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Gender Differences in Psychotropic Use Across Europe: Results From a Large Cross-Sectional, Population-Based Study

Published online by Cambridge University Press:  04 July 2015

A. Boyd ,
S. Van de Velde ,
M. Pivette ,
M. ten Have ,
S. Florescu ,
S. O’Neill ,
J.-M. Caldas-de-Almeida ,
G. Vilagut ,
J.M. Haro  and
J. Alonso
...Show all authors
A. Boyd
Affiliation:
École des hautes études en santé publique (EHESP), EA 4057, Paris Descartes University, 75014Paris, France Inserm UMR_S1136, Institut Pierre-Louis d’Épidémiologie et de Santé Publique, 75013Paris, France
S. Van de Velde
Affiliation:
École des hautes études en santé publique (EHESP), EA 4057, Paris Descartes University, 75014Paris, France Ghent University, Ghent, Belgium
M. Pivette
Affiliation:
École des hautes études en santé publique (EHESP), EA 4057, Paris Descartes University, 75014Paris, France
M. ten Have
Affiliation:
Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
S. Florescu
Affiliation:
National School of Public Health, Management and Professional Development, Bucharest, Romania
S. O’Neill
Affiliation:
Bamford Centre for Mental Health and Well-Being, University of Ulster, Londonderry, Northern Ireland
J.-M. Caldas-de-Almeida
Affiliation:
Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
G. Vilagut
Affiliation:
Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Spain
J.M. Haro
Affiliation:
Parc Sanitari Sant Joan de Déu, University of Barcelona, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
J. Alonso
Affiliation:
Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Spain Department of Experimental and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
V. Kovess-Masféty*
Affiliation:
École des hautes études en santé publique (EHESP), EA 4057, Paris Descartes University, 75014Paris, France
*
*Corresponding author. EHESP, rue du Pr-Léon-Bernard, 35043 Rennes, France. Tel.: +33299022536; fax: +33958492289. E-mail address: [email protected] (V. Kovess-Masféty).
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Abstract

Background

In many epidemiological studies, women have been observed to consume psychotropic medication more often than men. However, the consistency of this relationship across Europe, with differences in mental health care (MHC) resources and reimbursement policies, is unknown.

Methods

Questions on 12-month psychotropic use (antidepressants, benzodiazepines, antipsychotics, mood stabilizers) were asked to 34,204 respondents from 10 European countries of the EU-World Mental Health surveys. Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria were used to determine 12-month prevalence of mood/anxiety disorders using the Composite International Diagnostic Interview (v3.0).

Results

For all participating countries, women were significantly more likely than men to use psychotropic medication within the previous 12 months (overall-OR = 2.04, 95% CI: 1.81–2.31). This relationship remained significant after adjusting for common sociodemographic factors (age, income level, employment status, education, marital status) and country-level indicators (MHC provision, private household out-of-pocket expenditure, and Gender Gap Index). In multivariable gender-stratified risk-factor analysis, both women and men were more likely to have taken psychotropic medication with increasing age, decreasing income level, and mental health care use within the past 12 months, with no significant differences between genders. When only including participants with a mental disorder, gender differences overall were still significant with any 12-month mood disorder but not with any 12-month anxiety disorder, remaining so after adjusting for sociodemographic characteristics and country-level indicators.

Conclusions

Women use psychotropic medication consistently more often than men, yet reasons for their use are similar between genders. These differences also appear to be contingent on the specific mental disorder.

Keywords

AntidepressantBenzodiapineMood stabilizersAnxiety disordersMood disorders
Type
Original article
Information
European Psychiatry , Volume 30 , Issue 6 , September 2015 , pp. 778 - 788
Copyright
Copyright © Elsevier Masson SAS 2015

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References

Abbing-Karahagopian, V., Huerta, C., Souverein, P.C., de Abajo, F., Leufkens, H.G.M., Slattery, J., et al.Antidepressant prescribing in five European countries: application of common definitions to assess the prevalence, clinical observations, and methodological implications. Eur J Clin Pharmacol 2014;70:849–857. http://dx.doi.org/10.1007/s00228-014-1676-z.CrossRefGoogle ScholarPubMed
Almansa, J., Vermunt, J.K., Forero, C.G., Vilagut, G., De Graaf, R., De Girolamo, G., et al.Measurement and description of underlying dimensions of comorbid mental disorders using Factor Mixture Models: results of the ESEMeD project. Int J Methods Psychiatr Res 2011;20:116–133. http://dx.doi.org/10.1002/mpr.334.CrossRefGoogle ScholarPubMed
Alonso, J., Angermeyer, M.C., Bernert, S., Bruffaerts, R., Brugha, T.S., Bryson, H., et al.Psychotropic drug utilization in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl 2004;55–64. http://dx.doi.org/10.1111/j.1600-0047.2004.00331.x.CrossRefGoogle Scholar
Angst, J., Gamma, A., Gastpar, M., Lépine, J.-P., Mendlewicz, J., Tylee, A., et al.Gender differences in depression. Epidemiological findings from the European DEPRES I and II studies. Eur Arch Psychiatry Clin Neurosci 2002;252:201–209. http://dx.doi.org/10.1007/s00406-002-0381-6.CrossRefGoogle ScholarPubMed
Beck, C.A., Williams, J.V.A., Wang, J.L., Kassam, A., El-Guebaly, N., Currie, S.R., et al.Psychotropic medication use in Canada. Can J Psychiatry 2005;50:605–613.CrossRefGoogle ScholarPubMed
Bocquier, A., Cortaredona, S., Verdoux, H., Casanova, L., Sciortino, V., Nauleau, S., et al.Social inequalities in early antidepressant discontinuation. Psychiatr Serv 2014;65:618–625. http://dx.doi.org/10.1176/appi.ps.201300184.CrossRefGoogle ScholarPubMed
Boyd, A., Van de Velde, S., Vilagut, G., de Graaf, R., O’Neill, S., Florescu, S., et al.Gender differences in mental disorders and suicidality in Europe: results from a large cross-sectional population-based study. J Affect Disord 2015;173:245–254. http://dx.doi.org/10.1016/j.jad.2014.11.002.CrossRefGoogle ScholarPubMed
Bramness, J.G., Hausken, A.M., Sakshaug, S., Skurtveit, S., Rønning, M.Prescription of selective serotonin reuptake inhibitors 1990–2004. Tidsskr Nor Lægeforen 2005;125:2470–2473.Google ScholarPubMed
Butterworth, P., Rodgers, B.Mental health problems and marital disruption: is it the combination of husbands and wives’ mental health problems that predicts later divorce?. Soc Psychiatry Psychiatr Epidemiol 2008;43:758–763. http://dx.doi.org/10.1007/s00127-008-0366-5.CrossRefGoogle ScholarPubMed
Cafferata, G.L., Meyers, S.M.Pathways to psychotropic drugs. Understanding the basis of gender differences. Med Care 1990;28:285–300.CrossRefGoogle ScholarPubMed
Demyttenaere, K., Bonnewyn, A., Bruffaerts, R., De Girolamo, G., Gasquet, I., Kovess, V., et al.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;110:84–93. http://dx.doi.org/10.1016/j.jad.2008.01.011.CrossRefGoogle Scholar
Dezetter, A., Briffault, X., Alonso, J., Angermeyer, M.C., Bruffaerts, R., de Girolamo, G., et al.Factors associated with use of psychiatrists and non psychiatrist providers by ESEMeD respondents in six European countries. Psychiatr Serv 2011;62:143–151. http://dx.doi.org/10.1176/appi.ps.62.2.143.CrossRefGoogle ScholarPubMed
Dlouhy, M.Mental health policy in Eastern Europe: a comparative analysis of seven mental health systems. BMC Health Serv Res 2014;14:42. http://dx.doi.org/10.1186/1472-6963-14-42.CrossRefGoogle ScholarPubMed
Empereur, F., Baumann, M., Alla, F., Briançon, S.Factors associated with the consumption of psychotropic drugs in a cohort of men and women aged 50 and over. J Clin Pharm Ther 2003;28:61–68.CrossRefGoogle Scholar
Gardarsdottir, H., Heerdink, E.R., van Dijk, L., Egberts, A.C.G.Indications for antidepressant drug prescribing in general practice in the Netherlands. J Affect Disord 2007;98:109–115. http://dx.doi.org/10.1016/j.jad.2006.07.003.CrossRefGoogle ScholarPubMed
Haro, J.M., Arbabzadeh-Bouchez, S., Brugha, T.S., de Girolamo, G., Guyer, M.E., Jin, R., et al.Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. Int J Methods Psychiatr Res 2006;15:167–180.CrossRefGoogle ScholarPubMed
Hewitt, B., Turrell, G.Short-term functional health and well-being after marital separation: does initiator status make a difference?. Am J Epidemiol 2011;173:1308–1318. http://dx.doi.org/10.1093/aje/kwr007.CrossRefGoogle Scholar
Jacob, K.S., Sharan, P., Mirza, I., Garrido-Cumbrera, M., Seedat, S., Mari, J.J., et al.Mental health systems in countries: where are we now?. Lancet 2007;370:1061–1077. http://dx.doi.org/10.1016/S0140-6736(07)61241-0.CrossRefGoogle ScholarPubMed
Karanges, E.A., Stephenson, C.P., McGregor, I.S.Longitudinal trends in the dispensing of psychotropic medications in Australia from 2009–2012: focus on children, adolescents and prescriber specialty. Aust N Z J Psychiatry 2014;48:917–931. http://dx.doi.org/10.1177/0004867414538675.CrossRefGoogle ScholarPubMed
Kisely, S., Linden, M., Bellantuono, C., Simon, G., Jones, J.Why are patients prescribed psychotropic drugs by general practitioners? Results of an international study. Psychol Med 2000;30:1217–1225.CrossRefGoogle ScholarPubMed
Kovess-Masfety, V., Boyd, A., van de Velde, S., de Graaf, R., Vilagut, G., Haro, J.M., et al.Are there gender differences in service use for mental disorders across countries in the European Union? Results from the EU-World Mental Health survey. J Epidemiol Community Health 2014;68:649–656. http://dx.doi.org/10.1136/jech-2013-202962.CrossRefGoogle ScholarPubMed
Kovess-Masféty, V., Saragoussi, D., Sevilla-Dedieu, C., Gilbert, F., Suchocka, A., Arveiller, N., et al.What makes people decide who to turn to when faced with a mental health problem? Results from a French survey. BMC Public Health 2007;7:188. http://dx.doi.org/10.1186/1471-2458-7-188.CrossRefGoogle ScholarPubMed
LaMontagne, A.D., Smith, P.M., Louie, A.M., Quinlan, M., Ostry, A.S., Shoveller, J.Psychosocial and other working conditions: variation by employment arrangement in a sample of working Australians. Am J Ind Med 2012;55:93–106. http://dx.doi.org/10.1002/ajim.21038.CrossRefGoogle Scholar
Metsä-Simola, N., Martikainen, P.The effects of marriage and separation on the psychotropic medication use of non-married cohabiters: a register-based longitudinal study among adult Finns. Soc Sci Med 2014;121:10–20. http://dx.doi.org/10.1016/j.socscimed.2014.09.043.CrossRefGoogle ScholarPubMed
Nakagawa, A., Grunebaum, M.F., Ellis, S.P., Oquendo, M.A., Kashima, H., Gibbons, R.D., et al.Association of suicide and antidepressant prescription rates in Japan, 1999–2003. J Clin Psychiatry 2007;68:908–916.CrossRefGoogle Scholar
Noordam, R., Aarts, N., Verhamme, K.M., Sturkenboom, M.C.M., Stricker, B.H., Visser, L.E.Prescription and indication trends of antidepressant drugs in the Netherlands between 1996 and 2012: a dynamic population-based study. Eur J Clin Pharmacol 2015;71:369–375. http://dx.doi.org/10.1007/s00228-014-1803-x.CrossRefGoogle ScholarPubMed
Ohayon, M.M., Lader, M.H.Use of psychotropic medication in the general population of France, Germany, Italy, and the United Kingdom. J Clin Psychiatry 2002;63:817–825.CrossRefGoogle ScholarPubMed
Olfson, M., King, M., Schoenbaum, M.Benzodiazepine use in the United States. JAMA Psychiatry 2015;72:136–142. http://dx.doi.org/10.1001/jamapsychiatry.2014.1763.CrossRefGoogle ScholarPubMed
Pelfrene, E., Vlerick, P., Moreau, M., Mak, R.P., Kornitzer, M., De Backer, G.Use of benzodiazepine drugs and perceived job stress in a cohort of working men and women in Belgium. Results from the BELSTRESS-study. Soc Sci Med 2004;59:433–442. http://dx.doi.org/10.1016/j.socscimed.2003.11.002.CrossRefGoogle Scholar
Percudani, M., Barbui, C., Fortino, I., Petrovich, L.Antidepressant drug use in Lombardy, Italy: a population-based study. J Affect Disord 2004;83:169–175. http://dx.doi.org/10.1016/j.jad.2004.07.005.CrossRefGoogle ScholarPubMed
Poluzzi, E., Motola, D., Silvani, C., De Ponti, F., Vaccheri, A., Montanaro, N.Prescriptions of antidepressants in primary care in Italy: pattern of use after admission of selective serotonin reuptake inhibitors for reimbursement. Eur J Clin Pharmacol 2004;59:825–831. http://dx.doi.org/10.1007/s00228-003-0692-1.CrossRefGoogle ScholarPubMed
Pratt, L.A., Brody, D.J., Gu, Q.Antidepressant use in persons aged 12 and over: United States, 2005–2008. NCHS Data Brief 2011;76:1–8.Google Scholar
Robins, L.N., Wing, J., Wittchen, H.U., Helzer, J.E., Babor, T.F., Burke, J., et al.The Composite International Diagnostic Interview. An epidemiologic Instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Arch Gen Psychiatry 1988;45:1069–1077.CrossRefGoogle ScholarPubMed
Romans, S.E., Cohen, M.M., Forte, T., Du Mont, J., Hyman, I.Gender and psychotropic medication use: the role of intimate partner violence. Prev Med 2008;46:615–621. http://dx.doi.org/10.1016/j.ypmed.2007.07.019.CrossRefGoogle ScholarPubMed
Seedat, S., Scott, K.M., Angermeyer, M.C., Berglund, P., Bromet, E.J., Brugha, T.S., et al.Cross-national associations between gender and mental disorders in the World Health Organization World Mental Health Surveys. Arch Gen Psychiatry 2009;66:785–795. http://dx.doi.org/10.1001/archgenpsychiatry.2009.36.CrossRefGoogle ScholarPubMed
Simoni-Wastila, L.Gender and psychotropic drug use. Med Care 1998;36:88–94.CrossRefGoogle ScholarPubMed
Simoni-Wastila, L., Ritter, G., Strickler, G.Gender and other factors associated with the non medical use of abusable prescription drugs. Subst Use Misuse 2004;39:1–23.CrossRefGoogle Scholar
Sonnenberg, C.M., Bierman, E.J.M., Deeg, D.J.H., Comijs, H.C., van Tilburg, W., Beekman, A.T.F.Ten-year trends in benzodiazepine use in the Dutch population. Soc Psychiatry Psychiatr Epidemiol 2012;47:293–301. http://dx.doi.org/10.1007/s00127-011-0344-1.CrossRefGoogle ScholarPubMed
Stegmann, M.E., Ormel, J., de Graaf, R., Haro, J.-M., de Girolamo, G., Demyttenaere, K., et al.Functional disability as an explanation of the associations between chronic physical conditions and 12-month major depressive episode. J Affect Disord 2010;124:38–44. http://dx.doi.org/10.1016/j.jad.2009.10.026.CrossRefGoogle ScholarPubMed
United Nations Development Programme. Human development report: overcoming barriers: human mobility and development. Washington, DC: Communications Development Incorporated; 2009.Google Scholar
Van de Velde, S., Huijts, T., Bracke, P., Bambra, C.Macro-level gender equality and depression in men and women in Europe. Sociol Health Illn 2013;35(5):682–698.CrossRefGoogle ScholarPubMed
Vesga-López, O., Schneier, F.R., Wang, S., Heimberg, R.G., Liu, S.-M., Hasin, D.S., et al.Gender differences in generalized anxiety disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). J Clin Psychiatry 2008;69:1606–1616.CrossRefGoogle Scholar
Vittadini, G., Beghi, M., Mezzanzanica, M., Ronzoni, G., Cornaggia, C.M.Use of psychotropic drugs in Lombardy in time of economic crisis (2007–2011): a population-based study of adult employees. Psychiatry Res 2014;220:615–622. http://dx.doi.org/10.1016/j.psychres.2014.06.006.CrossRefGoogle ScholarPubMed
Wang, P.S., Aguilar-Gaxiola, S., Alonso, J., Angermeyer, M.C., Borges, G., Bromet, E.J., et al.Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet 2007;370:841–850. http://dx.doi.org/10.1016/S0140-6736(07)61414-7.CrossRefGoogle ScholarPubMed
Wendt, C., Kohl, J.Translating monetary inputs into health care provision: a comparative analysis of the impact of different modes of public policy. J Comp Policy Anal Res Pr 2010;12:11–31. http://dx.doi.org/10.1080/13876980903076161.Google Scholar
WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment. Oslo: WHO Collaborating Center for Drug Statistics Methodology; 2014.Google Scholar
Wittchen, H.U., Jacobi, F., Rehm, J., Gustavsson, A., Svensson, M., Jönsson, B., et al.The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 2011;21:655–679. http://dx.doi.org/10.1016/j.euroneuro.2011.07.018.CrossRefGoogle ScholarPubMed
World Economic Forum. The Global Gender Gap Report. 2006 http://www3.weforum.org/docs/WEF_GenderGap_Report_2006.pdf.Google Scholar
World Health Organization. European Health for All database (HFA-DB). 2014 http://www.euro.who.int/en/data-and-evidence/databases/european-health-for-all-database-hfa-db.Google Scholar
Wu, C.-S., Shau, W.-Y., Chan, H.-Y., Lee, Y.-C., Lai, Y.-J., Lai, M.-S.Utilization of antidepressants in Taiwan: a nationwide population-based survey from 2000 to 2009. Pharmacoepidemiol Drug Saf 2012;21:980–988. http://dx.doi.org/10.1002/pds.3255.CrossRefGoogle ScholarPubMed
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