Treatment resistant depression: A comparative study of access, pathways, and outcomes between Caucasian and ethnic minority individuals


Treatment resistant depression (TRD) is considered when an individual fails to respond to two or more different antidepressants in adequate doses, duration and with adequate adherence within the same major depressive episode.


To examine the clinical profiles of TRD patients through data from electronic healthcare records and compare characteristics and treatment pathways of ethnic minority and non-minority patients in UK.


A retrospective, longitudinal, observational cohort study of patients with TRD was carried out in 10 Mental Health NHS Foundation Trusts in the Akrivia Health/UK Clinical Record Interactive Search (CRIS) system network. The CRIS system was used as a means of analysing de-identified data across 3.2 million anonymised patients’ records.


10,048 patient records were deemed eligible for this study, of which 20.2 % of patients identified as BAME, and 79.8 % patients identified as White. Overall, around half of the patients were likely to be prescribed an antidepressant within 2 months of the MDD diagnosis. White patients were prescribed more antidepressants than the BAME group (p < 0.001), with a significant effect size for comorbidities.


The nature of the data source limited the ability to filter for short treatment durations as clinicians did not often record concrete medication end-dates in clinical note fields.


There are significant differences in care pathways between ethnic groups in relation to TRD patients. It is vital to understand factors causing these potential clinical biases and increase awareness and education to deliver the most effective treatments for TRD in ethnic minority patients.

Shanaya Rathod a, Zuzanna Skórniewska b, Tomas Engelthaler b, Benjamin Fell b, Sana Sajid a, Peter Phiri ac

aResearch and Innovation Department, Southern Health NHS Foundation Trust, Southampton SO30 3JB, UK

bAkrivia Health, Clarendon House, Cornmarket Street, Oxford, OX1 3HJ, UK

cSchool of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, UK

Received 11 September 2023, Revised 5 February 2024, Accepted 7 February 2024, Available online 10 February 2024, Version of Record 23 February 2024.