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The influence of gender and depression on drug utilization: Pharmacoepidemiological research in Sweden
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Description
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. , 67 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Pharmacy, ISSN 1651-6192 ; 238
Keyword [en]
adherence, anxiety, depression, drug utilization, gender, pharmacoepidemiology, prescription drugs, self-report
National Category
Medical and Health Sciences
Research subject
Pharmacoepidemiology
Identifiers
URN: urn:nbn:se:uu:diva-330136ISBN: 978-91-513-0088-7 (print)OAI: oai:DiVA.org:uu-330136DiVA: diva2:1146952
Public defence
2017-11-24, Sal IV, Universitetshuset, Biskopsgatan 3, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2017-11-01 Created: 2017-10-04 Last updated: 2017-11-01
List of papers
1. Women and men report different behaviours in, and reasons for medication non-adherence: a nationwide Swedish survey
Open this publication in new window or tab >>Women and men report different behaviours in, and reasons for medication non-adherence: a nationwide Swedish survey
2012 (English)In: Pharmacy Practice, ISSN 1885-642X, E-ISSN 1886-3655, Vol. 10, no 4, 207-221 p.Article in journal (Refereed) Published
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 behaviourand 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.

 

Keyword
Medication Adherence, Health knowledge, Attitudes, Practice, Health care surveys, Sweden
National Category
Pharmaceutical Sciences
Research subject
Pharmacoepidemiology
Identifiers
urn:nbn:se:uu:diva-193611 (URN)
Available from: 2013-02-05 Created: 2013-02-05 Last updated: 2017-12-06Bibliographically approved
2. The influence of symptoms of anxiety and depression on medication nonadherence and its causes: a population based survey of prescription drug users in Sweden
Open this publication in new window or tab >>The influence of symptoms of anxiety and depression on medication nonadherence and its causes: a population based survey of prescription drug users in Sweden
2013 (English)In: Patient Preference and Adherence, ISSN 1177-889X, E-ISSN 1177-889X, Vol. 7, 805-811 p.Article in journal (Refereed) Published
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 2802 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.

Keyword
Medication Adherence, Anxiety symptoms, Depression symptoms, Reasons
National Category
Medical and Health Sciences
Research subject
Pharmacoepidemiology
Identifiers
urn:nbn:se:uu:diva-205574 (URN)10.2147/PPA.S50055 (DOI)000323147600001 ()
Available from: 2013-08-20 Created: 2013-08-20 Last updated: 2017-12-06Bibliographically approved
3. Are men under-treated and women over-treated with antidepressants?: Findings from a cross-sectional survey in Sweden
Open this publication in new window or tab >>Are men under-treated and women over-treated with antidepressants?: Findings from a cross-sectional survey in Sweden
2017 (English)In: BJPsych bulletin, ISSN 2056-4694, E-ISSN 2056-4708, Vol. 41, no 3, 145-150 p.Article 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.

Keyword
Self-reported depression, Antidepressants, Gender differences, Over-treatment, Under-treatment
National Category
Pharmaceutical Sciences Psychiatry
Research subject
Pharmacoepidemiology
Identifiers
urn:nbn:se:uu:diva-310328 (URN)10.1192/pb.bp.116.054270 (DOI)000407961600004 ()28584650 (PubMedID)
Available from: 2016-12-14 Created: 2016-12-14 Last updated: 2017-11-24Bibliographically approved
4. Gender differences in the association between prescribed antidepressants and other prescribed drugs: a nationwide register-based study in Sweden
Open this publication in new window or tab >>Gender differences in the association between prescribed antidepressants and other prescribed drugs: a nationwide register-based study in Sweden
(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.

Keyword
Gender, Antidepressants, Prescribed drugs, Polypharmacy
National Category
Medical and Health Sciences
Research subject
Pharmacoepidemiology
Identifiers
urn:nbn:se:uu:diva-328064 (URN)
Available from: 2017-08-16 Created: 2017-08-16 Last updated: 2017-10-04Bibliographically approved

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