住房、债务或育儿问题等方面的支持。有了详细的地理地图，项目团队将制定有针对性的干预策略，以便在NI各地提供重点突出、环境敏感的社会处方。

Anti-depressant prescription rates in the United Kingdom (UK) are among the highest in Western Europe and prescription rates in Northern Ireland (NI) are significantly higher than the rest of the UK. Moreover, while prescription rates are climbing annually, rates of depression are not changing, and evidence suggests that a range of socio-economic and geographical factors may be responsible. Furthermore, the majority of UK GP's often believe that alternative treatments may be more appropriate and that they would prescribe antidepressants less frequently if other options were available. Evidence seems to indicate generally that (a) there are widely different reasons why people receive anti-depressants and why GP's prescribe them, and (b) the relative importance of these reasons may vary geographically (e.g. the likelihood of receiving antidepressants may vary due to the affluence of an area or the number and proximity of available primary care services; and the associated pressures on these services).A multi-disciplinary team of experienced academic researchers and the award winning NI charity, Aware Defeat Depression (Aware), aim to maximise the use of Census and Enhanced Prescribing Database data in NI to target, tailor and implement support for individuals in receipt of antidepressant prescriptions and to stimulate 'social prescribing' across the region (a mechanism for linking patients with non-medical sources of support within the community). Specifically the study aims to (i) provide a detailed geographical breakdown of antidepressant prescribing in NI to identify prescription 'hot spots' at a small geographical level, (ii) use linked census data to identify demographic variables (personal, social, and economic factors) that differentiate 'hot spots', (iii) determine if the association between demographic variables and 'hot spots' differs by geographical location, (iv) determine if long-term changes in people's lives (e.g. change in deprivation, family structure, physical health) are associated with antidepressant use and (v) stimulate 'social prescribing' across the region through targeted intervention.The project will address two main research questions highlighted in the 2015/16 ESRC strategic priority area 'Influencing Behaviour and Informing Intervention'.On the basis of the proposed analytic strategy the project team aims to develop a nationwide map detailing the socio-economic landscape of antidepressant prescribing in NI. This map will support the non-academic partners (Aware) in their efforts to develop and implement effective and coordinated intervention programs by (i) highlighting prescription hotspots at a small geographical level (ii) generating 'risk' profiles specific to identified hotspots using personal, social and economic data and (iii) identifying 'vulnerability' at a personal, social and economic level through longitudinal change modelling. The project has the potential to deliver effective and meaningful change. Partnership with Aware will ensure that findings can be acted upon immediately. Aware has been delivering intensive education and training programmes to thousands of adolescents and adults across NI since 1996 and has been awarded the GSK IMPACT Award in 2014. A primary focus of these programmes is to educate individuals about positive strategies that can be used in the recovery from depression. Aware, on the basis of the project findings, will tailor, target and promote 'social prescribing' in those areas and among those individuals in NI that need it most. Social prescribing may include opportunities for arts and creativity, physical activity, learning new skills, volunteering, mutual aid, befriending and self-help, as well as support with, e.g. employment, housing, debt, or parenting problems. Equipped with a detailed geographical map the project team will develop a targeted intervention strategy for delivering focussed, context sensitive social prescribing across NI.