طلاق و تغییرات در شیوع مصرف داروهای روان گردان: مطالعه طولی مبتنی بر ثبت نام در میان فنلاندیهای میانسال
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|37140||2013||10 صفحه PDF||سفارش دهید||محاسبه نشده|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Social Science & Medicine, Volume 94, October 2013, Pages 71–80
Abstract The annual prevalence of psychotropic medication use exceeds 10 percent in Europe and the United States, the prevalence being higher among the divorced than the married. We analysed changes in the three-month prevalence of psychotropic medication use (psycholeptics and psychoanaleptics excluding medication for dementia) by proximity to divorce, sex, medication type and socio-demographic characteristics, using register-data on 304,111 Finns between 25 and 64 years of age, of whom 23,956 divorced between 1995 and 2003 and 142,093 were continuously married from 1995 to 2004. Five years before divorce, men and women already displayed about one percentage point higher prevalence of psychotropic medication use than those who continued their marriage. The excess prevalence increased with approaching divorce and peaked six to nine months before divorce, reaching 7.3 percent (95% CI 6.8–8.0) among divorcing men and 8.1 percent (95% CI 7.5–8.8) among divorcing women. The peak was followed by an 18-month decline, after which the excess compared to the continuously married settled at nearly three percentage points. The excess was not due to being socio-economically disadvantaged, and socio-demographic factors also seemed to have few modifying effects. The changes in prevalence were largest for antidepressants and almost non-existent for antipsychotics. Our results suggest that the high prevalence of psychotropic medication use among the divorced results both from selective factors already present five years before divorce and the acute and long-term causal effects of becoming and being divorced. Counselling is needed for individuals in the process of divorce, rather than economic support for divorced individuals.
Introduction Psychotropic medicines are among the most widely prescribed medicines (Mojtabai and Olfson, 2008 and Paulose-Ram et al., 2004), with annual prevalence of use exceeding 10 percent both in Europe and the United States (ESEMeD/MHEDEA 2000 Investigators, 2004a and Paulose-Ram et al., 2007). The annual prevalence of mental disorders is lower – although nearly 10 percent in Europe (ESEMeD/MHEDEA 2000 Investigators, 2004b) – but patients with serious mental disorders are still largely untreated, even in developed countries (WHO World Mental Health Survey Consortium, 2004). The majority of treatment is received by patients with minor or mild disorders (Bijl et al., 2003) or no diagnosed psychiatric morbidity (Kessler et al., 2005). Furthermore, the rate of treatment has increased more among individuals with less severe mental disorders (Mojtabai, 2008), which accounts for a large part of the overall increase and cost of psychotropic medication (Brugha et al., 2004). A specific case in the optimal allocation of resources is the treatment for adverse life events such as divorce (Mechanic, 2003). The prevalence of psychotropic medication is higher among the previously married than the currently married (Beck et al., 2005, ESEMeD/MHEDEA 2000 Investigators, 2004a, Kessler et al., 2005 and Sihvo et al., 2008), but this might partly result from selective effects, as mental disorders increase the probability of future divorce (Hope et al., 1999 and Kessler et al., 1998). However, previous longitudinal research has consistently shown that divorce increases psychological distress (Blekesaune, 2008, Bulloch et al., 2009, Meadows et al., 2008, Simon, 2002, Strohschein et al., 2005, Wade and Pevalin, 2004, Waite et al., 2009, Williams and Dunne-Bryant, 2006 and Wu and Hart, 2002), suggesting that divorce could also have causal effects on the use of psychotropic medication. We studied changes in the prevalence of psychotropic medication use before and after the date of divorce. Based on the observed changes, we further estimated how important selective and causal effects were in producing increased psychotropic medication use among the divorced. An increase in the prevalence of psychotropic medication during the process of divorce would imply that divorce has causal effects on medication use. In contrast, there would be support for the selection argument if the probability of psychotropic medication use is already elevated before the process of divorce.
نتیجه گیری انگلیسی
Conclusions The higher prevalence of psychotropic medication use among the divorced compared to the continuously married seems to be the result of both selective and causal effects. The role of selection in divorce seems strongest in the case of mental disorders that need treatment with antipsychotics. The adverse effects of divorce appear strongest in the use of antidepressants, and they are mostly – but not solely – short-term. Thus, the crisis effect of going through divorce seems to be of greater importance than the chronic strain effect of being divorced. In further support of viewing divorce as a psychological crisis, the trajectories of psychotropic medication use among divorcing individuals are highly similar regardless of their varying socio-demographic characteristics. Furthermore, elevated medication use among the divorced as opposed to the continuously married is poorly explained by socio-economic disadvantage. Hence, counselling is needed for individuals in the process of divorce, rather than economic support for divorced individuals.