Prevalence of psychotropic and antidepressant use in a Brazilian Amazon city: analysis of two cross-sectional studies

Tiguman, Gustavo Magno Baldin; Silva, Marcus Tolentino; Galvão, Taís Freire

doi:10.1590/1413-81232023281.10152022

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ARTICLE • Ciênc. saúde coletiva 28 (01) • Jan 2023 • https://doi.org/10.1590/1413-81232023281.10152022 copy

Prevalence of psychotropic and antidepressant use in a Brazilian Amazon city: analysis of two cross-sectional studies

Prevalência de uso de psicotrópicos e antidepressivos em uma cidade da Amazônia brasileira: análise de dois estudos transversais

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This article aims to assess the prevalence of psychotropic and antidepressant use and associated factors in a Brazilian Amazon city. Two cross-sectional studies conducted in Manaus in 2015 and 2019 with adults selected by probabilistic sampling. Prevalence ratios (PR) and 95% confidence intervals (95%CI) were calculated by Poisson regression with robust variance. 3,479 participants were included in 2015 and 2,321 in 2019; 2.0% used psychotropics in 2015 and 2.7% in 2019. Antidepressants were used by 0.4% (2015) and 1.4% (2019). Psychotropic use was lower in younger (PR = 0.41; 95%CI: 0.19-0.90), partnerless (PR = 0.64; 95%CI: 0.44-0.93), and informal workers (PR=0.47; 95%CI: 0.25-0.86), but higher in people with poor health (PR=2.86; 95%CI: 1.71-4.80), multimorbidity (PR = 3.24; 95%CI: 1.87-5.60), and who visited doctors (PR = 3.04; 95%CI: 1.45-6.38) or dentists (PR = 1.50; 95%CI: 1.08-2.10). Antidepressant use was higher in 2019 (PR = 2.90; 95%CI: 1.52-5.54), people with poor health (PR = 2.77; 95%CI: 1.16-6.62), and multimorbidity (PR = 8.72; 95%CI: 2.71-28.00), while lower in informal workers (PR = 0.33; 95%CI: 0.12-0.87) and unemployed (PR = 0.26; 95%CI: 0.08-0.81). Use of psychotropics remained stable in Manaus from 2015 to 2019, while antidepressant use more than tripled, which was marked by social inequalities.

Key words:
Psychotropic drugs; Antidepressive agents; Drug utilization

Variables		Participants’ characteristics				Psychotropics				Antidepressants
		2015		2019		2015		2019		2015		2019
		n	%	n	%	n	%	n	%	n	%	n	%
Sex
	Women	1,856	65.13	1,233	64.69	40	1.35	36	1.90	9	0.30	19	1.02
	Men	1,623	34.87	1,088	35.31	31	0.69	22	0.76	6	0.14	10	0.37
Age group (years)
	18-24	716	16.23	405	13.52	11	0.26	6	0.22	1	0.02	1	0.04
	25-34	1,010	31.43	586	25.22	6	0.17	5	0.23	1	0.02	1	0.05
	35-44	744	22.19	553	24.96	15	0.44	18	0.82	5	0.14	12	0.53
	45-59	674	18.99	526	23.86	33	0.96	20	0.95	8	0.24	10	0.48
	≥ 60	335	11.15	251	12.44	6	0.21	9	0.45	0	0.00	5	0.28
Skin color
	White	674	19.17	349	14.93	10	0.29	10	0.49	5	0.15	4	0.21
	Non-white	2,805	80.83	1,972	85.07	61	1.75	48	2.17	10	0.29	25	1.18
Marital status
	With partner	1,266	37.76	898	39.65	47	1.36	40	1.85	8	0.23	20	0.96
	Without partner	2,213	62.24	1,423	60.35	24	0.67	18	0.81	7	0.20	9	0.43
Social class
	A/B	555	14.88	282	11.52	8	0.21	7	0.31	2	0.05	4	0.20
	C	2,006	57.52	1,244	53.47	38	1.12	30	1.37	8	0.23	18	0.84
	D/E	918	27.60	795	35.01	25	0.71	21	0.98	5	0.15	7	0.35
Education
	Higher education or above	131	3.90	153	6.89	4	0.10	4	0.18	2	0.04	1	0.05
	High school	1,695	47.24	1,171	49.37	20	0.56	26	1.16	7	0.20	16	0.74
	Elementary school	562	15.57	432	18.01	17	0.48	7	0.33	1	0.03	3	0.14
	Less than elementary school	1,091	33.28	565	25.72	30	0.89	21	0.99	5	0.16	9	0.46
Occupation
	Formal job	652	16.61	415	16.27	15	0.38	11	0.44	4	0.13	8	0.34
	Informal job	978	26.15	665	27.34	10	0.27	10	0.48	2	0.04	5	0.27
	Retired	270	8.67	162	7.55	13	0.38	10	0.48	2	0.04	5	0.25
	Student/housewife	1,069	34.23	632	31.33	18	0.59	20	1.01	6	0.19	8	0.42
	Unemployed	510	14.34	447	17.51	15	0.41	7	0.26	1	0.02	3	0.11
Health insurance
	No	3,027	87.00	1,978	85.34	65	1.89	46	2.16	12	0.36	24	1.16
	Yes	452	13.00	343	14.66	6	0.15	12	0.50	3	0.07	5	0.23
Health status
	Good	2,243	62.72	1,498	62.54	31	0.81	17	0.71	4	0.11	9	0.42
	Fair	1,012	30.31	671	30.35	24	0.71	29	1.35	6	0.18	15	0.71
	Poor	224	6.97	152	7.12	16	0.52	12	0.60	5	0.15	5	0.26
Visit to the doctor^a
	No	802	21.26	587	23.66	4	0.09	4	0.17	0	0.00	2	0.12
	Yes	2,677	78.74	1,734	76.34	67	1.94	54	2.49	15	0.44	27	1.27
Visit to the dentist^a
	No	2,213	63.50	1,123	49.10	38	1.15	26	1.24	7	0.21	15	0.76
	Yes	1,266	36.50	1,198	50.90	33	0.89	32	1.43	8	0.22	14	0.63
Hospital admission^a
	No	3,226	92.11	2,071	88.50	59	1.66	48	2.19	13	0.37	25	1.21
	Yes	253	7.89	250	11.50	12	0.38	10	0.47	2	0.06	4	0.18
Number of chronic diseases
	0	1,377	37.37	921	37.37	11	0.27	9	0.36	2	0.04	1	0.05
	1	989	28.08	682	29.05	15	0.38	6	0.22	1	0.02	2	0.08
	≥ 2	1,113	34.55	718	33.57	45	1.38	43	2.08	12	0.37	26	1.25
Total		3,479	100.00	2,321	100.00	71	2.03	58	2.66	15	0.44	29	1.39

Psychotropic agent	ATC code	2015		2019
Psychotropic agent	ATC code	n	%^a	n	%^a
Antidepressants	N06A	47	25.8	31	34.8
Non-selective monoamine reuptake inhibitors	N06AA	20	11.0	11	12.4
Selective serotonin reuptake inhibitors	N06AB	20	11.0	13	14.6
‘Other’ antidepressants	N06AX	7	3.8	7	7.9
Antiepileptics	N03A	46	25.3	24	27.0
Clonazepam	N03AE01	13	7.1	8	9.0
Phenobarbital	N03AA02	10	5.5	3	3.4
Carbamazepine	N03AF01	9	4.9	4	4.5
Phenytoin	N03AB02	8	4.4	3	3.4
Others^b	-	6	3.3	6	6.7
Antipsychotics	N05A	30	16.5	15	16.9
Risperidone	N05AX08	16	8.8	8	9.0
Lithium	N05AN01	6	3.3	3	3.4
Others^c	-	8	4.4	4	4.5
Anxiolytics	N05B	14	7.7	4	4.5
Diazepam	N05BA01	9	4.9	3	3.4
Others^d	-	5	2.7	1	1.1
Hypnotics and sedatives	N05C	18	9.9	0	0.0
Scopolamine	N05CM05	13	7.1	0	0.0
Others^e	-	5	2.7	0	0.0
Other psychotropic agents	-	27	14.8	15	16.9
Opioids	N02A	17	9.3	12	13.5
Anti-Parkinson drugs	N04	10	5.5	3	3.4

Variables		Psychotropics				Antidepressants
Variables		Unadjusted PR (95%CI)	p- value	Adjusted^a PR (95%CI)	p- value	Unadjusted PR (95%CI)	p- value	Adjusted^b PR (95%CI)	p- value
Year			0.134		0.526		< 0.001		0.001
	2015	1.00		1.00		1.00		1.00
	2019	1.31 (0.92-1.86)		1.12 (0.78-1.62)		3.19 (1.70-5.99)		2.90 (1.52-5.54)
Sex			0.364		-		0.308		-
	Women	1.00		-		1.00		-
	Men	0.85 (0.60-1.21)		-		0.73 (0.39-1.34)		-
Age group (years)			< 0.001		< 0.001		0.002		0.049
	18-24	1.00		1.00		1.00		1.00
	25-34	0.41 (0.19-0.89)		0.41 (0.19-0.90)		0.54 (0.07-3.94)		0.41 (0.05-3.16)
	35-44	1.57 (0.86-2.84)		1.34 (0.71-2.54)		5.68 (1.31-24.59)		2.66 (0.60-11.71)
	45-59	2.84 (1.63-4.94)		1.76 (0.92-3.39)		7.14 (1.66-30.75)		1.97 (0.43-8.99)
	≥ 60	1.61 (0.79-3.28)		0.52 (0.21-1.26)		4.23 (0.82-21.90)		0.81 (0.14-4.89)
Ethnicity			0.701		-		0.528		-
	White	1.00		-		1.00		-
	Non-White	1.10 (0.68-1.78)		-		0.79 (0.37-1.65)		-
Marital status			0.117		0.018		0.749		-
	With partner	1.00		1.00		1.00		-
	Without partner	0.74 (0.51-1.08)		0.64 (0.44-0.93)		0.90 (0.48-1.68)		-
Social class			0.357		-		0.957		-
	A/B	1.00		-		1.00		-
	C	1.20 (0.68-2.11)		-		1.03 (0.42-2.53)		-
	D/E	1.47 (0.82-2.66)		-		0.93 (0.35-2.50)		-
Educational level			0.025		0.322		0.687		-
	Higher education or above	1.00		1.00		1.00		-
	High school	0.64 (0.30-1.37)		0.84 (0.39-1.80)		0.88 (0.26-2.99)		-
	Elementary school	0.98 (0.44-2.21)		1.32 (0.58-3.02)		0.49 (0.11-2.20)		-
	Less than elementary school	1.19 (0.56-2.52)		1.07 (0.50-2.28)		0.94 (0.26-3.32)		-
Occupation			< 0.001		0.016		0.063		0.084
	Formal job	1.00		1.00		1.00		1.00
	Informal job	0.54 (0.30-0.98)		0.47 (0.25-0.86)		0.40 (0.15-1.02)		0.33 (0.12-0.87)
	Retired	2.09 (1.19-3.68)		1.50 (0.76-2.96)		1.21 (0.47-3.11)		0.72 (0.23-2.30)
	Student/Housewife	0.93 (0.56-1.54)		0.78 (0.46-1.31)		0.66 (0.31-1.44)		0.55 (0.26-1.19)
	Unemployed	0.91 (0.51-1.62)		0.86 (0.48-1.55)		0.28 (0.09-0.88)		0.26 (0.08-0.81)
Health insurance			0.715		-		0.560		-
	No	1.00		-		1.00		-
	Yes	0.91 (0.55-1.51)		-		1.26 (0.58-2.73)		-
Health status			< 0.001		< 0.001		< 0.001		0.070
	Good	1.00		1.00		1.00		1.00
	Fair	2.57 (1.73-3.82)		1.50 (0.97-2.33)		3.51 (1.74-7.07)		1.79 (0.86-3.71)
	Poor	6.34 (3.99-10.08)		2.86 (1.71-4.80)		7.42 (3.23-17.03)		2.77 (1.16-6.62)
Visit to the doctor^c			< 0.001		0.003		0.032		0.173
	No	1.00		1.00		1.00		1.00
	Yes	4.78 (2.28-10.03)		3.04 (1.45-6.38)		4.74 (1.15-19.61)		2.62 (0.66-10.49)
Visit to the dentist^c			0.168		0.016		0.489		-
	No	1.00		1.00		1.00		-
	Yes	1.28 (0.90-1.81)		1.50 (1.08-2.10)		1.23 (0.68-2.25)		-
Hospital admission^c			0.001		0.163		0.340		-
	No	1.00		1.00		1.00		-
	Yes	2.14 (1.36-3.38)		1.38 (0.88-2.16)		1.52 (0.64-3.63)		-
Number of chronic diseases			< 0.001		< 0.001		< 0.001		< 0.001
	0	1.00		1.00		1.00		1.00
	1	1.36 (0.72-2.54)		1.11 (0.60-2.08)		1.33 (0.26-6.82)		1.05 (0.22-5.03)
	≥ 2	5.90 (3.59-9.68)		3.24 (1.87-5.60)		15.93 (4.77-53.22)		8.72 (2.71-28.00)

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[1] Chief editors:

Romeu Gomes, Antônio Augusto Moura da Silva