Who with OCD gets referred? A 10-point deprivation gap in English primary care records

BACKGROUND: Psychological treatment and SSRIs are both first-line options for obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD), but whether people in deprived areas receive the same kind of care is unknown. NICE has published tables from English primary care records (CPRD Aurum) for two possibly overlapping cohorts: 20,253 people diagnosed within three years and 7,271 newly diagnosed.AIMS: To establish whether deprivation is associated with which care is recorded, mental health referral or SSRI prescribing, in adults and children.METHOD: We verified NICE's 1,171 values, rebuilt counts from rounded percentages, repeated every test over all admissible counts with multiplicity, clustering and missing-data sensitivity analyses, and compared findings with national prescribing, NHS Talking Therapies data and 25 published studies.RESULTS: Among newly diagnosed adults, 42% in the most deprived fifth had a mental health referral recorded, against 52% in the least, while SSRI prescribing barely differed (61% against 62%). In the three-year cohort, referral was 41% against 48% and SSRI prescribing higher in the most deprived fifth (54% against 49%). The two outcomes' slope indices differed by 17.0 percentage points (three-year cohort; Holm-adjusted P < 0.001) and 15.5 (newly diagnosed; Holm-adjusted P = 0.041; Bonferroni 0.082). NICE's comorbidity-adjusted estimates were similar. In newly diagnosed children, exploratory analyses showed referral of 46% against 54% (odds ratio 0.70 to 0.75), and lower SSRI prescribing in Asian than White children (0.60 to 0.65). In national NHS Talking Therapies data, OCD formed a smaller share of anxiety referrals in areas whose referrals came more from deprived neighbourhoods (Spearman's rho −0.48), unlike generalised anxiety disorder.CONCLUSIONS: In what are, to our knowledge, England's only national primary care data on OCD and BDD, deprived areas had less recorded mental health referral but no less SSRI prescribing: equal prescribing should not be read as equal care. Child differences need confirmation; linked records could show whether the gap is in treatment received.