Emotional problems and the use of psychotropic drugs: investigating racial inequality

Fernandes, Camila Stéfani Estancial; Lima, Margareth Guimarães; Barros, Marilisa Berti de Azevedo

doi:10.1590/1413-81232020255.33362019

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ARTICLE • Ciênc. saúde coletiva 25 (5) • May 2020 • https://doi.org/10.1590/1413-81232020255.33362019 copy

Emotional problems and the use of psychotropic drugs: investigating racial inequality

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The aim of the present study was to investigate the existence of racial inequalities in the prevalence of emotional problems, the search for healthcare services and the use of psychotropic drugs. A population-based, cross-sectional study was conducted with data from the 2014/15 Campinas Health Survey. Sample of 1953 individuals aged 20 years or older was analyzed. We estimated the prevalence of common mental disorders (CMDs), the reporting of emotional problems, insomnia, the search for and the use of healthcare services and the use of psychotropic drugs according to self-reported skin color (white and black/brown). Prevalence ratios were estimated using “Poisson” multiple regression. The prevalence of CMDs was higher among blacks/brown compared to whites but no difference was found regarding the reporting of emotional problems and insomnia. Whites sought healthcare services more due to emotional problems. The use of psychotropic drugs was also higher among whites. The results revealed racial inequalities in the presence of CMDs, the search for healthcare services and the use of psychotropics drugs, highlighting the need for actions to identify and overcome barriers that hinder access to mental health care by different racial segments of the population.

Key words
Race and health; Mental disorders; Social inequality

Variables	Study population	Skin color		p-value ᵡ²
	Study population	Black/Brown	White
	n	n (%)^a a percentages weighted for sampling design. ᵡ2 p-value of chi-square test.	n (%)^a a percentages weighted for sampling design. ᵡ2 p-value of chi-square test.
Total	1953	612 (31.8)	1341 (68.2)
Sex				0.9600
Male	833	265 (47.3)	568 (47.1)
Female	1120	347 (52.7)	773 (52.9)
Age group (years)				0.0023
20 to 39	537	213 (52.7)	324 (43.4)
40 to 59	459	145 (31.8)	314 (37.0)
60 or older	957	254 (15.5)	703 (19.6)
Schooling (years)				0.0000
0 to 4	715	231 (23.0)	484 (17.8)
5 to 11	896	323 (64.2)	573 (48.4)
12 or more	341	58 (12.8)	283 (33.8)
Family income per capita				0.0000
≤ 1.5 x BMMW	1099	416 (70.6)	683 (47.3)
> 1.5 X BMMW	854	196 (29.4)	658 (52.7)
Private health insurance				0.0000
No	1093	433 (68.2)	660 (46.5)
Yes	859	179 (31.8)	680 (53.5)

Variables	Skin color		p-value ᵡ²	Adjusted PR^a a Prevalence ratio adjusted by age and sex. (95% CI)	Adjusted PR^b b Prevalence ratio adjusted by age, sex and family income per capita. (95% CI)
	Black/Brown (1)	White (2)
	%	%		(2/1)	(2/1)
Emotional/mental problem	31.0	34.5	0.2804	1.1 (0.92-1.35)	1.1 (0.93-1.33)
Type of emotional/mental problem
Anxiety	24.1	25.8	0.5539	1.1 (0.88-1.37)	1.1 (0.86-1.33)
Depression	6.1	7.6	0.3370	1.2 (0.73-1.82)	1.3 (0.80-1.97)
Other problem	0.7	1.1	0.4991	1.5 (0.40-5.52)	1.6 (0.43-6.18)
Common mental disorder	20.1	15.2	0.0233	0.7 (0.58-0.94)	0.9 (0.67-1.13)
Insomnia	18.8	23.3	0.0771	1.2 (0.92-1.52)	1.2 (0.93-1.53)

Variables	Skin color		p-value ᵡ²	PR (95% CI)^a a Prevalence ratio adjusted by age and sex.	PR (95% CI)^b b Prevalence ratio adjusted by age, sex and family income per capita.
	Black/Brown (1)	White (2)		PR (95% CI)^a a Prevalence ratio adjusted by age and sex.
	%	%		(2/1)	(2/1)
Sought health service due to problem	43.4	55.7	0.0135	1.3 (1.06-1.57)	1.3 (1.05-1.56)
Reasons for not seeking
Did not find it necessary	78.2	91.7	0.0075	1.2 (1.01-1.38)	1.2 (1.01-1.37)
Other reasons	21.8	8.3	0.0075	0.4 (0.18-0.77)	0.4 (0.19-0.82)
Place of last appointment
Primary care unit /psychosocial care center	41.5	26.9	0.0183	0.6 (0.46-0.90)	0.8 (0.60-1.18)
Office of physician or other professional	37.1	64.0	0.0012	1.7 (1.17-2.56)	1.5 (1.04-2.26)
Other location	21.5	9.1	0.0148	0.4 (0.22-0.82)	0.5 (0.26-0.97)
Who paid for care
Public health system	63.3	34.0	0.0005	0.5 (0.39-0.72)	0.7 (0.50-0.91)
Private insurance/business accord	24.2	47.7	0.0056	2.0 (1.13-3.52)	1.7 (0.99-3.04)
Others	12.5	18.3	0.2868	1.5 (0.70-3.03)	1.4 (0.66-3.06)

Variables	Prevalence (in %)		Adjusted PR ^a a Prevalence ratio adjusted by age and sex. (95% CI)	Adjusted PR ^b b Prevalence ratio adjusted by age, sex and family income per capita. (95% CI)
	Black/Brown (1)	White (2)
	%	%	(2/1)	(2/1)
Total	7.2	13.9	1.8 (1.27-2.46)	1.8 (1.29-2.43)
Emotional/mental problem
No	3.0	6.1	1.8 (0.88-3.51)	1.8 (0.88-3.60)
Yes	16.7	28.6	1.6 (1.07-2.53)	1.6 (1.08-2.49)
Limitation due to problem
Without limitation	9.9	25.1	2.5 (1.26-5.10)	2.4 (1.23-4.79)
With limitation	24.2	31.9	1.2 (0.76-1.82)	1.2 (0.79-1.89)
Type of emotional/mental problem
Anxiety	11.0	23.3	2.0 (1.07-3.83)	2.0 (1.05-3.63)
Depression	33.7	42.6	1.3 (0.67-2.48)	1.3 (0.71-2.51)
Common mental disorder
No	4.7	10.0	1.9 (1.16-3.05)	1.8 (1.10-2.95)
Yes	17.3	35.8	2.0 (1.22-3.31)	2.0 (1.19-3.28)
Insomnia
No	5.1	9.7	1.7 (0.99-3.03)	1.7 (1.01-2.95)
Yes	16.6	27.5	1.6 (1.03-2.59)	1.6 (1.04-2.55)
Limitation due to insomnia
Without limitation	4.4	18.2	3.9 (1.57-9.63)	3.8 (1.54-9.21)
With limitation	23.1	34.3	1.5 (0.91-2.42)	1.5 (0.91-2.39)

Class of psychotropic	Prevalence of use (%)			Adjusted PR^a a Prevalence ratio adjusted by age and sex. (95% CI)	Adjusted PR^b b Prevalence ratio adjusted by age, sex and family income per capita. (95% CI)
	Study population	Skin color
	Study population	Black/Brown (1)	White (2)
	n (%)^a a Prevalence ratio adjusted by age and sex.	%^a a Prevalence ratio adjusted by age and sex.	%^a a Prevalence ratio adjusted by age and sex.	(2/1)	(2/1)
Antidepressants	148 (6.5)	4.0	7.7	1.8 (1.12-3.03)	1.8 (1.10-2.85)
Fluoxetine	42 (2.2)	1.4	2.5	1.8 (0.79-3.92)	1.6 (0.77-3.32)
Sertraline	31 (1.1)	0.8	1.1	1.2 (0.47-2.87)	1.3 (0.53-3.04)
Other antidepressants ¹ 1 Selective serotonin reuptake inhibitors (citalopram, paroxetine, escitalopram); Tricyclics (imipramine, clomipramine, amitriptyline, nortriptyline); Others (trazodone, mirtazapine, bupropion, venlafaxine, duloxetine, desvenlafaxine).	75 (3.2)	1.8	4.1	2.2 (1.06-4.54)	2.2 (1.01-4.70)
Benzodiazepines	111 (3.8)	3.2	4.0	1.1 (0.72-1.67)	1.2 (0.78-1.80)
Clonazepam	59 (2.0)	1.3	2.3	1.5 (0.78-2.93)	1.6 (0.84-3.18)
Diazepam	29 (1.1)	1.5	0.8	0.5 (0.18-1.31)	0.6 (0.23-1.64)
Other benzodiazepines² 2 lorazepam, bromazepam, clobazam, alprazolam, cloxazolam, flunitrazepam, zolpidem.	23 (0.7)	0.4	0.9	2.2 (0.55-8.39)	2.1 (0.55-7.89)
Antiepileptics ³ 3 carbamazepine, phenytoin, phenobarbital, primidone, oxcarbazepine, valproic acid, lamotrigine, topiramate, gabapentin, pregabalin.	51 (2.4)	1.6	2.8	1.7 (0.82-3.65)	2.0 (0.85-4.51)
Other psychotropics ⁴ 4 Opioid analgesics (morphine, codeine, tramadol); Anti-Parkinson's (biperiden, levodopa, amantadine, pramipexol, selegiline, rasagiline, entacapone); Antipsychotics (levomepromazine, haloperidol, olanzapine, quetiapine, lithium, risperidone, aripiprazole); Anxiolytics (buspirone); Psychostimulants: (methylphenidate, piracetam); Antidementia (rivastigmine, galantamine, memantine).	86 (2.9)	1.0	3.8	3.4 (1.49-7.68)	3.2 (1.42-7.38)

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[1] Collaborations

CSE Fernandes: analysis and interpretation of data, writing and critical review of the manuscript. MG Lima: interpretation of the data and critical review of the manuscript. MBA Barros: conception and guidance of the work, interpretation of the data and critical review of the manuscript.