The PAPER Study (Prescribing Antidepressants in Primary care: Ethnic inequalities in tReatment): a study protocol

South Asian people represent the largest minority ethnic group in the UK, but prior research has suggested unequal access to primary care and differences in antidepressant prescribing practices for these patients.

To understand the treatment of depression in South Asian patients, with specific reference to factors affecting appropriate prescribing. The secondary aim is to understand the intersection between ethnicity, age, and financial deprivation within this context.

A mixed-methods approach will be adopted, including primary and secondary analyses, to understand the ways in which inequalities may arise along the pathway from patient experience of symptoms to clinician decision to treat with antidepressants in UK primary care.

Two scoping reviews will inform our approach. Quantitative data analysis of UK Biobank will allow us to examine prevalence and heterogeneity in depressive symptoms, and antidepressant prescribing over time, stratified by ethnicity. Qualitative data will be generated through interviews and focus group discussions with patients and healthcare professionals to understand experiences of depression and document the depression management decision-making process.

The PAPER study will produce clinically relevant findings to support the treatment and management of depression in primary care for South Asian patients. The dissemination plan will be informed by patient and public involvement (PPI) group members and engagement with stakeholders. Our main outputs will include a toolkit of resources for use in primary care as well as community-facing materials.