Trends in the use of antidepressants among older adults: Bambuí Project

Loyola Filho, Antônio Ignácio de; Castro-Costa, Érico; Firmo, Josélia Oliveira Araújo; Peixoto, Sérgio Viana

doi:10.1590/S0034-8910.2014048005406

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Original Articles • Rev. Saúde Pública 48 (6) • Dec 2014 • https://doi.org/10.1590/S0034-8910.2014048005406 copy

Trends in the use of antidepressants among older adults: Bambuí Project

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE

To analyze the trends and factors associated with the antidepressant use among older adults.

METHODS

This population-based study evaluated older adults in 1997 (n = 351, baseline) and the survivors at the 15^th follow-up year (n = 462, in 2012) among the aging cohort of Bambuí. The prevalence of antidepressant use was estimated, and the most commonly used antidepressants each year were identified. Prevalence ratios with 95% confidence intervals were estimated using Poisson regression with robust variance to investigate differences in the prevalence of use between 1997 and 2012.

RESULTS

The overall consumption of antidepressants (PR = 2.87, 95%CI 1.94;4.25) and of selective serotonin reuptake inhibitors (PR = 7.50, 95%CI 3.74;15.02) was significantly higher in 2012. However, no significant difference was observed in the use of tricyclic antidepressants between the two cohorts (PR = 0.89, 95%CI 0.49;1.62). In the 2012 cohort, antidepressant use was associated with females, increased age, increased income (≥ 4 minimum wages), self-assessment of health as reasonable, and attending ≥ 5 medical consultations in the last 12 months.

CONCLUSIONS

The increased consumption of antidepressants in the period due to increased use of selective serotonin reuptake inhibitors was consistent with results observed in international studies of different population groups and contexts. The positive correlation observed between antidepressant use and family income may be a warning of possible inequalities in access to mental health services.

Aged; Antidepressive Agents, therapeutic use; Drug Utilization, trends; Socioeconomic Factors; Pharmacoepidemiology

Variable	1997 (N = 351)	2012 (N = 462)	p
Age in years^a	79.8 (3.7)	79.9 (3.8)	0.712
Sex
Male	39.9	33.6
Female	60.1	66.5	0.063
Education (years completed)
0	39.0	24.7
1 to 3	29.6	36.6
≥ 4	31.4	38.7	< 0.001
Marital status
Married/Consensual union	36.5	33.4
Widowed	50.4	57.7
Single or divorced	13.1	8.9	0.056
Family income (in minimum wage equivalents)
< 2.0	35.1	20.9
2.0 to 3.9	34.3	44.6
≥ 4.0	30.6	34.6	< 0.001
Lives alone
No	80.1	73.3
Yes	19.9	26.7	0.025
Depressive disorders
No	57.2	80.7
Yes	42.8	19.3	< 0.001
Self-assessment of health
Very good/Good	31.9	53.5
Reasonable	45.9	37.5
Poor	22.2	9.1	< 0.001
Number of chronic diseases
0	35.0	14.2
1	43.0	46.4
≥ 2	22.0	39.4	< 0.001
Inability to perform at least one basic activity of daily living
No	75.6	85.0
Yes	24.4	15.0	0.001
Number of medical consultations in the last 12 months
0 to 1	33.1	23.8
2 to 4	40.2	46.3
≥ 5	26.8	29.9	0.014
Hospitalization history in the past 12 months
No	71.8	77.9
Yes	28.2	22.2	0.048
Health insurance coverage
No	82.6	66.6
Yes	17.4	34.4	< 0.001

Characteristics	%	PR_raw	95%CI	PR_adjusted	95%CI
Age	80.7 (4.0)^a	1.06	1.01;1.10	1.05	1.01;1.09
Sex
Male	14.8	1.00		1.00
Female	28.0	1.89	1.24;2.87	1.77	1.11;2.82
Education (years completed)
None	19.3	1.00		1.00
1 to 3	29.4	1.29	0.81;2.04	1.43	0.87;2.35
≥ 4	25.1	1.30	0.83;2.05	1.33	0.78;2.26
Marital status
Married/Consensual union	19.5	1.00		1.00
Widowed	26.7	1.37	0.94;2.00	1.02	0.66;1.58
Single or divorced	19.5	2.00	0.50;2.02	1.02	0.53;1.97
Family income (in minimum wages)
< 2.0	18.2	1.00		1.00
2.0 to 3.9	20.0	1.07	0.65;1.76	1.40	0.82;2.39
≥ 4.0	30.2	1.61	1.00;2.60	1.93	1.08;3.45
Lives alone
No	23.0	1.00		1.00
Yes	23.8	1.03	0.71;1.50	1.33	0.82;2.13
Depressive disorders
No	20.9	1.00		1.00
Yes	34.8	1.67	1.18;2.36	1.26	0.86;1.86
Self-assessment of health
Very good/Good	18.2	1.00		1.00
Reasonable	29.5	1.62	1.14;2.30	1.62	1.13;2.32
Poor	31.0	1.70	1.01;2.87	1.50	0.83;2.70
Number of chronic diseases
None	24.6	1.00		1.00
1	24.1	0.98	0.60;1.59	0.80	0.50;1.26
≥ 2	23.3	0.95	0.57;1.57	0.74	0.45;1.22
Inability to perform at least one basic activity of daily living
No	22.1	1.00		1.00
Yes	31.9	1.45	0.98;2.14	1.01	0.65;1.59
Number of medical consultations
0 to 1	12.7	1.00		1.00
2 to 4	23.8	1.87	1.09;3.23	1.61	0.92;2.82
≥ 5	31.9	2.51	1.45;4.33	2.10	1.16;3.81
Hospitalization history
No	22.0	1.00		1.00
Yes	27.7	1.26	0.87;1.83	1.07	0.69;1.64
Health insurance coverage
No	20.0	1.00		1.00
Yes	31.4	1.57	1.13;2.17	1.37	0.95;1.97

Antidepressant use	1997	2012	PR_raw	95%CI	PR_adjusted^a	95%CI
Global (%)	8.3	23.6	2.86	1.94;4.20	2.87	1.94;4.25
Tricyclic compounds (%)	5.7	5.6	0.99	0.56;1.74	0.89	0.49;1.62
Selective serotonin reuptake inhibitors (%)	2.3	17.3	7.60	3.62;15.05	7.50	3.74;15.02

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[1] Correspondence
: Antônio Ignácio de Loyola Filho. Fundação Oswaldo Cruz. Av. Augusto de Lima, 1715 Sala 608. 30190-002 Belo Horizonte, MG, Brasil. E-mail: aloy@cpqrr.fiocruz.br