Use of psychotropic drugs by population in an area affected by the tailings dam rupture: Brumadinho Health Project

Loyola Filho, Antônio Ignácio de; Firmo, Josélia Oliveira Araújo; Mambrini, Juliana Vaz de Melo; Peixoto, Sérgio Viana; Souza Junior, Paulo Roberto Borges de; Nascimento, Mariana Martins Gonzaga do

doi:10.1590/1980-549720220012.supl.2

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Original Article • Rev. bras. Epidemiol. 25 (Supl 2) • 2022 • https://doi.org/10.1590/1980-549720220012.supl.2 copy

Use of psychotropic drugs by population in an area affected by the tailings dam rupture: Brumadinho Health Project

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

Objective:

To describe the consumption of psychotropic drugs in the adult population residing in Brumadinho, Minas Gerais, after the Vale dam collapse, which occurred in 2019.

Methods:

This is a cross-sectional study, part of the Brumadinho Health Project, developed in 2021, with a representative population-based sample of adults (18 years and over) residing in Brumadinho. A total of 2,805 adults with information on self-reported use of psychotropic drugs (antidepressants and anxiolytics-hypnotics/sedatives) in the last 15 days were included in the analysis. The prevalence of psychotropic drug use was estimated, and the most used psychotropic drugs were identified. Pearson’s chi-square test (with Rao-Scott correction) was used to test associations between exposures and use of psychotropic drugs, considering a significance level of p<0.05.

Results:

The use of antidepressants (14.2%) was more common than the use of anxiolytics or hypnotics/sedatives (5.2%), with sertraline and fluoxetine being the most used antidepressants. The use of anxiolytics and hypnotics/sedatives was higher among residents who lived in the area directly affected by the dam’s mud, and the use of any psychotropic drug was higher among those who lost a relative/friend in the disaster and assessed that their health worsened after the disaster, and among women.

Conclusion:

The results of the study corroborate what was observed in other populations exposed to similar tragedies, regarding the pattern of associations and the of use of psychotropic drugs.

Keywords:
Psychotropic drugs; Drug utilization; Disaster; Pharmacoepidemiology

		n	%^* * percentage calculated considering the sample weight and the design effect
Gender
	Male	1,288	42.9
	Female	1,557	57.1
Age range (in years)
	18–39	1,068	36.3
	40–59	1,036	33.2
	60 or more	701	30.5
Education^† † lack of information for: schooling (n=10); marital status (n=7); skin color (n=10); health self-assessment (n=7); loss of a resident of the household, family member or friend (n=9). Participants with information loss were removed to calculate the frequencies (absolute and relative) of the respective variables
	Elementary/Middle school	1,419	44.6
	High school	1,013	33.6
	Higher education	363	21.9
Marital status^† † lack of information for: schooling (n=10); marital status (n=7); skin color (n=10); health self-assessment (n=7); loss of a resident of the household, family member or friend (n=9). Participants with information loss were removed to calculate the frequencies (absolute and relative) of the respective variables
	Married	1,672	59.5
	Single	746	26.3
	Divorced/separated	194	7.8
	Widower	186	6.3
Self-referred skin color^† † lack of information for: schooling (n=10); marital status (n=7); skin color (n=10); health self-assessment (n=7); loss of a resident of the household, family member or friend (n=9). Participants with information loss were removed to calculate the frequencies (absolute and relative) of the respective variables
	White	942	42.9
	Black	389	11.8
	Brown	1,433	44.2
	Others^‡ ‡ yellow and indigenous.	31	1.1
Area of residence (in relation to the dam failure)
	Census sectors	1,453	95.5
	Area directly affected	881	2.9
	Mining region	471	1.6
Worsening health after the dam collapse^† † lack of information for: schooling (n=10); marital status (n=7); skin color (n=10); health self-assessment (n=7); loss of a resident of the household, family member or friend (n=9). Participants with information loss were removed to calculate the frequencies (absolute and relative) of the respective variables
	No	1,428	54.9
	Yes	1,370	45.1
Loss of a resident, family member or friend^† † lack of information for: schooling (n=10); marital status (n=7); skin color (n=10); health self-assessment (n=7); loss of a resident of the household, family member or friend (n=9). Participants with information loss were removed to calculate the frequencies (absolute and relative) of the respective variables
	No	728	37.9
	Yes	2,068	62.1

Drug		n	%
Subtotal 1 – Anxiolytics^* * clonazepam was included in the class of anxiolytics, due to its off-label use in Brazil (benzodiazepines) (N05B/N05CD)^† † ATC code (Anatomical-Therapeutic-Chemical Classification – WHO)		159	24.1
	Clonazepam	94
	Diazepam	31
	Alprazolam	23
	Others	11
Subtotal 2 – Hypnotics (Z-drugs) (N05CF)^† † ATC code (Anatomical-Therapeutic-Chemical Classification – WHO)		65	9.8
	Zolpidem	61
	Eszopiclone	4
Subtotal 3 – Antidepressants (N06A)^† † ATC code (Anatomical-Therapeutic-Chemical Classification – WHO)		437	66.1
Tricyclic antidepressants (N06AA)^† † ATC code (Anatomical-Therapeutic-Chemical Classification – WHO)		82	12.4
	Amitriptyline	56
	Nortriptyline	19
	Others	7
SSRI antidepressants^‡ ‡ selective serotonin reuptake inhibitors. (N06AB)^† † ATC code (Anatomical-Therapeutic-Chemical Classification – WHO)		288	43.6
	Sertraline	110
	Fluoxetine	89
	Escitalopram	41
	Citalopram	40
	Paroxetine	8
Other antidepressants (N06AX)^† † ATC code (Anatomical-Therapeutic-Chemical Classification – WHO)		67	10.1
	Venlafaxine	21
	Desvenlafaxine	15
	Duloxetine	11
	Mirtazapine	9
	Bupropion	9
	Others	2
Total		661	100.0

		Psychotropic use (p-value)^* * obtained by Pearson’s chi-square, with Rao-Scott correction factor; significant when <0.05		Anxiolytics and hypnotics use (p-value)^* * obtained by Pearson’s chi-square, with Rao-Scott correction factor; significant when <0.05		Antidepressant use (p-value)^* * obtained by Pearson’s chi-square, with Rao-Scott correction factor; significant when <0.05
Gender
	Male	10.0	7.7–12.9	3.4	2,1–5,3	7,4	5,4–10,0
	Female	22.7	19.3–26.4	6.6	2,9–8,8	19,3	12,0–16,7
		(p<0.001)		(p=0.010)		(p<0.001)
Age (in years)
	18–39	16.9	13.2–21.4	5.1	3,3–7,9	13,1	9,7–17,4
	40–59	17.2	13.9–21.1	4.6	3,0–6,9	15,0	11,9–18,6
	60 or more	17.6	13.3–22.8	6.0	4,0–9,0	14,2	12,0–16,7
		(p=0.975)		(p=0.658)		(p=0.765)
Education
	Elementary/Middle school	15.9	13.0–19.3	5.4	3,8–7,6	13,2	10,5–16,3
	High school	19.3	15.4–23.8	5.9	3,8–9,1	16,2	12,7–20,4
	Higher education	16.6	11.9–22.7	3.4	1,5–7,3	13,3	8,9–19,3
		(p=0.427)		(p=0.424)		(p=0.427)
Self-referred skin color
	White	19.1	15.5–23.4	5.9	4,0–8,7	16,0	12,5–20,1
	Black	17.0	11.2–24.9	5.0	2,6–9,7	13,9	8,6–21,7
	Brown	16.0	13.2–19.4	4.7	3,3–6,7	12,9	10,3–16,1
	Others^† † yellow and indigenous.	0.9	0.3–3.3	0.6	0,1–2,8	0,3	0,0–2,4
		(p=0.160)		(p=0.523)		(p=0.175)
Marital status
	Married	17.9	15.0–21.3	4.5	3,2–6,4	15,5	12,7–18,8
	Single	16.2	12.4–21.1	6.2	4,0–9,6	11,5	8,1–15,9
	Separated/divorced	13.7	8.3–21.8	4.3	1,8–9,6	11,2	6,4–18,7
	Widower	19.5	12.5–29.3	8.8	4,5–16,7	16,5	10,0–26,1
		(p=0.646)		(p=0.268)		(p=0.240)
Area of residence
	Census sectors	17.1	14.5–19.8	4.9	3,7–6,5	14,1	11,8–16,7
	Area directly affected	21.5	18.9–24.4	11.1	9,2–13,3	17,2	14,7–19,4
	Mining region	19.3	15.5–23.8	11.7	8,9–15,3	14,2	11,0–18,1
		(p=0.051)		(p<0.001)		(p=0.203)
Loss of a resident, family member or friend
	No	12.2	9.1–16.1	2.7	1,5–4,8	10,1	7,2–14,1
	Yes	20.4	17.3–23.8	6.8	5,1–9,0	16,7	13,9–19,9
		(p=0.001)		(p=0.004)		(p=0.007)
Worsening health after the dam collapse
	No	8.6	6.6–11.0	2.4	1,6–3,8	6,5	4,8–8,7
	Yes	27.8	23.7–32.2	8.6	6,4–11,6	23,5	19,6–27,8
		(p<0.001)		(p<0.001)		(p<0.001)

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[1] CORRESPONDING AUTHOR: Antônio Ignácio de Loyola Filho. Avenida Augusto de Lima, 1.715, CEP: 30190-003, Belo Horizonte (MG), Brazil. E-mail: antonio.filho@fiocruz.br