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  • 1.
    Sundbom Thunander, Lena
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Bingefors, Kerstin
    Department of Pharmacy, University of Uppsala, Uppsala, Sweden.
    Isacson, Dag
    Department of Pharmacy, University of Uppsala, Uppsala, Sweden.
    Self-reported depression and prescription of antidepressants: Does gender matter?2015In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 18, no 3, p. A116-, article id PMH12Article in journal (Other academic)
    Abstract [en]

    OBJECTIVES

    Women are diagnosed with depression twice as often as men. Concerning self-reported depression though, gender differences are not that distinct. Prescription of antidepressants (ADs) has increased considerably the past decades, especially for women. This study aimed to examine gender differences in self-reported depression and the relation to prescribed ADs and also in the prescription of various types of ADs.

    METHODS

    Data from the population-based cross-sectional survey “Public Health in Sweden 2012” was used (n=16,000 aged 18-84 years, response rate 49.3%). Symptoms of depression were measured with the Hospital Anxiety Depression Scale (HADS, cut-off score ≥8). Self-reported use of ADs two weeks prior to receiving the questionnaire was supplemented with prescription data (ATC-codes) from the national Swedish Prescribed Drug Register.

    RESULTS

    Men and women reported depression to similar extent (men 12.3%, women 11.2%). However, women were more often prescribed ADs compared to men (men 3.7%, women 6.8%; p<0.0001). Nine per cent of all women in the study population reported depression but had no AD treatment, 2.1% reporting depression and used ADs, and 4.7% used ADs but reported no depression. The corresponding figures for men were 10.8%, 1.5% and 2.2% (p<0.0001). Selective serotonin reuptake inhibitors (SSRIs, N06AB) were the most commonly prescribed ADs for both men (74.8%) and women (79.2%). As for the SSRIs, no statistical significant gender difference was found for the tricyclic antidepressants (TCAs, N06AA; men 9.5%, women 6.7%). However, men were prescribed “Other ADs” (N06AX) significantly more often than women (men 43.3%, women 29.2%; p<0.005).

    CONCLUSIONS

    Although women and men reported depression to similar extent, women were prescribed ADs almost twice as often as men. Also, women used ADs without being currently depressed more often than men. Further, men were prescribed “Other ADs” more frequently than women.

  • 2.
    Sundbom Thunander, Lena
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Hedborg, Kerstin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Association between prescribed antidepressants and other prescribed drugs differ by gender: a nationwide register-based study in Sweden2019In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 73, no 1, p. 73-79Article, review/survey (Refereed)
    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 the association between antidepressants, other types of prescribed drugs, and polypharmacy, by gender.

    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 the associations between antidepressantsand other drugs, by gender.

    Results: For both men and women, associations were found between antidepressants and drugs for alimentary tract problems, respiratory problems, blood, nervous system, analgesics, and polypharmacy. However, for women, but not men, associations were alsofound for drugs for diabetes, musculoskeletal problems, dermatological problems, and systemic hormones. 

    Conclusions: Associations were found between antidepressants and many other types of drugs for both men and women; indicating comorbidity between depression and other conditions.Further, several of the associations between antidepressants and other drugs were found to be specific among women. 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, comorbidity impairs the possibility of recovery; in the somatic condition as well as the depression. Thus,physicians need to be aware of that the association between antidepressants and other types of drugs are more common among women than men.

  • 3.
    Thunander Sundbom, Lena
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Förskrivning och följsamhet av antidepressiva hade koppling till kön2017In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, no 51-52Article, book review (Other (popular science, discussion, etc.))
    Abstract [sv]

    Avhandling. Kvinnor diagnostiseras med depression dubbelt så ofta som män och förskrivs antidepressiva betydligt oftare. Syftet med denna avhandling var att studera hur psykisk ohälsa och kön påverkar läkemedelsanvändning när det gäller följsamhet respektive förskrivning.

    Vi lät 16 000 slumpmässigt utvalda personer mellan 18 och 84 år (svarsfrekvens 48 procent) skatta depression genom formuläret HADS (Hospital anxiety and depression scale). Männen hade rapporterad depression i något högre utsträckning än kvinnorna. Dessa data kopplades sedan på individnivå till förskrivna antidepressiva via Läkemedelsregistret. En högre andel av männen än kvinnorna hade rapporterad depression utan att använda antidepressiva, vilket kan bero på att män inte söker vård vid psykisk ohälsa eller på att mäns psykiska besvär inte upptäcks då symtomen ofta avviker från vårdens diagnoskriterier.

    Kvinnorna däremot använde antidepressiva utan att ha rapporterad depression betydligt oftare än männen, vilket kan bero på tillfrisknande från depressionen eller på att kvinnor förskrivs antidepressiva redan vid mycket lindriga besvär. Vi lät även 7 985 slumpmässigt utvalda personer mellan 18 och 84 år (svarsfrekvens 61 procent) svara på frågor gällande följsamhet.

    Kvinnorna rapporterade betydligt oftare än männen att de avstod från att ta sina läkemedel på grund av läkemedelsbiverkningar, medan männen oftare än kvinnorna rapporterade att de ändrade doserna och glömde att ta sina läkemedel. Resultaten tyder på att kön bör beaktas i riktlinjer för diagnostik och behandling av depression och vid bristande följsamhet: även om studiedesignen i form av tvärsnittsstudier inte möjliggör fastställande av orsakssamband belyser denna avhandling könsskillnader, vilka bör beaktas såväl inom klinisk praxis som framtida studier.

  • 4.
    Thunander Sundbom, Lena
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Uppsala universitet, Institutionen för farmaci.
    The influence of gender and depression on drug utilization: Pharmacoepidemiological research in Sweden2017Doctoral 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.

  • 5.
    Thunander Sundbom, Lena
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Medical science. Uppsala universitet.
    The influence of gender and psychological distress on adherence to prescribed medication2014Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: The lack of adherence to drug therapy is a major problem; it can contribute to significant deterioration of disease and increased health-care costs. Improving medication adherence is a big challenge; there is no simple solution to the problem. It is thus essential to improve our knowledge of non-adherence (NA) and its causes.

    Aims: The aims of the thesis were to study the influence of gender and psychological distress on self-reported, intentional and unintentional non-adherent behaviour, and to investigate the reasons for NA.

    Methods: A population-based study that included a postal questionnaire was carried out in a cross-section of the general Swedish population (n=7,985, aged 18-84 years). The response rate was 61.1% (n=4,875) and current prescription drug use was reported by 2,802 participants. The questionnaire covered use of prescription drugs, NA to the drug regimens, reasons for NA, economic status, attitudes to drugs, and the presence of somatic or mental problems, and also included the Hospital Anxiety and Depression Scale questionnaire.

    Results: The results showed differences in various self-reported non-adherent behaviour patterns and reasons for NA between the genders. In most cases, these remained after controlling for confounders such as socioeconomic factors and attitudes to drugs that are known to differ between women and men. Associations were also found between symptoms of anxiety and/or depression and the presence of intentional or unintentional non-adherent behaviour (with a stronger average association for intentional NA), and between anxiety/depression and some of the reasons given for NA, e.g. adverse drug reactions (ADRs).

    Conclusions: Although it was not possible to confirm causal relationships, this thesis emphasises the effects of gender and psychological distress on NA. In summary, both gender and anxiety and/or depression influenced non-adherent behaviour and the reasons given for NA. For instance, ADRs seemed to influence the decision not to take the drug as prescribed, especially among women and participants under psychological distress. It is suggested that a deep understanding of the causes of NA and of the impact of gender and psychological distress on the outcomes would help those aiming to improve adherence to prescribed medication.

  • 6.
    Thunander Sundbom, Lena
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Medical science.
    Bingefors, Kerstin
    Uppsala Universitet.
    The influence of symptoms of anxiety and depression on medication nonadherence and its causes: a population based survey of prescription drug users in Sweden2013In: Patient Preference and Adherence, ISSN 1177-889X, E-ISSN 1177-889X, Vol. 7, p. 805-811Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this study was to evaluate the associations between self-reported symptoms of anxiety and/or depression, nonadherent (NA) behaviors, and reasons for NA to medication regimens.

    Methods: A population based cross-sectional study with questionnaire was performed in the general Swedish population. The participants were 2,802 prescription drug users aged 18–84 years. The questionnaire covered use of prescription drugs, symptoms of anxiety and/or depression, based on the Hospital Anxiety and Depression Scale (HADS), various NA behavior types, intentional and unintentional, and various reasons for NA.

    Results: Symptoms of anxiety and depression, independently and in combination, were associated with unintentional and intentional NA, with a stronger association with intentional NA. Regarding the reasons given for NA, for example anxiety, independently or in combination with depression, was associated with a fear of developing adverse drug reactions (ADRs). Depression, independently or in combination with anxiety, on the other hand, was associated with the actual development of ADRs.

    Conclusion: A cross-sectional design such as this does not allow assessment of causality derived from the results. However, the results indicate that patients experiencing symptoms of psychological distress are at increased risk of NA, especially intentional NA, and could therefore benefit from extra attention from the health care professional. Patients with symptoms of anxiety and/or depression should be identified and monitored for the development and/or fear of ADRs, in order to improve adherence to medication regimens.

  • 7.
    Thunander Sundbom, Lena
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Medical science. Department of Pharmacy, University of Uppsala, Uppsala, Sweden.
    Bingefors, Kerstin
    Department of Pharmacy, University of Uppsala, Uppsala, Sweden.
    Women and men report different behaviours in, and reasons for medication non-adherence : a nationwide Swedish survey [Hombres y mujeres comunican diferentes comportamientos y razones para el incumplimiento de la medicación: Encuesta nacional Sueca]2012In: Pharmacy Practice, ISSN 1885-642X, E-ISSN 1886-3655, Vol. 10, no 4, p. 207-221Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of the present study was to analyse gender differences in self-reported non-adherence (NA) to prescribed medication in the Swedish general population. We aimed to study unintentional and intentional NA as well as the reasons given for NA.

    Methods: A questionnaire was mailed to a cross-sectional, random, national sample of people aged 18-84 years in Sweden (n=7985). The response rate was 61.1% (n=4875). The questionnaire covered use of prescription drugs, NA behaviour and reasons for NA.

    Results: Use of prescription drugs was reported by 59.5% (n=2802) of the participants, and 66.4% (n=1860) of these participants did not adhere to the prescribed regimen. No overall gender differences in reporting NA were found. However, when analysing the various types of NA behaviour and the reasons for NA, different gender patterns emerged. Men were more likely to report forgetting [OR 0.77 (95% CI 0.65:0.92)], changing the dosage [OR 0.64 (95% CI 0.52:0.79)] and that they had recovered [14.3%, (OR 0.71 (95% CI 0.56:0.90)] as a reason. In contrast, more women than men reported filling the prescription but not taking the drug [OR 1.25 (95% CI 1.02:1.54)] and reported the development of adverse drug reactions (ADRs) [OR 1.89 (95% CI 1.37:2.59)] as a reason more commonly. The gender differences remained, in most cases, after controlling for confounders such as age, socioeconomic factors, medical problems and attitudes toward drugs.

    Conclusions: Women and men have different patterns of NA behaviour and different reasons for NA. Therefore, if adherence is to be improved, a wide knowledge of all the reasons for NA is required, along with an understanding of the impact of gender on the outcomes.

  • 8.
    Thunander Sundbom, Lena
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Pharmacy, Uppsala University, Uppsala, Sweden.
    Bingefors, Kerstin
    Department of Pharmacy, Uppsala University, Uppsala, Sweden.
    Hedborg, Kerstin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Isacson, Dag
    Department of Pharmacy, Uppsala University, Uppsala, Sweden.
    Are men under-treated and women over-treated with antidepressants?: Findings from a cross-sectional survey in Sweden2017In: BJPsych bulletin, ISSN 2056-4694, E-ISSN 2056-4708, Vol. 41, no 1, p. 145-150Article in journal (Refereed)
    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.

  • 9.
    Thunander Sundbom, Lena
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Uppsala universitet, Institutionen för farmaci.
    Hedborg, Kerstin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Gender differences in the association between prescribed antidepressants and other prescribed drugs: a nationwide register-based study in SwedenManuscript (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.

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