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Open Access 01-12-2020 | Antidepressant Drugs | Research article

How did the use of psychotropic drugs change during the Great Recession in Portugal? A follow-up to the National Mental Health Survey

Authors: Manuela Silva, Ana Antunes, Sofia Azeredo-Lopes, Graça Cardoso, Miguel Xavier, Benedetto Saraceno, José Miguel Caldas-de-Almeida

Published in: BMC Psychiatry | Issue 1/2020

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.

European Commission. Economic crisis in Europe: causes, consequences and responses. European Commission: Luxembourg; 2009.

Bambra C, Garthwaite K, Copeland A, Barr B. All in it together? Health inequalities, austerity, and the ‘great recession’. In: Smith KE, Hill S, Bambra C, editors. Health inequalities, critical perspectives. Oxford: Oxford University Press; 2016. p. 164–76.

Karanikolos M, Mladovsky P, Cylus J, Thomson S, Basu S, Stuckler D, Mackenbach JP, McKee M. Financial crisis, austerity, and health in Europe. Lancet. 2013;381(9874):1323–31. https://doi.org/10.1016/S0140-6736(13)60102-6.CrossRefPubMed

Legido-Quigley H, Karanikolos M, Hernandez-Plaza S, de Freitas C, Bernardo L, Padilla B, Sá Machado R, Diaz-Ordaz K, Stuckler D, McKee M. Effects of the financial crisis and troika austerity measures on health and health care access in Portugal. Health Policy. 2016;120(7):833–9. https://doi.org/10.1016/j.healthpol.2016.04.009..CrossRefPubMed

Thomson S, Figueras J, Evetovits T, Jowett M, Mladovsky P, Maresso A, Cylus J, Karanikolos M, Kluge H. Economic crisis, health systems and health in Europe: impact and implications for policy (policy summary 12). WHO Regional Office for Europe/European Observatory on Health Systems and Policies: Copenhagen; 2014.

International Monetary Fund. Portugal: Letter of Intent, Memorandum of Economic and Financial Policies, and Technical Memorandum of Understanding. 2011. https://www.imf.org/external/np/loi/2011/prt/051711.pdf. Accessed 5 July 2019.

Leopold C, Zhang F, Mantel-Teeuwisse AK, Vogler S, Valkova S, Ross-Degnan D, Wagner AK. Impact of pharmaceutical policy interventions on utilization of antipsychotic medicines in Finland and Portugal in times of economic recession: interrupted time series analyses. Int J Equity Health. 2014;13:53. https://doi.org/10.1186/1475-9276-13-53.CrossRefPubMedPubMedCentral

OECD. Health at a Glance 2009: OECD Indicators. Paris: OECD Publishing; 2009. https://doi.org/10.1787/health_glance-2009-en.CrossRef

OECD. Health at a Glance 2017: OECD Indicators. Paris: OECD Publishing; 2017. https://doi.org/10.1787/health_glance-2017-en.CrossRef

10.

Andersson K, Petzold MG, Sonesson C, Lönnroth K, Carlsten A. Do policy changes in the pharmaceutical reimbursement schedule affect drug expenditures? Interrupted time series analysis of cost, volume and cost per volume trends in Sweden 1986-2002. Health Policy. 2006;79(2–3):231–43. https://doi.org/10.1016/j.healthpol.2006.01.007.CrossRefPubMed

11.

Kozman D, Graziul C, Gibbons R, Alexander GC. Association between unemployment rates and prescription drug utilization in the United States, 2007-2010. BMC Health Serv Res. 2012;12:435. https://doi.org/10.1186/1472-6963-12-435.CrossRefPubMed

12.

Modrek S, Stuckler D, McKee M, Cullen MR, Basu S. A review of health consequences of recessions internationally and a synthesis of the US response during the great recession. Public Health Rev. 2013;35:10. https://doi.org/10.1007/BF03391695.CrossRef

13.

Frasquilho D, Matos MG, Salonna F, Guerreiro D, Storti CC, Gaspar T, Caldas-de-Almeida JM. Mental health outcomes in times of economic recession: a systematic literature review. BMC Public Health. 2016;16:115. https://doi.org/10.1186/s12889-016-2720-y.CrossRefPubMed

14.

Martin-Carrasco M, Evans-Lacko S, Dom G, Christodoulou NG, Samochowiec J, González-Fraile E, Bienkowski P, Gómez-Beneyto M, Dos Santos MJ, Wasserman D. EPA guidance on mental health and economic crises in Europe. Eur Arch Psychiatry Clin Neurosci. 2016;266(2):89–124. https://doi.org/10.1007/s00406-016-0681-x.CrossRefPubMed

15.

Evans-Lacko S, Knapp M, McCrone P, Thornicroft G, Mojtabai R. The mental health consequences of the recession: economic hardship and employment of people with mental health problems in 27 European countries. PLoS One. 2013;8(7):e69792. https://doi.org/10.1371/journal.pone.0069792.CrossRefPubMedPubMedCentral

16.

Silva M, Resurrección DM, Antunes A, Frasquilho D, Cardoso G. Impact of economic crises on mental health care: a systematic review. Epidemiol Psychiatr Sci. 2018:1–13. https://doi.org/10.1017/S2045796018000641.

17.

Bradford WD, Lastrapes WD. A prescription for unemployment? Recessions and the demand for mental health drugs. Health Econ. 2014;23(11):1301–25. https://doi.org/10.1002/hec.2983.CrossRefPubMed

18.

Modrek S, Hamad R, Cullen MR. Psychological well-being during the great recession: changes in mental health care utilization in an occupational cohort. Am J Public Health. 2015;105(2):304–10. https://doi.org/10.2105/AJPH.2014.302219.CrossRefPubMedPubMedCentral

19.

Barceló MA, Coll-Negre M, Coll-de-Tuero G, Saez M. Effects of the financial crisis on psychotropic drug consumption in a cohort from a semi-urban region in Catalonia, Spain. PLoS One. 2016;11(2):e0148594. https://doi.org/10.1371/journal.pone.0148594.CrossRefPubMedPubMedCentral

20.

Gotsens M, Malmusi D, Villarroel N, Vives-Cases C, Garcia-Subirats I, Hernando C, Borrell C. Health inequality between immigrants and natives in Spain: the loss of the healthy immigrant effect in times of economic crisis. Eur J Pub Health. 2015;25(6):923–9. https://doi.org/10.1093/eurpub/ckv126.CrossRef

21.

Sicras-Mainar A, Navarro-Artieda R. Use of antidepressants in the treatment of major depressive disorder in primary care during a period of economic crisis. Neuropsychiatr Dis Treat. 2015;12:29–40. https://doi.org/10.2147/NDT.S91227.CrossRefPubMed

22.

Chen J, Dagher R. Gender and race/ethnicity differences in mental health care use before and during the great recession. J Behav Health Serv Res. 2016;43(2):187–99. https://doi.org/10.1007/s11414-014-9403-1.CrossRefPubMed

23.

Gili M, Campayo JG, Roca M. Crisis económica y salud mental. Informe SESPAS 2014. Gac Sanit. 2014;28(S1):104–8. https://doi.org/10.1016/j.gaceta.2014.02.005.CrossRefPubMed

24.

Nicieza-García ML, Alonso-Lorenzo JC, Suárez-Gil P, Rilla-Villar N. Effect of the economic crisis on consumption of psychotropic drugs in Asturias (Spain). Gac Sanit. 2016;30(6):464–7. https://doi.org/10.1016/j.gaceta.2016.02.006.CrossRefPubMed

25.

Arroyo E, Cabrera-León A, Renart G, Saurina C, Serra Saurina L, Daponte A, Saez M. Did psychotropic drug consumption increase during the 2008 financial crisis? A cross-sectional population-based study in Spain. BMJ Open. 2019;9(1):e021440. https://doi.org/10.1136/bmjopen-2017-021440.CrossRefPubMedPubMedCentral

26.

Boyd A, Van de Velde S, Pivette M, Ten Have M, Florescu S, O'Neill S, Caldas-de-Almeida JM, Vilagut G, Haro JM, Alonso J, Kovess-Masféty V. Gender differences in psychotropic use across Europe: results from a large cross-sectional, population-based study. Eur Psychiatry. 2015;30(6):778–88. https://doi.org/10.1016/j.eurpsy.2015.05.001.CrossRefPubMed

27.

Abbing-Karahagopian V, Huerta C, Souverein PC, de Abajo F, Leufkens HG, Slattery J, Alvarez Y, Miret M, Gil M, Oliva B, Hesse U, Requena G, de Vries F, Rottenkolber M, Schmiedl S, Reynolds R, Schlienger RG, de Groot MC, Klungel OH, van Staa TP, van Dijk L, Egberts AC, Gardarsdottir H, De Bruin ML. Antidepressant prescribing in five European countries: application of common definitions to assess the prevalence, clinical observations, and methodological implications. Eur J Clin Pharmacol. 2014;70(7):849–57. https://doi.org/10.1007/s00228-014-1676-z.CrossRefPubMed

28.

Infarmed. Psicofarmácos: Evolução do Consumo em Portugal Continental (2000–2012). 2013. https://www.infarmed.pt/documents/15786/17838/psicofarmacos_relatorio2013+%281%29.pdf/3e52568f-7f90-47c8-9903-d128395c73e5. Accessed 15 July 2019.

29.

Programa Nacional para a Saúde Mental. Portugal – Saúde Mental em números – 2013. 2013. https://www.dgs.pt/estatisticas-de-saude/estatisticas-de-saude/publicacoes/portugal-saude-mental-em-numeros-2013-pdf.aspx. Accessed 15 July 2019.

30.

Antunes A, Frasquilho D, Azeredo-Lopes S, Neto D, Silva M, Cardoso G, Caldas-de-Almeida JM. Disability and common mental disorders: results from the world mental health survey initiative Portugal. Eur Psychiatry. 2018;49:56–61. https://doi.org/10.1016/j.eurpsy.2017.12.004.CrossRefPubMed

31.

Wang P, Aguilar-Gaxiola S, AlHamzawi A, Alonso J, Andrade L, Angermeyer M, Borges G, Bromet E, Bruffaerts R, Bunting B, Caldas-de-Almeida JM, Florescu S, de Girolamo G, de Graaf R, Gureje O, Haro JM, Hinkov HR, Hu C, Karam E, Kovess V, Lee S, Levinson D, Ono Y, Petukhova M, Posada-Villa J, Sagar R, Seedat S, Wells J, Kessler R. Treated and untreated prevalence of mental disorders: results from the World Health Organization World Mental Health (WMH) surveys. In: Thornicroft G, Szmukler G, Mueser K, Drake R, editors. Oxford Textbook of Community Mental Health. Oxford: Oxford University Press; 2011. https://doi.org/10.1093/med/9780199565498.003.0027.CrossRef

32.

Direção-Geral da Saúde. Relatório 2017 do Programa Nacional Para a Saúde mental. 2017. https://www.dgs.pt/portal-da-estatistica-da-saude/diretorio-de-informacao/diretorio-de-informacao/por-serie-883589-pdf.aspx?v=%3d%3dDwAAAB%2bLCAAAAAAABAArySzItzVUy81MsTU1MDAFAHzFEfkPAAAA. Accessed 15 July 2019.

33.

Xavier M, Baptista H, Mendes JM, Magalhães P, Caldas-de-Almeida JM. Implementing the world mental health survey initiative in Portugal – rationale, design and fieldwork procedures. Int J Ment Health Syst. 2013;7(1):19. https://doi.org/10.1186/1752-4458-7-19.CrossRefPubMedPubMedCentral

34.

Antunes A, Frasquilho D, Azeredo-Lopes S, Silva M, Cardoso G, Caldas-de-Almeida JM. Changes in socioeconomic position among individuals with mental disorders during the economic recession in Portugal: a follow-up of the National Mental Health Survey. Epidemiol Psychiatric Sci. 2018;6:1–6. https://doi.org/10.1017/S2045796018000392.CrossRef

35.

Galobardes B, Shaw M, Lawlor DA, Lynch JW, Davey SG. Indicators of socioeconomic position (part 1). J Epidemiol Community Health. 2006;60(1):7–12. https://doi.org/10.1136/jech.2004.023531.CrossRefPubMedPubMedCentral

36.

Agresti A. An introduction to categorical data analysis. 3rd ed. New York: Wiley; 2018.

37.

Højsgaard S, Halekoh U, Yan J. The R Package geepack for Generalized Estimating Equations. J Stat Softw. 2006;15:1–11. https://doi.org/10.18637/jss.v015.i02.CrossRef

38.

Yan J, Fine J. Estimating equations for association structures. Stat Med. 2004;23(6):859–74. https://doi.org/10.1002/sim.1650.CrossRefPubMed

39.

Demyttenaere K, Bonnewyn A, Bruffaerts R, De Girolamo G, Gasquet I, Kovess V, Haro JM, Alonso J. Clinical factors influencing the prescription of antidepressants and benzodiazepines: results from the European study of the epidemiology of mental disorders (ESEMeD). J Affect Disord. 2008;110(1–2):84–93. https://doi.org/10.1016/j.jad.2008.01.011.CrossRefPubMed

40.

Alonso J, Liu Z, Evans-Lacko S, Sadikova E, Sampson N, Chatterji S, Abdulmalik J, Aguilar-Gaxiola S, Al-Hamzawi A, Andrade LH, Bruffaerts R, Cardoso G, Cia A, Florescu S, de Girolamo G, Gureje O, Haro JM, He Y, de Jonge P, Karam EG, Kawakami N, Kovess-Masfety V, Lee S, Levinson D, Medina-Mora ME, Navarro-Mateu F, Pennell BE, Piazza M, Posada-Villa J, Ten Have M, Zarkov Z, Kessler RC, Thornicroft G. Treatment gap for anxiety disorders is global: Results of the World Mental Health Surveys in 21 countries. Depress Anxiety. 2018;35(3):195–208. https://doi.org/10.1002/da.22711.CrossRefPubMedPubMedCentral

41.

Thornicroft G, Chatterji S, Evans-Lacko S, Gruber M, Sampson N, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Andrade L, Borges G, Bruffaerts R, Bunting B, de Almeida JM, Florescu S, de Girolamo G, Gureje O, Haro JM, He Y, Hinkov H, Karam E, Kawakami N, Lee S, Navarro-Mateu F, Piazza M, Posada-Villa J, de Galvis YT, Kessler RC. Undertreatment of people with major depressive disorder in 21 countries. Br J Psychiatry. 2017;210(2):119–24. https://doi.org/10.1192/bjp.bp.116.188078.CrossRefPubMedPubMedCentral

42.

Cornaggia CM, Beghi M, Mezzanzanica M, Ronzoni G, Vittadini G, Maffenini W. Psychotropic drug consumption and employment status in time of economic crisis (2007-2011). Psychiatr Q. 2017;88(2):371–84. https://doi.org/10.1007/s11126-016-9448-9.CrossRefPubMed

43.

Vittadini G, Beghi M, Mezzanzanica M, Ronzoni G, Cornaggia CM. Use of psychotropic drugs in Lombardy in time of economic crisis (2007-2011): a population-based study of adult employees. Psychiatry Res. 2014;220(1–2):615–22. https://doi.org/10.1016/j.psychres.2014.06.006.CrossRefPubMed

44.

Virtanen M, Honkonen T, Kivimäki M, Ahola K, Vahtera J, Aromaa A, Lönnqvist J. Work stress, mental health and antidepressant medication findings from the health 2000 study. J Affect Disord. 2007;98(3):189–97. https://doi.org/10.1016/j.jad.2006.05.034.CrossRefPubMed

45.

Córdoba-Doña JA, San Sebastián M, Escolar-Pujolar A, Martínez-Faure JE, Gustafsson PE. Economic crisis and suicidal behaviour: the role of unemployment, sex and age in Andalusia, southern Spain. Int J Equity Health. 2014;13:55. https://doi.org/10.1186/1475-9276-13-55.CrossRefPubMedPubMedCentral

46.

Moscone F, Tosetti E, Vittadini G. The impact of precarious employment on mental health: the case of Italy. Soc Sci Med. 2016;158:86–95. https://doi.org/10.1016/j.socscimed.2016.03.008.CrossRefPubMed

47.

Fiori F, Rinesi F, Spizzichino D, Di Giorgio G. Employment insecurity and mental health during the economic recession: an analysis of the young adult labour force in Italy. Soc Sci Med. 2016;153:90–8. https://doi.org/10.1016/j.socscimed.2016.02.010.CrossRefPubMed

48.

Ghoshraya A, Ordóñez J, Sala H. Euro, crisis and unemployment: youth patterns, youth policies? Econ Model. 2016;58:442–53. https://doi.org/10.1016/j.econmod.2016.05.017.CrossRef

49.

Salomonsson S, Santoft F, Lindsäter E, Ejeby K, Ljótsson B, Öst LG, Ingvar M, Lekander M, Hedman-Lagerlöf E. Stepped care in primary care - guided self-help and face-to-face cognitive behavioural therapy for common mental disorders: a randomized controlled trial. Psychol Med. 2018;48(10):1644–54. https://doi.org/10.1017/S0033291717003129.CrossRefPubMed

50.

Ho FY, Yeung WF, Ng TH, Chan CS. 1. The Efficacy and Cost-Effectiveness of Stepped Care Prevention and Treatment for Depressive and/or Anxiety Disorders: A Systematic Review and Meta-Analysis. Sci Rep. 2016;6:29281. https://doi.org/10.1038/srep29281.CrossRefPubMedPubMedCentral

Title: How did the use of psychotropic drugs change during the Great Recession in Portugal? A follow-up to the National Mental Health Survey
Authors: Manuela Silva
Ana Antunes
Sofia Azeredo-Lopes
Graça Cardoso
Miguel Xavier
Benedetto Saraceno
José Miguel Caldas-de-Almeida
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Antidepressant Drugs
Public Health
Antidepressant Drugs
Published in: BMC Psychiatry / Issue 1/2020
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-020-02620-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

How did the use of psychotropic drugs change during the Great Recession in Portugal? A follow-up to the National Mental Health Survey

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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