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Initiation of psychotropic medication after partner bereavement: a matched cohort study.

Shah SM, Carey IM, Harris T, DeWilde S, Victor CR, Cook DG - PLoS ONE (2013)

Bottom Line: Evaluation of the potential effect of this change requires an understanding of existing psychotropic medication prescribing by non-specialists after bereavement.The early increase and trend in antidepressant use after bereavement suggests some clinicians did not adhere to the bereavement exclusion, with implications for its recent removal in DSM-5.Family practice variation in use of anxiolytics/hypnotics suggests uncertainty over their role in bereavement with the potential for inappropriate long term use.

View Article: PubMed Central - PubMed

Affiliation: Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom.

ABSTRACT

Background: Recent changes to diagnostic criteria for depression in DSM-5 remove the bereavement exclusion, allowing earlier diagnosis following bereavement. Evaluation of the potential effect of this change requires an understanding of existing psychotropic medication prescribing by non-specialists after bereavement.

Aims: To describe initiation of psychotropic medication in the first year after partner bereavement.

Methods: In a UK primary care database, we identified 21,122 individuals aged 60 and over with partner bereavement and no psychotropic drug use in the previous year. Prescribing (anxiolytic/hypnotic, antidepressant, antipsychotic) after bereavement was compared to age, sex and practice matched controls.

Results: The risks of receiving a new psychotropic prescription within two and twelve months of bereavement were 9.5% (95% CI 9.1 to 9.9%) and 17.9% (17.3 to 18.4%) respectively; an excess risk of initiation in the first year of 12.4% compared to non-bereaved controls. Anxiolytic/hypnotic and antidepressant initiation rates were highest in the first two months. In this period, the hazard ratio for initiation of anxiolytics/hypnotics was 16.7 (95% CI 14.7 to 18.9) and for antidepressants was 5.6 (4.7 to 6.7) compared to non-bereaved controls. 13.3% of those started on anxiolytics/hypnotics within two months continued to receive this drug class at one year. The marked variation in background family practice prescribing of anxiolytics/hypnotics was the strongest determinant of their initiation in the first two months after bereavement.

Conclusion: Almost one in five older people received a new psychotropic drug prescription in the year after bereavement. The early increase and trend in antidepressant use after bereavement suggests some clinicians did not adhere to the bereavement exclusion, with implications for its recent removal in DSM-5. Family practice variation in use of anxiolytics/hypnotics suggests uncertainty over their role in bereavement with the potential for inappropriate long term use.

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Probability of Initiation (%) of Psychotropic Drugs in the Year after Bereavement in Bereaved (B) and Non Bereaved (NB) Patients.Initiation probabilities during the first year after bereavement are derived from Kaplan Meier estimates and divided into the following periods Light Grey: 6–12 months Medium Grey: 2–6 months Dark Grey: 0–2 months.
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pone-0077734-g002: Probability of Initiation (%) of Psychotropic Drugs in the Year after Bereavement in Bereaved (B) and Non Bereaved (NB) Patients.Initiation probabilities during the first year after bereavement are derived from Kaplan Meier estimates and divided into the following periods Light Grey: 6–12 months Medium Grey: 2–6 months Dark Grey: 0–2 months.

Mentions: The probability of initiation of medications during the first year after bereavement is shown in figure 2. 9.5% (95% CI 9.1 to 9.9%) of bereaved individuals were newly prescribed any psychotropic medication in the two months after bereavement and 17.9% (17.3 to 18.4%) within a year of bereavement. This compares to 0.9% (0.8 to 1.0%) and 5.4% (5.3 to 5.6%) for the non-bereaved controls. This is an absolute difference in the probability of initiation of 8.6% in the first two months and 12.4% at one year between the bereaved and non-bereaved groups.


Initiation of psychotropic medication after partner bereavement: a matched cohort study.

Shah SM, Carey IM, Harris T, DeWilde S, Victor CR, Cook DG - PLoS ONE (2013)

Probability of Initiation (%) of Psychotropic Drugs in the Year after Bereavement in Bereaved (B) and Non Bereaved (NB) Patients.Initiation probabilities during the first year after bereavement are derived from Kaplan Meier estimates and divided into the following periods Light Grey: 6–12 months Medium Grey: 2–6 months Dark Grey: 0–2 months.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3818377&req=5

pone-0077734-g002: Probability of Initiation (%) of Psychotropic Drugs in the Year after Bereavement in Bereaved (B) and Non Bereaved (NB) Patients.Initiation probabilities during the first year after bereavement are derived from Kaplan Meier estimates and divided into the following periods Light Grey: 6–12 months Medium Grey: 2–6 months Dark Grey: 0–2 months.
Mentions: The probability of initiation of medications during the first year after bereavement is shown in figure 2. 9.5% (95% CI 9.1 to 9.9%) of bereaved individuals were newly prescribed any psychotropic medication in the two months after bereavement and 17.9% (17.3 to 18.4%) within a year of bereavement. This compares to 0.9% (0.8 to 1.0%) and 5.4% (5.3 to 5.6%) for the non-bereaved controls. This is an absolute difference in the probability of initiation of 8.6% in the first two months and 12.4% at one year between the bereaved and non-bereaved groups.

Bottom Line: Evaluation of the potential effect of this change requires an understanding of existing psychotropic medication prescribing by non-specialists after bereavement.The early increase and trend in antidepressant use after bereavement suggests some clinicians did not adhere to the bereavement exclusion, with implications for its recent removal in DSM-5.Family practice variation in use of anxiolytics/hypnotics suggests uncertainty over their role in bereavement with the potential for inappropriate long term use.

View Article: PubMed Central - PubMed

Affiliation: Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom.

ABSTRACT

Background: Recent changes to diagnostic criteria for depression in DSM-5 remove the bereavement exclusion, allowing earlier diagnosis following bereavement. Evaluation of the potential effect of this change requires an understanding of existing psychotropic medication prescribing by non-specialists after bereavement.

Aims: To describe initiation of psychotropic medication in the first year after partner bereavement.

Methods: In a UK primary care database, we identified 21,122 individuals aged 60 and over with partner bereavement and no psychotropic drug use in the previous year. Prescribing (anxiolytic/hypnotic, antidepressant, antipsychotic) after bereavement was compared to age, sex and practice matched controls.

Results: The risks of receiving a new psychotropic prescription within two and twelve months of bereavement were 9.5% (95% CI 9.1 to 9.9%) and 17.9% (17.3 to 18.4%) respectively; an excess risk of initiation in the first year of 12.4% compared to non-bereaved controls. Anxiolytic/hypnotic and antidepressant initiation rates were highest in the first two months. In this period, the hazard ratio for initiation of anxiolytics/hypnotics was 16.7 (95% CI 14.7 to 18.9) and for antidepressants was 5.6 (4.7 to 6.7) compared to non-bereaved controls. 13.3% of those started on anxiolytics/hypnotics within two months continued to receive this drug class at one year. The marked variation in background family practice prescribing of anxiolytics/hypnotics was the strongest determinant of their initiation in the first two months after bereavement.

Conclusion: Almost one in five older people received a new psychotropic drug prescription in the year after bereavement. The early increase and trend in antidepressant use after bereavement suggests some clinicians did not adhere to the bereavement exclusion, with implications for its recent removal in DSM-5. Family practice variation in use of anxiolytics/hypnotics suggests uncertainty over their role in bereavement with the potential for inappropriate long term use.

Show MeSH
Related in: MedlinePlus