157 Antidepressant therapy prescription, do psychologists help? Evidence from Portugal ranged from 0 to 8 psychologists/100,000 patients in the local groups. Given this wide range, the addition of one psychologist/100,000 patients might represent a relative change of 100% to 12% in supply, respectively, and is expected to have a non-linear association with prescription. Secondly, we examined how the relationship of interest was influenced by certain characteristics of GPs, such as sex, age, tenure, patient list size, and degree of urbanization. These characteristics have been presented in the literature as determinants of antidepressant prescription, and heterogeneous results would provide insight into the role of GPs’ beliefs, attitudes, and personal experiences in the treatment decision. Thirdly, the magnitude of the relationship was explored based on the average antidepressant prescription share of each GP. Because our measure of prescription is a share, being standardised for the prevalence of depression in the patient list, prescription patterns should reflect mostly GP treatment preferences towards psychotherapy or antidepressants, rather than patient case mix. In grouping GPs by how often they prescribe we explore how the unmeasured characteristics shaping GP preferences influence our results. The paper is structured as follows: section Setting presents background information describing the Portuguese context and the study setting, and section Data introduces the data, our empirical approach and statistical analysis. Section Results starts with some descriptive results and moves on to the findings of our models, and section Discussion interpret these results and concludes. SETTING Depression and treatment approaches in Portugal Portugal has a high prevalence of psychiatric disorders compared to other European countries, with common mental disorders making the biggest difference [38]. According to the National Epidemiological Study of Mental Health, the 12-month prevalence of depression was 6.8% in 2013, and 19.3% of the Portuguese population would experience depression during their lifetime [39]. As in other countries, the prevalence of psychiatric disorders in Portugal tends to differ from diagnosis rates in primary care [40]. Compared to the 12-month prevalence of psychiatric disorders of 22.9% [39], the proportion of patients identified as having a mental health condition in Portuguese GP´s patient list ranged from 29% to 59% [41]. Portuguese consumption of antidepressants has also been consistently high for the past years. The country had the highest percentage of the population reporting taking antidepressants in Europe in 2010 (15.7%) [42] and antidepressants accounted for 3.7% of the volume of drugs sold in Portugal in 2020, ranking second among OECD countries [26]. On the other hand, there is limited availability of psychotherapy services in the Portuguese NHS. In 2019, there were 9.6 NHS psychologists for every 100,000 inhabitants in Portugal [43], a figure that is much lower than most European countries and the (minimum) recommended 20 psychologists / 100,000 inhabitants. Most of these 5
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