The PAPER Study

We know that there are differences between ethnic groups in the amounts and types of medications prescribed. We are interested in understanding the prescribing of antidepressant medication, particularly focussing on the experiences of patients from a South Asian minority ethnic background, who are living in the UK.

We wish to focus on antidepressants for a number of reasons:

• Depression presents itself differently in different patients so it can be difficult to diagnose.
• Even if diagnosed, depression can be very difficult to treat effectively, and many patients do not respond to treatment at all.  
• Depressed patients do not always take the medications they are prescribed. 

All these things may contribute to inappropriate prescribing of antidepressants.  

We wish to focus on South Asian patients because:  

• They are the largest minority ethnic group in the UK.  
• Previous research has shown they may be particularly vulnerable to depression and not get the treatment they need or want.  

Therefore, it is important to understand the specific needs of these patients and what changes can be made to the healthcare system to better support them.  

Our project has several different parts to it: 

1. The first study will use information from a large study called the UK Biobank which contains records for over half a million adults. We will use this data to see how many people from a minority ethnic background have depression, what types of symptoms they report and how often they are prescribed antidepressant medications.
2. The second study aims to understand whether the current questions general practitioners (GPs) use to diagnose depression are useful in South Asian patients. We will interview patients from the South Asian community to understand the types of depression symptoms they experience and how these relate to the sorts of questions they would typically be asked in an appointment with their GP. We will also interview important representatives within the South Asian community to get their view on the things that are important to understand in relation to the diagnosis of depression.
3. The third study will examine the decision-making process during a GP appointment that leads to the diagnosis of depression and a treatment decision, which may include a prescription of antidepressants. This will involve interviews with both patients from a South Asian background recently prescribed antidepressants, and interviews with GPs. We will also speak to groups of GPs and present them with various fictional patients with symptoms of depression and ask them to talk us through the questions they would ask to help them decide on a treatment plan.

Our study team includes psychologists, an anthropologist and health policy researcher, a statistician, a GP, and two patrons of the South Asian Health Foundation (SAHF). By bringing together all our scientific expertise, and the insights of our Patient Public Involvement panel of experts with lived experience, we will be able to make sure we think about the issues of antidepressant prescribing among South Asians living in the UK from all angles.

This project aims to understand the treatment of depression in South Asian patients, with specific reference to factors affecting appropriate prescribing in this patient group. The secondary aim is to understand the intersection between ethnicity, age and financial deprivation within this context. Our objectives are:

1. To estimate the prevalence and heterogeneity of depressive symptoms and antidepressant prescribing among minority ethnic individuals in the UK.
2. To understand the presentation of depression in South Asians and if existing depression screening tools in primary care are culturally competent.
3. To identify aspects of the consultation that affect antidepressant prescribing at the point of diagnosis/first-ever antidepressant prescription among South Asian patients.