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Dackehag M, Ellegård LM, Gerdtham UG, Nilsson T. Macroeconomic fluctuations and individual use of psychotropic medications: evidence from Swedish administrative data. Eur J Public Health 2023; 33:93-98. [PMID: 36622208 PMCID: PMC9898001 DOI: 10.1093/eurpub/ckac182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND A growing literature finds that adult mental health worsens during economic downturns. Current insights on the relationship between macroeconomic fluctuations and psychotropic medication are based on self-reported information or aggregate measures on prescriptions. This study assesses the relationship between local macroeconomic conditions and individual use of psychotropic medication as reported in administrative registers. METHODS We use local information on unemployment linked to individual-level longitudinal data on detailed psychotropic drug consumption from administrative registers, for individuals in working age (20-65) in Sweden 2006-13. Any psychotropic medication uptake and the related number of redeemed prescriptions are the primary outcomes. Mortality is considered a secondary outcome. RESULTS Among young men (aged 20-44) and older women (aged 45-65), we find reduced use of psychotropic medication (2-4% compared to the mean) when the local labor market conditions deteriorate. The relationship is driven by reduced use of antidepressants. The same age-gender groups experience a significantly higher risk of mortality in bad times. CONCLUSIONS This study shows that economic downturns may not only put strain on individuals' mental health but also on their access to psychopharmaceutic treatments.
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Affiliation(s)
| | - Lina Maria Ellegård
- Department of Economics, Lund University, Lund, Sweden.,Faculty of Business, Kristianstad University, Kristianstad, Sweden
| | - Ulf-G Gerdtham
- Department of Economics, Lund University, Lund, Sweden.,Department of Clinical Sciences (Malmö), Lund University, Malmö, Sweden
| | - Therese Nilsson
- Department of Economics, Lund University, Lund, Sweden.,Research Institute of Industrial Economics, Stockholm, Sweden
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Norberto MJ, Rodríguez-Santos L, Montanero J, Cáceres MC. Concordance in psychopharmacological treatment before and after first mental health consultation. Arch Psychiatr Nurs 2022; 39:66-72. [PMID: 35688546 DOI: 10.1016/j.apnu.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/08/2022] [Accepted: 03/19/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To analyse concordance between treatment prescribed before and after the first mental health consultation. We understand concordance in two different senses: first, as a similar amount of equivalent doses and drug type; second, as a similar treatment for each patient. METHOD This is an analytical, descriptive, retrospective study on psychopharmacological treatment before and after first mental health consultation of 1236 patients. Drugs were classified into four groups and the equivalent dose respect to reference medication was considered in each group in order to make a comparison between primary and mental health. RESULTS Moderate concordance was found in prescribed treatments before and after first mental health consultation (except antidepressants). The average number of benzodiazepines decreased, as did average doses prescribed at mental health consultation respect to previously prescribed treatment; average doses of antidepressants, however, increased. From the patient's perspective, dose increase was more frequent than decrease. Nevertheless, a high percentage of polymedicated patients were found, although this percentage decreased after the first mental health consultation. CONCLUSION There exists a moderate concordance between the pharmacological treatment prescribed before and after the first mental health consultation. However, the use of benzodiazepines diminished significantly after the first consultation, mainly due to a decrease in the percentage of polymedicated patients.
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Affiliation(s)
- M J Norberto
- Unit of Psychiatry, Servicio Extremeño de Salud, Badajoz, Spain.
| | - L Rodríguez-Santos
- Area de Psiquiatría, Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, Badajoz, Spain.
| | - J Montanero
- Departamento de Matemáticas, Universidad de Extremadura, Badajoz, Spain.
| | - M C Cáceres
- Departamento de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, Badajoz, Spain.
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Guerra O, Eboreime E. The Impact of Economic Recessions on Depression, Anxiety, and Trauma-Related Disorders and Illness Outcomes-A Scoping Review. Behav Sci (Basel) 2021; 11:119. [PMID: 34562956 PMCID: PMC8464685 DOI: 10.3390/bs11090119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022] Open
Abstract
In the wake of a global economic recession secondary to the COVID-19 pandemic, this scoping review seeks to summarize the current quantitative research on the impact of economic recessions on depression, anxiety, traumatic disorders, self-harm, and suicide. Seven research databases (PsycINFO, MEDLINE, Embase, Web of Science: Core Collection, National Library of Medicine PubMed, PubMed Central, and Google Scholar) were searched for keywords returning 3412 preliminary results published since 2008 in Organisation for Economic Coordination and Development (OECD)nations. These were screened by both authors for inclusion/exclusion criteria resulting in 127 included articles. Articles included were quantitative studies in OECD countries assessing select mental disorders (depression, anxiety, and trauma-/stress-related disorders) and illness outcomes (self-harm and suicide) during periods of economic recession. Articles were limited to publication from 2008 to 2020, available online in English, and utilizing outcome measures specific to the disorders and outcomes specified above. A significant relationship was found between periods of economic recession and increased depressive symptoms, self-harming behaviour, and suicide during and following periods of recession. Results suggest that existing models for mental health support and strategies for suicide prevention may be less effective than they are in non-recession times. It may be prudent to focus public education and medical treatments on raising awareness and access to supports for populations at higher risk, including those vulnerable to the impacts of job or income loss due to low socioeconomic status preceding the recession or high levels of financial strain, those supporting others financially, approaching retirement, and those in countries with limited social safety nets. Policy makers should be aware of the potential protective nature of unemployment safeguards and labour program investment in mitigating these negative impacts. Limited or inconclusive data were found on the relationship with traumatic disorders and symptoms of anxiety. In addition, research has focused primarily on the working-age adult population with limited data available on children, adolescents, and older adults, leaving room for further research in these areas.
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Affiliation(s)
- Olivia Guerra
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada;
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Sane Schepisi M, Di Napoli A, Asciutto R, Vecchi S, Mirisola C, Petrelli A. The 2008 Financial Crisis and Changes in Lifestyle-Related Behaviors in Italy, Greece, Spain, and Portugal: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8734. [PMID: 34444482 PMCID: PMC8392284 DOI: 10.3390/ijerph18168734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/12/2021] [Accepted: 08/14/2021] [Indexed: 12/17/2022]
Abstract
Italy, Greece, Spain, and Portugal have all been strongly affected by the 2008 financial crisis, which has had a negative impact on health. We systematically evaluated the effects of the crisis on lifestyle and socioeconomic inequalities. We conducted a literature search using MEDLINE, Embase, the Cochrane Library, and health economics databases for studies reporting quantitative comparisons before and after (or during) the crisis on the following risk behaviors: alcohol consumption, smoking habit, healthy diet, physical activity, and psychotropic drugs and substance abuse, without setting any age restrictions. We selected 34 original articles published between 2011 and 2020. During/after the crisis, alcohol consumption and substance abuse decreased, while psychotropic drug use increased. We also observed a deterioration in healthy eating behavior, with a reduction in fruit and vegetable consumption. Smoking habit and physical activity showed a more complex, controversial trend. Socioeconomic inequalities were affected by the recession, and the negative effects on unhealthy lifestyle tended to be more pronounced among the disadvantaged. These results suggest the need to implement health policies and interventions aimed at monitoring risk behaviors, with special regard to disadvantaged people, and considering the potential additional impact of the COVID-19 pandemic.
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Affiliation(s)
- Monica Sane Schepisi
- National Institute for Health, Migration and Poverty (INMP), 00153 Rome, Italy; (M.S.S.); (A.D.N.); (R.A.); (C.M.)
- Ministry of Health—General Directorate for Health Prevention, 00144 Rome, Italy
| | - Anteo Di Napoli
- National Institute for Health, Migration and Poverty (INMP), 00153 Rome, Italy; (M.S.S.); (A.D.N.); (R.A.); (C.M.)
| | - Rosario Asciutto
- National Institute for Health, Migration and Poverty (INMP), 00153 Rome, Italy; (M.S.S.); (A.D.N.); (R.A.); (C.M.)
| | - Simona Vecchi
- Department of Epidemiology—Lazio Region, ASL Rome 1, 00147 Rome, Italy;
| | - Concetta Mirisola
- National Institute for Health, Migration and Poverty (INMP), 00153 Rome, Italy; (M.S.S.); (A.D.N.); (R.A.); (C.M.)
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), 00153 Rome, Italy; (M.S.S.); (A.D.N.); (R.A.); (C.M.)
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Lopez-Herranz M, Jiménez-García R, Ji Z, de Miguel-Diez J, Carabantes-Alarcon D, Maestre-Miquel C, Zamorano-León JJ, López-de-Andrés A. Mental Health among Spanish Adults with Diabetes: Findings from a Population-Based Case-Controlled Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116088. [PMID: 34200056 PMCID: PMC8200218 DOI: 10.3390/ijerph18116088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/24/2021] [Accepted: 06/03/2021] [Indexed: 12/15/2022]
Abstract
Background: The purpose of this study was to assess and compare the prevalence of self-reported mental disorders, psychological distress, and psychotropic drug consumption among people with diabetes mellitus (DM) and matched non-DM controls. Methods: A case–controlled study using data from the Spanish National Health Interview Survey was conducted in 2017. We identified 2116 DM adults (aged ≥35 years). Non-DM controls were matched 1:1 by age, sex, and province of residence. Results: Prevalence of mental disorders (25.0% vs. 19.2%; p < 0.001), psychological distress (29% vs. 19.5%; p < 0.001), and consumption of psychiatric medications (29.7% vs. 23.5%; p < 0.001) among DM cases were higher than those among matched non-DM controls. The DM patient variables associated with experiencing a mental disorder, psychological distress, and consumption of psychiatric medications were: being a woman, worse self-rated health, and a visit to a psychologist within the last year. Older age (≥80 years) was associated with a lower probability of reporting mental disorders and psychological distress among DM cases. Not practicing physical exercise was significantly associated with experiencing psychological distress. Conclusions: Adults with DM included in our investigation have a significantly higher prevalence of mental disorders, psychological distress, and consumption of psychiatric medications than non-DM controls. It is necessary to implement screening strategies and psychological interventions to improve the mental health of DM patients in Spain, focusing especially on women and those aged 35 to 59 years.
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Affiliation(s)
- Marta Lopez-Herranz
- Nursing Department, Faculty of Nursing, Physiotherapy and Podology, Complutense University of Madrid, 28040 Madrid, Spain;
| | - Rodrigo Jiménez-García
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (D.C.-A.); (J.J.Z.-L.); (A.L.-d.-A.)
- Correspondence:
| | - Zichen Ji
- Respiratory Care Department, Health Research Institute of the Hospital General Universitario Gregorio Marañón (IiSGM), Complutense University of Madrid, 28007 Madrid, Spain; (Z.J.); (J.d.M.-D.)
| | - Javier de Miguel-Diez
- Respiratory Care Department, Health Research Institute of the Hospital General Universitario Gregorio Marañón (IiSGM), Complutense University of Madrid, 28007 Madrid, Spain; (Z.J.); (J.d.M.-D.)
| | - David Carabantes-Alarcon
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (D.C.-A.); (J.J.Z.-L.); (A.L.-d.-A.)
| | - Clara Maestre-Miquel
- School of Health Sciences, University of Castilla–La Mancha, 45600 Talavera de la Reina, Spain;
| | - José J. Zamorano-León
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (D.C.-A.); (J.J.Z.-L.); (A.L.-d.-A.)
| | - Ana López-de-Andrés
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (D.C.-A.); (J.J.Z.-L.); (A.L.-d.-A.)
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Silva M, Antunes A, Azeredo-Lopes S, Cardoso G, Xavier M, Saraceno B, Caldas-de-Almeida JM. How did the use of psychotropic drugs change during the Great Recession in Portugal? A follow-up to the National Mental Health Survey. BMC Psychiatry 2020; 20:215. [PMID: 32393219 PMCID: PMC7216710 DOI: 10.1186/s12888-020-02620-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/26/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Research suggests that economic recessions might be associated with a higher use of psychotropic drugs, but literature is scarce and contradictory in identifying the most vulnerable groups. This study aims to assess possible changes in the use of psychotropic drugs due to the economic recession in Portugal, by comparing self-reported consumption in 2008/09 and 2015/16. METHODS Data from the World Mental Health Survey Initiative Portugal (2008/09) and the National Mental Health Survey Follow-Up (2015/16) were used (n = 911). McNemar's tests were performed to estimate changes in consumption of any psychotropic drug and of antidepressants, anxiolytics, and hypnotics/sedatives. Multiple Generalised Estimating Equations models with interaction effects were used to estimate the population odds of consuming psychotropic drugs according to year, gender and age. RESULTS An increase of 6.74% was estimated in the consumption of psychotropic drugs from 2008/09 to 2015/16. Population odds of consuming any psychotropic drugs in 2015/16 were estimated to be 1.5 times higher than in 2008/09 (OR = 1.50;95%CI:1.13-2.01), particularly for hypnotics/sedatives (OR = 1.60;95%CI:1.14-2.25). Women and older individuals presented higher odds of consuming any psychotropic drugs (OR = 2.79;95%CI:2.03-3.84, and OR = 1.80;95%CI:1.28-2.54), after adjusting for year of assessment and education. However, when evaluating the interaction effect of the year with gender and age, men and younger individuals reported higher odds of consuming any psychotropic drugs in 2015/16, when compared to 2008/09 (OR = 1.85;95%CI:1.08-3.17, and OR = 1.95;95%CI:1.32-2.90, respectively). CONCLUSIONS The findings indicate that the period of economic recession was associated with an increased risk of psychotropic drugs use in Portugal. Consumption of psychotropic drugs remained higher among women and older individuals, but the results suggest that the economic crisis had a disproportionate impact on men and younger individuals. This identification of the most vulnerable population groups is useful to design effective and targeted public health interventions aimed at alleviating the effects of economic recessions.
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Affiliation(s)
- Manuela Silva
- Comprehensive Health Research Centre (CHRC), Lisbon Institute of Global Mental Health. Nova Medical School, Nova University of Lisbon. Rua do Instituto Bacteriológico, n°5, 1150-190, Lisbon, Portugal.
| | - Ana Antunes
- grid.9983.b0000 0001 2181 4263Comprehensive Health Research Centre (CHRC), Lisbon Institute of Global Mental Health. Nova Medical School, Nova University of Lisbon. Rua do Instituto Bacteriológico, n°5, 1150-190, Lisbon, Portugal
| | - Sofia Azeredo-Lopes
- grid.10772.330000000121511713Nova Medical School, Nova University of Lisbon. Campo Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
| | - Graça Cardoso
- grid.9983.b0000 0001 2181 4263Comprehensive Health Research Centre (CHRC), Lisbon Institute of Global Mental Health. Nova Medical School, Nova University of Lisbon. Rua do Instituto Bacteriológico, n°5, 1150-190, Lisbon, Portugal
| | - Miguel Xavier
- grid.10772.330000000121511713Chronic Diseases Research Centre (CEDOC). Nova Medical School, Nova University of Lisbon. Rua do Instituto Bacteriológico, n°5, 1150-190, Lisbon, Portugal
| | - Benedetto Saraceno
- grid.9983.b0000 0001 2181 4263Comprehensive Health Research Centre (CHRC), Lisbon Institute of Global Mental Health. Nova Medical School, Nova University of Lisbon. Rua do Instituto Bacteriológico, n°5, 1150-190, Lisbon, Portugal
| | - José Miguel Caldas-de-Almeida
- grid.9983.b0000 0001 2181 4263Comprehensive Health Research Centre (CHRC), Lisbon Institute of Global Mental Health. Nova Medical School, Nova University of Lisbon. Rua do Instituto Bacteriológico, n°5, 1150-190, Lisbon, Portugal
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