Gender differences in the use of anxiolytics and antidepressants: a population based study

New users of anxiolytics and sedatives in Sweden-Drug type, doses, prescribers' characteristics, and psychiatric comorbidity in more than 750,000 patients

OBJECTIVES

Anxiety and sleep disorders are common in the population and anxiolytics and sedatives are widely used. Our aim was to describe the drug utilization of new users of anxiolytics and sedatives in adults including type of drug, doses, prescribers' characteristics, and psychiatric comorbidity.

METHODS

A register-based cohort study of new users (18-64 years) of anxiolytics and sedatives in 2015-2019, free of any such drug 5 years prior to inclusion. The individuals were linked to national registers on dispensed drugs and recorded diagnoses.

RESULTS

In total, 764,432 new users of anxiolytics and sedatives were identified, which corresponds to an incidence of 26/1000 inhabitants and year. The proportion of new users of benzodiazepines (including both anxiolytics and sedatives) decreased, whereas the proportion of sedative antihistamines and melatonin increased. The most common drug dispensed was hydroxizin (33%) followed by benzodiazepine related drugs (zopiclone and zolpidem; 20%), propiomazine (14%) and benzodiazepines (13%). The majority (68%) of the prescriptions were from primary care. Most new users were prescribed 1-30DDDs and 52% among women and 49% among men were dispensed their drug only once during the first year. Half of the new users had a previous comorbid psychiatric disorder.

CONCLUSIONS

The findings are well reflecting the recommendations in national guidelines.

The influence of prescriber and patient gender on the prescription of benzodiazepines: results from the Florida Medicaid Dataset

BACKGROUND

Benzodiazepine (BZD) prescription rates have increased over the past decade in the United States. Available literature indicates that sociodemographic factors may influence diagnostic patterns and/or prescription behaviour. Herein, the aim of this study is to determine whether the gender of the prescriber and/or patient influences BZD prescription.

METHODS

Cross-sectional study using data from the Florida Medicaid Managed Medical Assistance Program from January 1, 2018 to December 31, 2018. Eligible recipients ages 18 to 64, inclusive, enrolled in the Florida Medicaid plan for at least 1 day, and were dually eligible. Recipients either had a serious mental illness (SMI), or non-SMI and anxiety.

RESULTS

Total 125 463 cases were identified (i.e., received BZD or non-BZD prescription). Main effect of patient and prescriber gender was significant F(1, 125 459) = 0.105, P = 0 .745, partial η2 < 0.001. Relative risk (RR) of male prescribers prescribing a BZD compared to female prescribers was 1.540, 95% confidence intervals (CI) [1.513, 1.567], whereas the RR of male patients being prescribed a BZD compared to female patients was 1.16, 95% CI [1.14, 1.18]. Main effects of patient and prescriber gender were statistically significant F(1, 125 459) = 188.232, P < 0.001, partial η2 = 0.001 and F(1, 125 459) = 349.704, P < 0.001, partial η2 = 0.013, respectively.

CONCLUSIONS

Male prescribers are more likely to prescribe BZDs, and male patients are more likely to receive BZDs. Further studies are required to characterize factors that influence this gender-by-gender interaction.

Sex differences in psychotropic and analgesic drug use before and after initiating treatment with acetylcholinesterase inhibitors

BACKGROUND/AIMS

The aim was to explore the impact of sex on prevalence, patterns and trends in the prescription of psychotropics and analgesics in users of acetylcholinesterase inhibitors (AChEIs), before and after AChEI initiation, compared to the general population.

METHODS

A prospective study applying data from the Norwegian Prescription Database (NorPD) in the period 2004-2016. Prescription of antidepressants, antipsychotics, analgesics including opioids, benzodiazepines and z-hypnotics in persistent AChEI users was studied in a follow-up period from four years before to two years after AChEI initiation in men and women of four age groups: 37-64, 65-72, 73-80 and 81-88 years.

RESULTS

Use of antidepressants, antipsychotics and weaker analgesics increased in both sexes during the follow-up period in 11.764 persistent AChEI users. Women with pre-dementia and dementia stages of AD showed a prescription pattern with more use of psychotropics and opioids than men, except for antipsychotics.

CONCLUSION

Female sex showed to have a significant influence on the prescriptions of psychotropics and analgesics in AD patients in a pre-dementia and dementia stage. The exception is for antipsychotics, that men used more than women. The prescription pattern showed a higher extent of polypharmacy of psychotropics and/or opioids in women than in men. The total prescription pattern of analgesics could indicate an undertreatment of pain in pre-dementia and dementia stages, most pronounced in men.

Changes in benzodiazepine use in the French general population after November 2015 terrorist attacks in Paris: an interrupted time series analysis of the national CONSTANCES cohort

OBJECTIVES

To determine whether the terrorist attacks occurring in Paris on November 2015 have changed benzodiazepine use in the French population.

DESIGN

Interrupted time series analysis.

SETTING

National population-based cohort.

PARTICIPANTS

90 258 individuals included in the population-based CONSTANCES cohort from 2012 to 2017.

OUTCOME MEASURES

Benzodiazepine use was evaluated according to two different indicators using objective data from administrative registries: weekly number of individuals with a benzodiazepine delivered prescriptions (BDP) and weekly number of defined daily dose (DDD). Two sets of analyses were performed according to sex and age (≤50 vs >50). Education, income and area of residence were additional stratification variables to search for at-risk subgroups.

RESULTS

Among women, those with younger age (incidence rate ratios (IRR)=1.18; 95% CI=1.05 to 1.32 for BDP; IRR=1.14; 95% CI=1.03 to 1.27 for DDD), higher education (IRR=1.23; 95% CI=1.03 to 1.46 for BDP; IRR=1.23; 95% CI=1.01 to 1.51 for DDD) and living in Paris (IRR=1.27; 95% CI=1.05 to 1.54 for BDP) presented increased risks for benzodiazepine use. Among participants under 50, an overall increase in benzodiazepine use was identified (IRR=1.14; 95% CI=1.02 to 1.28 for BDP and IRR=1.12; 95% CI=1.01 to 1.25 for DDD) and in several strata. In addition to women, those with higher education (IRR=1.22; 95% CI=1.02 to 1.47 for BDP), lower income (IRR=1.17; 95% CI=1.02 to 1.35 for BDP) and not Paris residents (IRR=1.13; 95% CI=1.02 to 1.26 for BDP and IRR=1.13; 95% CI=1.03 to 1.26 for DDD) presented increased risks for benzodiazepine use.

CONCLUSION

Terrorist attacks might increase benzodiazepine use at a population level, with at-risk subgroups being particularly concerned. Information and prevention strategies are needed to provide appropriate care after such events.

Effects of subanesthetic intravenous ketamine infusion on neuroplasticity-related proteins in male and female Sprague-Dawley rats

Although ketamine, a multimodal dissociative anesthetic, is frequently used for analgesia and treatment-resistant major depression, molecular mechanisms of ketamine remain unclear. Specifically, differences in the effects of ketamine on neuroplasticity-related proteins in the brains of males and females need further investigation. In the current study, adult male and female Sprague-Dawley rats with an indwelling jugular venous catheter received an intravenous ketamine infusion (0, 10, or 40 mg/kg, 2-h), starting with a 2 mg/kg bolus for ketamine groups. Spontaneous locomotor activity was monitored by infrared photobeams during the infusion. Two hours after the infusion, brain tissue was dissected to obtain the medial prefrontal cortex (mPFC), hippocampus including the CA1, CA3, and dentate gyrus, and amygdala followed by Western blot analyses of a transcription factor (c-Fos), brain-derived neurotrophic factor (BDNF), and phosphorylated extracellular signal-regulated kinase (pERK). The 10 mg/kg ketamine infusion suppressed locomotor activity in male and female rats while the 40 mg/kg infusion stimulated activity only in female rats. In the mPFC, 10 mg/kg ketamine reduced pERK levels in male rats while 40 mg/kg ketamine increased c-Fos levels in male and female rats. Female rats in proestrus/estrus phases showed greater ketamine-induced c-Fos elevation as compared to those in diestrus phase. In the amygdala, 10 and 40 mg/kg ketamine increased c-Fos levels in female, but not male, rats. In the hippocampus, 10 mg/kg ketamine reduced BDNF levels in male, but not female, rats. Taken together, the current data suggest that subanesthetic doses of intravenous ketamine infusions produce differences in neuroplasticity-related proteins in the brains of male and female rats.

Gender differences in treatment with antidepressants during first weeks of a sick-leave spell due to depressive episode

Background

The incidence of depression is higher in women; women are more often on sick leave due to depression, and more women than men use antidepressants. The objective of this study was to explore possible gender differences in buying prescribed antidepressants during the first 21 days of a new sick-leave spell due to depressive episode.

Methods

Included were all individuals living in Sweden in working age (18–64 years old) who in 2010 or 2011 began a new sick-leave spell due to depressive episode (ICD-10 F32) lasting at least 21 days (n = 44 863). Register data on sociodemographics, morbidity and dispensed prescription medication were used to investigate associations between gender and buying prescribed antidepressants in the total group and in subgroups, using multiple logistic regression models.

Results

The study population consisted of 69.5% women. Within the first 21 days of the sick-leave spell, 48.0% of the men and 42.1% of the women had dispensed prescribed antidepressants. In the adjusted multiple logistic regression model, men had an odds ratio of 1.28 (95% confidence interval 1.23–1.33) as compared with women, for buying prescribed antidepressants.

Conclusions

In this nationwide register study, nearly half of the women and men on sick leave with depressive episode bought prescribed antidepressants during the first three weeks of the sick-leave spell. In the adjusted models, men were more likely to do this. Further studies are needed to elucidate the reasons for this gender difference.

Sex differences in pharmacological treatment of major depressive disorder: results from the AMSP pharmacovigilance program from 2001 to 2017

Data on drug prescription for outpatients with major depressive disorder (MDD) suggest women are more likely to be treated with psychotropic drugs, while data on sex differences regarding pharmacological treatment of psychiatric inpatients are currently not available. Drug utilization data from the program "Drug Safety in Psychiatry" (German: Arzneimittelsicherheit in der Psychiatrie, AMSP) of 44,418 psychiatric inpatients with MDD were analyzed for sex differences between 2001 and 2017. Sex differences were analyzed using relative risks (RR) and 95% confidence intervals (95% CI). Time trends were analyzed by comparing the first (2001-2003) with the last time period (2015-2017). In general, men and women were equally likely to use psychotropic drugs. Monotherapy was more common in men. Women were more likely to utilize ≥ 4 psychotropic drugs. Antidepressant drugs (ADDs) were the most prescribed drug class. Men had a higher utilization of noradrenergic and specific serotonergic antidepressants (RR 1.15; 95% CI 1.12-1.19), especially mirtazapine (RR 1.16; 95% CI 1.12-1.19), but also of other ADDs such as bupropion (RR 1.50; 95% CI 1.35-1.68). Males had a slightly higher utilization of second-generation antipsychotic drugs (RR 1.06; 95% CI 1.03-1.09) and were less often treated with low-potency first-generation antipsychotic drugs (RR 0.86; 95% CI 0.83-0.90). Tranquilizing (e.g., benzodiazepines; RR 0.89; 95% CI 0.86-0.92) and hypnotic drugs (e.g., Z-drugs; RR 0.85; 95% CI 0.81-0.89) were less utilized in the treatment of male patients. Not all sex differences were stable over time. More sex differences were detectable in 2015-2017 than in 2001-2003. Findings suggest that certain psychotropic drugs are preferred in the treatment of men vs. women, however, sex differences found in this study are not as large as in ambulatory settings. To make evidence-based sex-specific recommendations in the treatment of MDD, differences in drug response and tolerability need to be further researched.

Trends in Psychotropic Medication Prescriptions in Urban China From 2013 to 2017: National Population-Based Study

Purpose: Psychotropic medications are commonly used for treating mental disorders; however, there is currently no study on how commonly they are used in China. This study reported the trends in psychotropic medications prescriptions in urban China. Methods: A national population-based study was conducted using the China Health Insurance Research Association database to estimate the period prescription prevalence of 11 major classes of psychotropic medications annually during 2013-2017. The World Health Organization Anatomical Therapeutic Chemical (ATC) classification codes were used to identify psychotropic medications. Results: The prescription prevalence of any psychotropic medication increased from 8.110% (8.106-8.114%) in 2013 to 11.362% (11.357-11.366%) in 2017. The prescription prevalence of six classes increased significantly during 2013-2017, including sedatives-hypnotics (from 3.177 to 5.388%), anxiolytics (from 1.436 to 2.200%), antiepileptic drugs (from 1.416 to 2.140%), antipsychotics (from 0.809 to 1.156%), antidepressants (from 0.891 to 1.045%), and psycholeptic polypills (from 0.682 to 0.866%). The prescription prevalence of antidementia drugs increased from 0.069 to 0.122%, and mood stabilizers increased from 0.029 to 0.037%, although not statistically significant. The prescription prevalence of nootropic drugs, attention deficit hyperactivity disorder (ADHD) medications and drugs used in the treatment of addictive disorders was largely stable. Psychotropic medication prescription increased with age for all classes except for ADHD medications and mood stabilizers. Conclusion: Increasing trends in prescription prevalence were observed for most classes of psychotropic medications in urban China, although the prevalence was still lower than that in most developed countries. Further research is warranted to explore the potential treatment gap between China and most developed countries.

The Effect of Prescription Drugs and Alcohol Consumption on Intimate Partner Violence Victim Blaming

Intimate Partner Violence (IPV) is a public health problem with harsh consequences for women's well-being. Social attitudes towards victims of IPV have a big impact on the perpetuation of this phenomenon. Moreover, specific problems such as the abuse of alcohol and drugs by IPV victims could have an effect on blame attributions towards them. The aim of this study was to evaluate whether the external perception (Study 1) and self-perception (Study 2) of blame were influenced by the victims' use and abuse of alcohol or by the victims' use of psychotropic prescription drugs. Results of the first study (N = 136 participants) showed a significantly higher blame attribution towards female victims with alcohol abuse compared to those without it. No significant differences were found on blame attributed to those with psychotropic prescription drugs abuse and the control group. Results of the second study (N = 195 female victims of interpersonal violence) showed that alcohol consumption is associated with higher self-blame and self-blame cognitions among IPV victims. However, results did not show significant differences on self-blame associated to the victims' use of psychotropic prescription drugs. Our findings indicate that alcohol consumption, but not prescription drugs use, plays a relevant role in the attribution of blame by general population and self-blame by victims of IPV.

Trends in the consumption rates of benzodiazepines and benzodiazepine-related drugs in the health region of Lleida from 2002 to 2015

Background

The high prevalence and long-term use of benzodiazepines (BZDs) treatment are debated topics because of the risk they can cause to the patients. Despite the current information on the risk-benefit balance of these drugs, their consumption remains particularly high. We determined the trend in the consumption prevalence of benzodiazepines (BZDs) and drugs related to BZDs (Z-drugs) in the population of the Health Region of Lleida to explore patterns of use and the associated characteristics associated between 2002 and 2015.

Methods

An analysis of secular trends was carried out between 2002 and 2015; the databased included all individuals from the Health Region of Lleida, which had 358,157 inhabitants in 2015, that consumed BZDs. The consumption of BZDs was evaluated using prescription billing data from the Public Health System. All types of BZDs and BZD analogues that had been approved by the drug agency were included. Trends by age and sex were investigated.

Results

Over the whole study period, a total of 161,125 individuals accounted for 338,148 dispensations. Overall, 59% were women, and the mean age was 56 years. The dispensing prevalence of BZDs use in 2015 was 14.2% overall —18.8% in women and 9.6% in men—and was 36% in those over 65 years. According to the half-life of BZDs, the prevalence of short-intermediate BZD use, intermediate-long BZD use, and Z-drugs use was 9.7, 5.5 and 0.8%, respectively. The evolution of the annual prevalence of BZD dispensing showed a progressive decline, from 15.3% in 2002 to 14.2% in 2015, which was attributed to a decrease in the consumption of intermediate-long half-life BZDs (8.0% vs. 5.5%) and Z-drugs (1.4% vs. 0.8%).

Conclusion

The dispensing prevalence of BZDs and Z-drugs was high, although a small reduction was observed during this time period. The dispensing prevalence was especially high in the population over 65, despite the risk of cognitive decline and falls. Integral actions are required to lower the BZD prescription rate.

Common and dissociable effects of oxytocin and lorazepam on the neurocircuitry of fear

Benzodiazepines (BZDs) represent the gold standard of anxiolytic pharmacotherapy; however, their clinical benefit is limited by side effects and addictive potential. Consequently, there is an urgent need to develop novel and safe anxiolytics. The peptide hormone oxytocin (OXT) exhibits anxiolytic-like properties in animals and humans, but whether OXT and BZDs share similar effects on the neural circuitry of fear is unclear. Therefore, the rationale of this ultra-high-field functional MRI (fMRI) study was to test OXT against the clinical comparator lorazepam (LZP) with regard to their neuromodulatory effects on local and network responses to fear-related stimuli. One hundred twenty-eight healthy male participants volunteered in this randomized double-blind, placebo-controlled, between-group study. Before scanning using an emotional face-matching paradigm, participants were randomly administered a single dose of OXT (24 IU), LZP (1 mg), or placebo. On the behavioral level, LZP, but not OXT, caused mild sedation, as evidenced by a 19% increase in reaction times. On the neural level, both OXT and LZP inhibited responses to fearful faces vs. neutral faces within the centromedial amygdala (cmA). In contrast, they had different effects on intra-amygdalar connectivity; OXT strengthened the coupling between the cmA and basolateral amygdala, whereas LZP increased the interplay between the cmA and superficial amygdala. Furthermore, OXT, but not LZP, enhanced the coupling between the cmA and the precuneus and dorsomedial prefrontal cortex. These data implicate inhibition of the cmA as a common denominator of anxiolytic action, with only OXT inducing large-scale connectivity changes of potential therapeutic relevance.

Prevalence of prescribed benzodiazepine long-term use in the French general population according to sociodemographic and clinical factors: findings from the CONSTANCES cohort

Background

Data are lacking regarding the prevalence of benzodiazepine long-term use in the general population. Our aim was to examine the prevalence of prescribed benzodiazepine long-term use (BLTU) according to sociodemographic and clinical factors in the French general population.

Methods

Data came from 4686 men and 4849 women included in 2015 in the French population-based CONSTANCES cohort. BLTU was examined using drug reimbursement administrative registries from 2009 to 2015. Analyses were weighted to provide results representative of the French general population covered by the general health insurance scheme. Weighted prevalence of BTLU and weighted Odds Ratios (OR) of having BTLU were computed with their 95% Confidence Interval (95% CI) according to age, education level, occupational status, occupational grade, household income, marital status, alcohol use disorder risk and depressive symptoms. All the analyses were stratified for gender.

Results

Weighted prevalence of BLTU were 2.8%(95% CI:2.3–3.4) and 3.8%(95% CI: 3.3–4.5) in men and women, respectively. Compared to men, women had an increased risk of having benzodiazepine long-term use with OR = 1.34(95% CI = 1.02–1.76). Aging, low education, not being at-work, low occupational grade, low income, being alone and depressive state were associated with increased risks of having BTLU.

Conclusions

BLTU is widespread in the French general population, however this issue may particularly concern vulnerable subgroups. These findings may help in raising attention on this public health burden as well as targeting specific at-risk subgroups in preventive intervention.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6933-8) contains supplementary material, which is available to authorized users.

Primary care chaplaincy: an intervention for complex presentation

AIM

To determine the responsiveness of primary care chaplaincy (PCC) to the current variety of presenting symptoms seen in primary care. This was done with a focus on complex and undifferentiated illness.

BACKGROUND

Current presentations to primary care are often complex, undifferentiated and display risk factors for social isolation and loneliness. These are frequently associated with loss of well-being and spiritual issues. PCC provides holistic care for such patients but its efficacy is unknown in presentations representative of such issues. There is therefore a need to assess the characteristics of those attending PCC. The effectiveness of PCC relative to the type and number of presenting symptoms should also be analysed whilst evaluating impact on GP workload.

METHODS

This was a retrospective observational study based on routinely collected data. In total, 164 patients attended PCC; 75 were co-prescribed antidepressants (AD) and 89 were not (No-AD). Pre- and post-PCC well-being was assessed by the Warwick-Edinburgh mental well-being score. Presenting issue(s) data were collected on a separate questionnaire. GP appointment utilisation was measured for three months pre- and post-PCC.

FINDINGS

Those displaying undifferentiated illness and risk factors for social isolation and loneliness accessed PCC. PCC (No-AD) was associated with a clinically meaningful and statistically significant improvement in well-being in all presenting issues. This effect was maintained in those with multiple presenting issues. PCC was associated with a reduction in GP appointment utilisation in those not co-prescribed AD.

Psychotropic drug use as indicator of mental health in adolescents affected by a plexus injury at birth: A large population-based study in Sweden

Chronic handicap in early life may have a long-term impact on children’s psychosocial well-being. Here, we investigated whether Brachialis Plexus Birth Injury (BPBI)—an unpredictable injury at birth—is associated with worse mental health later on, as indicated by prescription and use of psychotropic drugs in adolescence. We explored further whether this association is different depending on socioeconomic characteristics of the child’s family, as well as sex. Of the 641 151 children born to native parents in Sweden 1987–1993 (alive and still living in Sweden at the end of 2008), identified in the Swedish Medical Birth Registry, 1587 had suffered a BPBI. Logistic regression analysis was performed to assess the impact of socioeconomic characteristics and associations with later psychosocial health. Results show that beyond the known increased risks for females as compared to males, BPBI, but also lower family income, further increased the risk of burdened mental health requiring psychotropic drug use in adolescence. The effects were additive. Thus, compared to unaffected peers, teenagers who suffered a BPBI at birth are at higher risk of suffering poor mental health during adolescence, independently of surgical intervention and its outcome. Girls growing up in families with lower socioeconomic status have this risk added to their already increased risk of poor mental health during adolescence.

Gender in Endocrine Diseases: Role of Sex Gonadal Hormones

Gender- and sex- related differences represent a new frontier towards patient-tailored medicine, taking into account that theoretically every medical specialty can be influenced by both of them. Sex hormones define the differences between males and females, and the different endocrine environment promoted by estrogens, progesterone, testosterone, and their precursors might influence both human physiology and pathophysiology. With the term Gender we refer, instead, to behaviors, roles, expectations, and activities carried out by the individual in society. In other words, "gender" refers to a sociocultural sphere of the individual, whereas "sex" only defines the biological sex. In the last decade, increasing attention has been paid to understand the influence that gender can have on both the human physiology and pathogenesis of diseases. Even the clinical response to therapy may be influenced by sex hormones and gender, but further research is needed to investigate and clarify how they can affect the human pathophysiology. The path to a tailored medicine in which every patient is able to receive early diagnosis, risk assessments, and optimal treatments cannot exclude the importance of gender. In this review, we have focused our attention on the involvement of sex hormones and gender on different endocrine diseases.

The efficacy of primary care chaplaincy compared with antidepressants: a retrospective study comparing chaplaincy with antidepressants

Aim To determine the effectiveness of primary care chaplaincy (PCC) when used as the sole intervention, with outcomes being compared directly with those of antidepressants. This was to be carried out in a homogenous study population reflective of certain demographics in the United Kingdom.

BACKGROUND

Increasing numbers of patients are living with long-term conditions and 'modern maladies' and are experiencing loss of well-being and depression. There is an increasing move to utilise non-pharmacological interventions such as 'talking therapies' within this context. Chaplaincy is one such 'talking therapy' but within primary care its evidence base is sparse with only one quantitative study to date. There is therefore a need to evaluate PCC excluding those co-prescribed antidepressants, as this is not evidenced in the literature as yet. PCC also needs to be directly compared with the use of antidepressants to justify its use as a valid alternative treatment for loss of well-being and depression.

METHODS

This was a retrospective observational study based on routinely collected data. There were 107 patients in the PCC group and 106 in the antidepressant group. Socio-demographic data were collected. Their pre- and post-intervention (either chaplaincy or antidepressant) well-being was assessed, by the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) which is a validated Likert scale. Findings The majority of both groups were female with both groups showing marked ethnic homogeneity. PCC was associated with a significant and clinically meaningful improvement in well-being at a mean follow-up of 80 days. This treatment effect was maintained after those co-prescribed antidepressants were removed. PCC was associated with an improvement in well-being similar to that of antidepressants with no significant difference between the two groups.

Trends in the dispensation of antidepressant drugs over the past decade (2000-2010) in Andalusia, Spain

PURPOSE

To study antidepressant drug dispensation in the Spanish region of Andalusia and in the Almeria Health Area (AHA) over the past decade, analyzing the variability, trends, and influential factors.

METHODS

We conducted an observational ecological study of antidepressant drug dispensation between 2000 and 2010 in Andalusia. Dispensation was measured as Defined Daily Dose (DDD) per 1,000 inhabitants per day. A multilevel analysis (STATA 11.1) was performed to determine the variability among the basic health zones (BHZs) (2004-2010) and influential factors.

RESULTS

Between 2000 and 2010, the total dispensation of antidepressant drugs increased by more than 100 % in Andalusia and in the AHA. This increase was primarily caused by the greater dispensation of selective serotonin reuptake inhibitors (ATC-N06AB) and other antidepressants (ATC-N06AX). Multilevel analysis revealed a wide variability in the levels and trends of antidepressant dispensation among BHZs. Urbanicity and the percentage of immigrants in the BHZ were negatively associated with their dispensation, which was positively influenced by a higher proportion of women and over 65-year-olds in the population.

CONCLUSIONS

The elevated dispensation of several groups of antidepressant drugs in this study population indicates the need for health policies to rationalize their use. Further research is required into the differences in antidepressant dispensations between immigrant and native populations and the implications for public health policies.

Psychotropic drug use in adolescents born with an orofacial cleft: a population-based study

OBJECTIVES

Being born with an orofacial cleft (OFC) can, due to an incomplete closure of the lip and/or palate, convey a deviant speech and/or deviant facial aesthetics, which may in turn increase the risk for poor psychological health later in life. Previous investigations have been based on small samples and self-reports, not distinguishing between the three different types of OFC: cleft lip (CL), CL and palate (CLP) and cleft palate only (CPO). We present a large population-based study, considering psychotropic drug use as a proxy for poor psychological health and distinguishing between three different types of OFC.

DESIGN AND METHODS

Using the Swedish Medical Birth Register, and linking to it the Swedish Prescribed Drug Register, the National Mortality Register, the Emigration Register and the National Inpatient Register, we identified all singletons born to native mothers in Sweden between 1987 and 1993, alive and residing in Sweden at the end of an 18-year follow-up period (N=626 109). We compared psychotropic drug use among individuals with and without OFC during the individuals' adolescence (2005-2008) by multiple logistic regressions, using ORs with 95% CIs.

RESULTS

When adjusted for potential confounders, having a CL (OR=1.63, 95% CI 1.08 to 2.46) or a CPO (OR=1.54, 95% CI 1.18 to 2.01) increased the risk of psychotropic drug use. Results were not significant regarding adolescents who had a CLP (OR=1.21, 95% CI 0.81 to 1.80).

CONCLUSIONS

Being born with a CL or a CPO increases the risk for psychotropic drug use in adolescence, but not for adolescents born with a CLP. Our findings suggest that, since the three OFC types are associated with different long-term risks of poor psychological health, the three groups should be studied separately concerning long-term psychosocial consequences.

Use of mental health services by women in low and middle income countries

Purpose

– The purpose of this paper is to examine sex differences in mental health service usage among upper-middle, lower-middle, and low-income countries (LICs).

Design/methodology/approach

– Data from 62 low- and middle-income countries (LAMICs) were collected with the World Health Organization – Assessment Instrument for Mental Health Systems (WHO-AIMS). Sex differences in mental health service utilization were assessed by comparing the proportion female in the general population with the proportion female treated for mental illness in five different types of mental health facility.

Findings

– Two-sided t-tests for significance (a=0.05) revealed a significant difference between the proportion female in the population and the proportion treated in inpatient facilities (community-based and mental hospitals) in LICs. There was also a trend toward decreased use of outpatient facilities by women in LICs (p=0.08). Lower-middle and upper-middle income countries showed no differences. In day treatment facilities for the entire sample, there was a significant difference between the proportion female in the population and the proportion treated female (weighted mean difference overall=0.10, p=0.035).

Research limitations/implications

– The authors found significantly reduced utilization of mental health services by women in LICs in community-based inpatient facilities and mental hospitals and a trend toward decreased use in outpatient facilities. Future studies investigating the factors contributing to the lower utilization of services by women in LICs are essential.

Originality/value

– This study presents the first comprehensive study of mental health service usage by sex in 62 LAMICs.

Quality of life and social determinants of anxiolytics and hypnotics use in women in Poland: a population-based study

BACKGROUND

The majority of studies show a substantially higher consumption of anxiolytics and antidepressants among women than among men and in the age bracket above 45 years.

AIMS

To analyse association between the use of hypnotics/anxiolytics, and various characteristics of Polish women, including health-related quality of life.

METHOD

One thousand, five hundred and sixty (1,560) women aged 45-60 years completed a questionnaire dealing with the use of hypnotics/anxiolytics, demographic characteristics, environmental and work stress exposure, and self-reported quality of life (SF-36 form).

RESULTS

The following variables were revealed as the predictors of hypnotic/anxiolytic use on univariate analysis: age; social pension; stress at work and environmental stress; hormone replacement therapy; headache; palpitations; mood swings or increased muscular tension; anger; duration of symptoms longer than one week; consulting a specialist; and low physical and mental health-related quality of life. The significant protective factors included: vocational and tertiary education; job satisfaction; and home as place of rest. The independent predictors of anxiolytic/hypnotic use included consulting a specialist and symptoms lasting more than one week, while job satisfaction and home as place of rest were the independent protective factors.

CONCLUSIONS

The use of hypnotic/anxiolytic medication is strongly associated with environmental and psychosocial characteristics of women between 40 and 65 years of age.

Psychosocial characteristics of benzodiazepine addicts compared to not addicted benzodiazepine users

OBJECTIVE

Although the addictive potential of benzodiazepine drugs has been known for a long time, new cases of benzodiazepine addictions keep emerging in clinical practice. The etiology of benzodiazepine addiction seems to be multifactorial. The objective of this study was to investigate and measure psychological and situational factors differentiating benzodiazepine addicts from not addicted users.

METHODS

A psychological profile and situational factors of patients with the diagnosis of benzodiazepine addiction and a carefully matched control group of not addicted former benzodiazepine users were defined and investigated.

RESULTS

The investigated benzodiazepine addicts differed significantly from the control group in particular psychological dimensions, such as higher neuroticism and introversion, prevalence of emotional rather than task based coping mechanisms. There were also significant correlations between the addiction and situational factors such as BZD - treatment circumstances and adverse life events previous to the treatment.

CONCLUSIONS

The results show psychological and situational factors which differentiate benzodiazepine addicts from not addicted benzodiazepine users. This data suggest that benzodiazepine addiction might be associated with higher neuroticism, introversion and less effective coping mechanisms as well as with previous accumulation of adverse life events and/or inadequate BZD treatment. The psychological and situational factors mentioned above might be considered as potential risk factors for benzodiazepine addiction.

Patterns of depressive symptoms and antidepressant use among women survivors of intimate partner violence

PURPOSE

One of the primary mental health responses of women experiencing intimate partner violence (IPV) is depression, yet little is known about the mental health and antidepressant use of women in the period after leaving an abusive partner. We investigate patterns of antidepressant use and depressive symptoms by various social indicators (parenting status, socioeconomic status, severity of abuse and disclosure of abuse). Second, we examine whether variation in antidepressant use is explained by higher rates of depression diagnoses and/or depressive symptoms, taking these social indicators into consideration.

METHODS

We examine data from the Women's Health Effects Study, a community sample of 309 Canadian women who have recently left an abusive partner.

RESULTS

Bivariate results reveal that over 80% of women with elevated depressive symptoms are without diagnosis and antidepressant medication. Multivariate analyses show that antidepressant use is predicted by an indicator of economic disadvantage, with women who receive social assistance or disability benefits being more likely to report elevated antidepressant use, controlling for both depressive symptoms and depression diagnoses.

CONCLUSIONS

Documenting and explaining depressive symptoms and antidepressant use among IPV survivors provides insight into one of many possible treatment options available to women with depression, and sheds light on potential health disparities among this subgroup of the population.

Is drug utilization in Greece sex dependent? A population-based study

Despite scarce data pertaining to prescription drug sales in Greece, the lack of large-scale epidemiological studies has made it difficult to elaborate on putative differences regarding drug consumption patterns between the two sexes. Herein, we sought to investigate whether sex may have an impact on medication trends of the Greek population. The data reported are part of a survey conducted under the auspices of the National Center for Social Research. Information was collected from 2499 Athenian citizens. Probability of drug use was assessed through Pearson chi-square (χ(2) ) test and logistic regression was implemented to clarify whether sex or other socio-economic and morbidity factors may influence drug utilization. Women consumed more drugs as compared to men. Sex proved to be a differentiating factor influencing the use of analgesic/non-steroidal anti-inflammatory drugs, cardiovascular, anxiolytic and antidepressant drugs, as well as drugs for the treatment of thyroid diseases and osteoporosis. Present results further implicate other socio-economic factors (e.g. education, employment and financial status) in the harnessing of drug use in Greece. To the best of our knowledge, this is the largest pharmacoepidemiological study to report that Greek women consume more drugs and present different medication patterns, as compared to men. Further research is considered imperative in order for the awareness of prescribers, policy-makers and the general public on this sensitive matter to be increased.

[Co-medication with benzodiazepines]

BACKGROUND

The various benzodiazepines have essentially the same mechanism of action and differ from one another primarily through differences in pharmacokinetics. There is no pharmacological basis for using more than one benzodiazepine for the same patient. The purpose of the study was to examine the occurence of co-medication with different types of benzodiazepines in Norway.

MATERIAL AND METHOD

Data were obtained from the Norwegian Prescription Database. Patients who received at least one benzodiazepine in 2008 were included (n = 299,185). The percentage of users who were co-medicated with at least two different benzodiazepines and the amounts prescribed were calculated and stratified by gender and age.

RESULTS

It is highly probably that 27,861 (14,6%) of patients who received at least two benzodiazepines in the course of 2008 used two different benzodiazepines simultaneously. 13,267 (6.9%) of the patients were prescribed at least two different benzodiazepines on the same prescription. A larger number of women were co-medicated with different benzodiazepines, but the proportion of comedication was higher in men than in women, and most frequent in the age group 18-49 years.

INTERPRETATION

There is an extensive and unfortunate prescription practice whereby the same patient is prescribed different benzodiazepines that are used concurrently. Patients who use different benzodiazepines concurrently are mainly prescribed these by one and the same doctor.

High prevalence and prescription of benzodiazepines for elderly: data from psychiatric consultation to patients from an emergency room of a general hospital

OBJECTIVES

The aim of this study is to compare the use and prescription of psychotropic drugs, with emphasis on benzodiazepines, in elderly and non-elderly patients who are assisted at the emergency room by a psychiatric consultation of a university teaching hospital.

METHOD

This is a cross-sectional study. We analyzed all records of psychiatric consultation in an emergency room of a general hospital from March 2009 until March 2010. Sociodemographic and clinical variables were compared between the group of elderly and non-elderly in two cutoff points (≥60 and ≥65 years), with emphasis on the use and prescription of benzodiazepines.

RESULTS

Five hundred seventy-five records were found with 71 elderly and 504 nonelderly for the first cutoff point and 51 elderly and 524 nonelderly in the second. Differences between groups were found in all sociodemographic variables (gender, marital status, education, current occupational status). Elderly patients treated at emergency rooms used more psychotropic drugs, particularly antidepressants and benzodiazepines, than non-elderly. About 25% of the patients received benzodiazepine treatment in the emergency setting, and there was no statistical difference between age groups.

CONCLUSION

There is a wide prevalence of benzodiazepine use among elderly patients in a psychiatric emergency service. Despite the recommendations for its judicious use, benzodiazepines were the most commonly used drug by psychiatrists on duty, regardless of patient's age. These results call for caution in prescribing these drugs and require alternatives to the treatment of psychiatric disorders in the elderly.