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Gender differences in the association between prescribed antidepressants and other prescribed drugs: a nationwide register-based study in Sweden
University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Uppsala universitet, Institutionen för farmaci.
University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: People with depression are prescribed more drugs than people in general, partly due to comorbidity with other conditions. However, little research has been done on depression-related drug use from a gender perspective.

Aim: Examine gender differences in the association between antidepressants, other drugs, and polypharmacy.

Methods: Data on drugs dispensed October to December 2016 to all Swedish citizens aged 18-84 years were collected from the Swedish prescribed drug register. Logistic regression analyses were performed to examine gender differences in the associations between antidepressants and other drugs.

Results: For both men and women, associations were found between antidepressants and drugs for alimentary tract problems, respiratory problems, drugs for the blood, and drugs for the nervous system, analgesics, and polypharmacy. For many of the drugs, for example those for respiratory problems and analgesics, the association was stronger in women than in men. However, concerning drugs for the nervous system and polypharmacy, the association was stronger in men than in women. Furthermore, for women, but not men, associations were found for drugs for diabetes, musculoskeletal problems, dermatological problems, and systemic hormones.

Conclusions: Many of the associations between antidepressants and other drugs were found to be specific, or stronger, among women than among men. In some cases, however, the associations were stronger in men. Whether this indicates that men and women differ in comorbidity between depression and other conditions cannot be concluded based on this cross-sectional study. However, physicians should be aware that possible gender differences in comorbidity exist, and because comorbidity between depression and other conditions impairs the possibility of recovery, and decreases adherence, screening for depression could be valuable.

Keywords [en]
Gender, Antidepressants, Prescribed drugs, Polypharmacy
National Category
Medical and Health Sciences
Research subject
Pharmacoepidemiology
Identifiers
URN: urn:nbn:se:hig:diva-25538OAI: oai:DiVA.org:hig-25538DiVA, id: diva2:1157606
Projects
Drug related problems in Sweden: a nationwide epidemiological surveyAvailable from: 2017-11-16 Created: 2017-11-16 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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