A data linkage study of the effects of the Great Recession and austerity on antidepressant prescription usage
A data linkage study of the effects of the Great Recession and austerity on antidepressant prescription usage
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DOI：
10.1093/eurpub/ckaa253
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发表时间：
2021-02-07
影响因子：
4.4
通讯作者：
Pearce, Jamie
中科院分区：
文献类型：
--
作者：
Cherrie, Mark;Curtis, Sarah;Pearce, Jamie
背景：国际文献显示，大衰退期间的失业和收入损失恶化了人们的心理健康。这项个人层面的纵向研究使用大量具有代表性的人口样本的行政处方数据，研究了地区经济趋势和紧缩措施与抑郁症的关系。方法：来自苏格兰纵向研究样本(N=8600)的记录与每月初级保健抗抑郁药处方(2009-15)相关联。区域经济趋势以年度全职就业数据(2004-14)为特征。紧缩的经济影响是通过福利改革(2010-15年)导致的每个工作年龄成年人的年收入损失来衡量的。序列分析确定了使用抗抑郁药物的新病例，基于群体的轨迹建模将地区划分为类似的经济轨迹。多水平Logistic回归检验了区域经济趋势和新的抗抑郁药物处方之间的关系。结构方程中介分析评估了福利改革的贡献作用。结果：居住在经济衰退后没有恢复的地区的就业人员开始新的抗抑郁药物疗程的风险最高(AOR 1.23；95%CI 1.08-1.38)。生活在恢复轨迹较好地区的个人风险最低。中介分析显示，50%(95%可信区间7-61%)的关联可以用福利改革对人均收入的影响来解释。结论：在大衰退之后，当地劳动力市场的衰退和紧缩措施与越来越多的抗抑郁药使用有关，加剧了地区精神健康方面的不平等。这项研究证明了紧缩对健康不平等的影响，并表明经济状况和福利政策对人口健康有影响。减轻精神疾病的负担主要需要对社会决定因素采取行动。
Background: International literature shows unemployment and income loss during the Great Recession worsened population mental health. This individual-level longitudinal study examines how regional economic trends and austerity related to depression using administrative prescription data for a large and representative population sample. Methods: Records from a sample of the Scottish Longitudinal Study (N=86 500) were linked to monthly primary care antidepressant prescriptions (2009-15). Regional economic trends were characterized by annual full-time employment data (2004-14). Economic impact of austerity was measured via annual income lost per working age adult due to welfare reforms (2010-15). Sequence analysis identified new cases of antidepressant use, and group-based trajectory modelling classified regions into similar economic trajectories. Multi-level logistic regression examined relationships between regional economic trends and new antidepressant prescriptions. Structural equation mediation analysis assessed the contributory role of welfare reforms. Results: Employed individuals living in regions not recovering post-recession had the highest risk of beginning a new course of antidepressants (AOR 1.23; 95% CI 1.08-1.38). Individuals living in areas with better recovery trajectories had the lowest risk. Mediation analyses showed that 50% (95% CI 7-61 %) of this association was explained by the impact of welfare benefit reforms on average incomes. Conclusions: Following the Great Recession, local labour market decline and austerity measures were associated with growing antidepressant usage, increasing regional inequalities in mental health. The study evidences the impact of austerity on health inequalities and suggests that economic conditions and welfare policies impact on population health. Reducing the burden of mental ill-health primarily requires action on the social determinants.