A cross-sectional prevalence survey of psychotropic medication prescribing patterns in prisons in England

Psychotropic medications: a descriptive study of prescription trends in Tabriz, Iran, 2021-2022

INTRODUCTION

Mental disorders, such as anxiety and depression, significantly impacted global populations in 2019 and 2020, with COVID-19 causing a surge in prevalence. They affect 13.4% of the people worldwide, and 21% of Iranians have experienced them. Prescription analysis is critical for evaluating and improving medical care in a cost-effective manner. This study examined prescription patterns for psychotropic drugs in outpatient settings to improve the understanding of medication utilization in a variety of patients. It aimed to assist healthcare professionals in making well-informed decisions about drug prescriptions, a topic not much addressed in Iran.

METHOD

A descriptive study was conducted using data extracted from the Social Security Organization in Iran. We analyzed prescriptions in Tabriz from March 2021 to March 2022. Prescription data were categorized by medication category, physician specialty, age group, and sex. Then statistical analysis was performed using SPSS 2022.

RESULTS

We analyzed the number of psychotropic medication prescriptions issued by 7246 doctors to a group of 413,466 individuals over a year representing 44.9% of our target population. The average age of individuals receiving psychotropic drugs was 45.57 years. Gabapentin had the highest prescription rate, followed by sertraline. Antidepressants accounted for 38.1% of all prescriptions, with anxiolytics accounting for 18.6%. Other psychotropic drugs included alprazolam, chlordiazepoxide, and valproate. Adults in all age groups had the highest frequency of prescriptions for psychotropic medications. The majority of patients were female (63.5%). General practitioners had the highest number of instances of prescribing psychotropic drugs, with psychiatrists contributing 54.7% of the total prescriptions.

CONCLUSION

Approximately 45% of the target population received psychotropic medication, which highlights the significant prevalence of mental health issues in Iran. Antidepressants were the most commonly administered class, highlighting the need for training programs that specifically address their possible negative effects and the correct dosage. The goal is to provide healthcare practitioners with a comprehensive understanding of prescription trends, enabling them to administer the most appropriate treatments.

Common Mental Disorder and Its Associated Factors among Prisoners in North Wollo Zone Correctional Institutions, Northeastern Ethiopia

Background

Globally, about 450 million people suffer from mental disorders of which about 11% are assumed to be prisoners. The presence of mental illness among prisoners contributes to an increase in the risk of suicide, violence, morbidity, and mortality. In Ethiopia, there is a paucity of data particularly from resource-limited areas to assist policy maker's efforts in reforming mental health care.

Objective

This study is aimed at assessing common mental disorders and its associated factors among prisoners in North Wollo zone correctional institutions, Northeastern Ethiopia.

Method

Institution-based cross-sectional study was conducted on 401 study participants from January-February 2021. A simple random sampling technique was employed to enroll the study participants. Structured interviewer-administered Self Reporting Questionnaires-20 (SRQ-20) developed by the World Health Organization was used to collect the data. Data were checked for completeness, coded and entered into Epi data version 4.2, and transferred to SPSS version 23.0 for final analysis. Binary logistic regression analysis was carried out to identify factors associated with common mental disorders. Statistical significance was declared at p values < 0.05 in the final model.

Results

The prevalence of common mental disorders was found to be 63.6% (95% CI 58.9, 68.3). After adjusting for confounding factors using multiple logistic regression, having children (AOR = 3.7, 95% CI: 1.93, 7.36), poor social support (AOR = 6.6, 95% CI: 2.93, 14.93), history of mental illness (AOR = 6.5, 95% CI: 1.78, 24.3), one- to five-year prison stay (AOR = 2.6, 95% CI: 1.38, 5.04), greater than five-year prison stay (AOR = 5.7, 95% CI: 2.05, 16.27), experiencing one stressful life event (AOR = 5.2, 95% CI: 1.83, 15.01), experiencing two or more stressful life events (AOR = 7.3, 95% CI: 2.98, 17.9), unavailability of reading materials (AOR = 4.3, 95% CI: 1.63, 11.43), and greater than or equal to eleven years of sentences (AOR = 4.4, 95 CI: 1.82, 10.70) were factors significantly associated with common mental disorders.

Conclusion

Common mental disorders are highly prevalent among prisoners in this study area. The result of this study suggests the importance of screening and providing psychiatric counseling to this highly vulnerable population.

Patient and public involvement (PPI) in prisons: the involvement of people living in prison in the research process - a systematic scoping review

BACKGROUND

Patient and Public Involvement (PPI) in health and social care research is increasingly prevalent and is promoted in policy as a means of improving the validity of research. This also applies to people living in prison and using social care services. Whilst evidence for the effectiveness of PPI was limited and reviews of its application in prisons were not found, the infancy of the evidence base and moral and ethical reasons for involvement mean that PPI continues to be advocated in the community and in prisons.

OBJECTIVES

To conduct a review of the literature regarding the involvement of people or persons living in prison (PLiP) in health and social care research focused on: (i) aims; (ii) types of involvement; (iii) evaluations and findings; (iv) barriers and solutions; and (v) feasibility of undertaking a systematic review.

METHODS

A systematic scoping review was undertaken following Arksey and O'Malley's (International Journal of Social Research Methodology 8: 19-32, 2005) five-stage framework. A comprehensive search was conducted involving ten electronic databases up until December 2020 using patient involvement and context related search terms. A review-specific spreadsheet was created following the PICO formula, and a narrative synthesis approach was taken to answer the research questions. PRISMA guidelines were followed in reporting.

RESULTS

39 papers were selected for inclusion in the review. The majority of these took a 'participatory' approach to prisoner involvement, which occurred at most stages during the research process except for more 'higher' level research operations (funding applications and project management), and only one study was led by PLiPs. Few studies involved an evaluation of the involvement of PLiP, and this was mostly PLiP or researcher reflections without formal or independent analysis, and largely reported a positive impact. Barriers to the involvement of PLiP coalesced around power differences and prison bureaucracy.

CONCLUSION

Given the very high risk of bias arising from the available 'evaluations', it was not possible to derive firm conclusions about the effectiveness of PLiP involvement in the research process. In addition, given the state of the evidence base, it was felt that a systematic review would not be feasible until more evaluations were undertaken using a range of methodologies to develop the field further.

Development of prescribing safety indicators related to mental health disorders and medications: Modified e-Delphi study

AIM

To develop a set of prescribing safety indicators related to mental health disorders and medications, and to estimate the risk of harm associated with each indicator.

METHOD

A modified two-stage electronic Delphi. The first stage consisted of two rounds in which 31 experts rated their agreement with a set of 101 potential mental health related prescribing safety indicators using a five-point scale and given the opportunity to suggest other indicators. Indicators that achieved 80% agreement were accepted. The second stage comprised a single round in which 29 members estimated the risk of harm for each accepted indicator by assessing the occurrence likelihood and outcome severity using two five-point scales. Indicators were considered high or extreme risk when at least 80% of participants rated each indicator as high or extreme.

RESULTS

Seventy-five indicators were accepted in the first stage. Following the second stage, 42 (56%) were considered to be high or extreme risk for patient care. The 42 indicators comprised different types of hazardous prescribing, including drug-disease interactions (n = 12), drug-drug interactions (n = 9), inadequate monitoring (n = 5), inappropriate duration (n = 4), inappropriate dose (n = 4), omissions (n = 4), potentially inappropriate medications (n = 3) and polypharmacy (n = 1). These indicators also covered different mental health related medication classes, including antipsychotics (n = 14), mood stabilisers (n = 8), antidepressants (n = 6), sedative, hypnotics and anxiolytics (n = 6), anticholinergic (n = 6) and nonspecific psychotropics (n = 2).

CONCLUSION

This study has developed the first suite of prescribing safety indicators related to mental health disorders and medications, which could inform the development of future safety improvement initiatives and interventional studies.

Nearly three in every five prisoners experience common mental disorders (CMDs) in Jimma correctional institution; south-West Ethiopia

BACKGROUND

Millions of people are currently suffering from some form of mental disorders. The prevalence of common disorders is twofold higher in prison than general population and the condition is found to be worst in African in general and Ethiopia in particular. The aim of this study was to assess the prevalence of common mental disorders and its correlates among prisoners in Jimma town correctional institution; Ethiopia.

METHODS

A cross sectional quantitative study was conducted enrolling 300 prisoners. The participants were recruited using systematic random sampling technique. The World health organization Self Reporting Questionnaire (SRQ-20) scale; was adapted to assess prevalence of mental disorders. Data were collected on interviewer administered basis by trained personnel. Statistical package for social sciences (SPSS) version 20 for widows was used for data analysis. Multivariate logistic regression modelling was conducted to identify the independent predictors of common mental disorders. P-value less than 5% was considered to indicate significant associations.

RESULTS

The prevalence of common mental disorder was found to be 62.70, 95% CI; [57.30, 68.50]. Prisoners who had monthly income of 1500-3000birr, AOR = 3.30, 95% CI; [1.25, 8.69] and above 3000birr; AOR = 4.75, 95% CI; [1.57, 14.33], family history of mental illness; AOR = 6.14, 95% CI; [1.65, 22.79] and who ever used Khat; AOR = 4.33, 95% CI; [2.02, 9.27] were more likely to experience common mental disorders. Conversely; having some sort of work in prison; AOR = 0.25, 95% CI; [0.12, 0.54], perceived moderate social support; AOR = 0.094, 95% CI; [0.04-0.215] and perceived moderate strong; AOR = 0.025, 95% CI; [0.009, 0.07] were found to be protective factors.

CONCLUSION

Prevalence of common mental disorder was considerably high as nearly more than three in every five prisoner experience some form of the disorder. Early screening of prisoners up on their arrival, appropriate treatment and follow up should be done. Furthermore; creating prison based jobs that could bring prisoners together and encouraging positive relationships to build social supports as coping strategy is required.