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Are men under-treated and women over-treated with antidepressants?: Findings from a cross-sectional survey in Sweden
University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Pharmacy, Uppsala University, Uppsala, Sweden.ORCID iD: 0000-0003-4877-506X
Department of Pharmacy, Uppsala University, Uppsala, Sweden.
University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
Department of Pharmacy, Uppsala University, Uppsala, Sweden.
2017 (English)In: BJPsych bulletin, ISSN 2056-4694, E-ISSN 2056-4708, Vol. 41, no 1, p. 145-150Article in journal (Refereed) Published
Abstract [en]

Aims and method To examine gender differences in self-reported depression and prescribed antidepressants (ADs). The Hospital Anxiety and Depression Scale was used to assess depression, and information on prescribed ADs was obtained from the Swedish Prescribed Drug Register.

Results Depression was reported by 11.7% of the participants (12.3% men and 11.2% women). ADs were prescribed for 7.6% of the participants (5.3% men, 9.8% women). Among men, 1.8% reported depression and used ADs, 10.5% reported depression but did not use ADs, and 3.6% used ADs but did not report depression. The corresponding figures for women were 2.6%, 8.6% and 7.2%.

Clinical implications Men report depression to a greater extent than women but are prescribed ADs to a lesser extent, possibly a sign of under-treatment. Women are prescribed ADs without reporting depression more often than men, possibly a sign of over-treatment. Although the causes remain unclear, diagnostic and treatment guidelines should benefit from considering gender differences in these respects.

Place, publisher, year, edition, pages
2017. Vol. 41, no 1, p. 145-150
Keywords [en]
Self-reported depression, Antidepressants, Gender differences, Over-treatment, Under-treatment
National Category
Psychiatry Pharmaceutical Sciences
Identifiers
URN: urn:nbn:se:hig:diva-23026DOI: 10.1192/pb.bp.116.054270ISI: 000407961600004PubMedID: 28584650Scopus ID: 2-s2.0-85020234639OAI: oai:DiVA.org:hig-23026DiVA, id: diva2:1056114
Projects
Drug related problems in Sweden: a nationwide epidemiological surveyAvailable from: 2016-12-14 Created: 2016-12-14 Last updated: 2018-03-13Bibliographically approved
In thesis
1. The influence of gender and depression on drug utilization: Pharmacoepidemiological research in Sweden
Open this publication in new window or tab >>The influence of gender and depression on drug utilization: Pharmacoepidemiological research in Sweden
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Drug use has increased over recent decades, and is especially great among women and among people with mental health problems. To take advantage of the full potential of drugs and to avoid drug-related problems, drug prescription needs to be correct and the drugs need to be taken according to the prescribed regimens. Research on drug utilization is thus important to the public health.

Aim To study the influence of gender and depression on drug utilization, prescription of drugs and self-reported use of drugs, i.e. adherence.

Methods The thesis included two population-based questionnaires and data from the Swedish Prescribed Drug Register (SPDR) covering Swedish citizens 18-84 years. The questionnaire in Study I and II included items on prescription drug use and adherence to treatment regimens; Study II also included the Hospital Anxiety and Depression Scale (HADS) for self-estimation of anxiety/depression. The questionnaire in Study III included the HADS and data from the SPDR on prescribed antidepressants. Study IV included data from the SPDR on all types of prescribed drugs.

Results Men and women differed in non-adherent behaviours and reasons for non-adherence, for example, men were more likely to report forgetting to take the drug, while women were more likely to report adverse drug reactions (ADRs) as a reason for non-adherence. Further, both anxiety and depression were associated with non-adherence and with ADRs as a reason for non-adherence. In addition, men reported depression to a greater extent than women did but used antidepressants to a lesser extent, while women used antidepressants without reporting depression more often than men did, which may be a sign of under-treatment among men and over-treatment among women. Moreover, the associations between antidepressants and other types of drugs differed by gender; they were often specific, or stronger, in women than in men, which may be a sign of a gender difference in comorbidity between depression and other conditions.

Conclusions Although the cross-sectional study design prevented confirmation of causality, the thesis found that gender and depression influence both prescription of drugs and adherence, and are thus important to pay attention to in clinical practice as well as research.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. p. 67
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Pharmacy, ISSN 1651-6192 ; 238
Keywords
adherence, anxiety, depression, drug utilization, gender, pharmacoepidemiology, prescription drugs, self-report
National Category
Medical and Health Sciences
Research subject
Pharmacoepidemiology
Identifiers
urn:nbn:se:hig:diva-25537 (URN)978-91-513-0088-7 (ISBN)
Public defence
2017-11-24, Universitetshuset, sal IV, Biskopsgatan 3, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Projects
Drug related problems in Sweden: a nationwide epidemiological survey
Available from: 2017-11-16 Created: 2017-11-16 Last updated: 2018-04-10Bibliographically approved

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Thunander Sundbom, LenaHedborg, Kerstin

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