Did Brexit Vote Lead to Higher Levels of Depression?

Peter Russell

November 21, 2018

Prescriptions for antidepressants increased in England after the referendum that triggered Brexit, in contrast to other classes of drugs where demand was in decline, according to a study.

A research team led by King's College London (KCL) said the results were open to interpretation but that the trend might have been prompted by the increased uncertainty experienced by some sectors of the population in the aftermath of the vote.

The UK voted to leave the EU on June 23rd 2016 and led to a prolonged period of national uncertainty over what the future had in store.
 

Concerns and Insecurity

"Some people might have been concerned about their jobs, some businesses were threatening to relocate, [and] EU nationals might have been worried about whether they would be allowed to stay," Sotiris Vandoros, senior lecturer in health economics at KCL, told Medscape News UK.

Writing in the Journal of Epidemiology & Community Health, the researchers said the findings pointed to the importance of maintaining a strategy for good public mental health in times of economic and political upheaval.

The study compared official monthly prescribing data for antidepressants for all 326 voting areas in England with other classes of drugs for conditions less likely to be immediately affected by changes in mood. These included drugs to treat iron-deficiency anaemia, gout, and thyroid disease, drugs to lower blood glucose and blood fats, insulins, and muscle relaxants.

Antidepressant prescriptions were selected as an indicator of psychological distress, the researchers explained. The other drugs were chosen because they reflected conditions that were not expected to fluctuate in response to mental health conditions.

5 Year Prescribing Patterns

Prescribing patterns were recorded for every July between 2011 and 2016 to capture prescribing trends up to and including the immediate aftermath of the referendum result being declared.

To ensure they could compare the different types of drugs, they calculated a 'defined daily dose', reached by quantifying the number of milligrams prescribed – derived from the number of pills in a box, multiplied by the strength of each pill.

Analysis of the data showed that before the referendum, the defined daily dose for antidepressants rose during the month of July year-on-year, as did prescriptions for the other classes of drugs.

However, in the month after the referendum, antidepressant demand continued to rise, albeit at a slower pace, but those for the other drugs fell. 

The only exception was prescriptions for muscle relaxants, which had already been in decline.

The researchers calculated that after the referendum the volume of antidepressants prescribed increased by 13.4% relative to the other drugs.
 

'Population Distress'

The authors concluded that the "results suggest that the Brexit vote might have had consequences beyond changes in trade, immigration or the economy, influencing psychological wellbeing and leading to increased distress in the population."

However, they said the results were open to interpretation and should be treated with caution. "It does not capture mood for people not on antidepressants," said Sotiris Vandoros. "We do not suggest that there's any kind of average deterioration of mood in the UK. The majority voted to leave, so probably those people were happy, but that wouldn't be captured in the data."

However, he said that when combined with previous research, including the effects of economic recessions on populations, it was important to emphasise that "people should take care of their mental health in the same way as they take care of their physical health".
 

'Treat Results With Caution'

Commenting on the study, Allan Young, professor of mood disorders at the Institute of Psychiatry Psychology & Neuroscience, KCL, said: "Whilst these findings are interesting and eye catching they should be treated with great caution. As the authors note, an observational study such as this cannot ascribe cause and effect. 

"Antidepressant prescriptions have risen in England consistently over recent years and these data may simply reflect that rather than one single event. It should be noted that antidepressants are prescribed to treat anxiety disorders as well as mood disorders and it is credible that people may be more anxious because of recent uncertainty in society. However, levels of anxiety across the population were not reported in this study so cannot be shown explicitly.

"Nevertheless, the call to support mental health issues should be heeded."

Philippa Bradnock, information manager at the mental health charity, Mind, said: "The causes of mental health problems like depression and anxiety are complex and vary from person to person, so it’s very difficult to draw conclusions about how one factor might affect our mental health.

"Too often, though, people were unable to access the support they need," she said. "In the recent budget we were promised £2bn extra for mental health and that was welcome, but we see this as more of a 'down-payment' on what needs to be much faster growth in future.

"It will require a huge amount of investment over many years to reverse the damage caused by cuts to the NHS, social care, public health and the benefits system."

The EU referendum and mental health in the short term: a natural experiment using antidepressant prescriptions in England, Vandoros S et al, J Epidemiol Community Health.

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