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The stratified medicalisation of mental health symptoms: educational inequalities in the use of psychotropic medication in Belgium

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Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

Several studies have shown socioeconomic inequalities in psychotropic medication use, but most of these studies are inspired by Andersen’s behavioural model of health care use, which strongly focusses on individuals’ needs. Andersen’s model pays little attention to health care use that is not based on need and insubstantially recognises the context dependentness of individuals. Medicalisation, however, is a context-dependent interactive process that not only interacts with need determinants, but also with non-need determinants that affect health care use. Therefore, this study will examine if psychotropic medication use is stratified, and whether this is not simply the result of differences in need for care, but also influenced by factors not based on need, initiating the stratified medicalisation of mental health symptoms.

Methods

Data from the Belgian Health Interview Survey (BHIS) are used. This study covers information from five successive waves: 2001, 2004, 2013, 2018. The weighted data represent a sample of the adult Belgian population. The research aims are analysed using stepwise Poisson regression models, where the models are also plotted to detect evolutions over time, using marginal means postestimation.

Results

The results reveal that educational inequalities in psychotropic medication use are significant and persistently visible over time. Even after entering need for care, educational inequalities remain significant.

Conclusion

This study shows that psychotropic medication use is stratified and that this is not simply the result of differences in need for care, but also influenced by factors linked to the stratified medicalisation of mental health symptoms.

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Availability of data and materials

The data will not be deposited, since its subject to a contract with Sciensano (The Scientific Institute of public health of the federal Belgian State).

Code availability

Codes are available upon request from the corresponding author.

References

  1. Chiappini S, Schifano F, Martinotti G (2021) Prescribing psychotropics: misuse, abuse, dependence. Withdrawal Addict Front Psychiatry 12:597

    Google Scholar 

  2. Estrela M, Herdeiro MT, Ferreira PL, Roque F (2020) The use of antidepressants, anxiolytics, sedatives and hypnotics in Europe: focusing on mental health care in Portugal and prescribing in older patients. Int J Environ Res Public Health 17(22):8612

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Gisle L, Drieskens S, Demarest S, Van der Heyden J (2020) Mental health: Health Interview Survey 2018. Sciensano

  4. Federal Planning Bureau (FPB) (2021) Good health and well-being: reimbursed psychotropic medication. Retrieved from https://indicators.be/en/i/G03_RPM/Reimbursed_psychotropic_medication

  5. Andersen RM (1995) Revisiting the behavioral model and access to medical care: does it matter? Journal of health and social behavior:1–10

  6. Lorant V, Boland B, Humblet P, Deliège D (2002) Equity in prevention and health care. J Epidemiol Community Health 56(7):510–516

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Hanratty B, Zhang T, Whitehead M (2007) How close have universal health systems come to achieving equity in use of curative services? A systematic review. Int J Health Serv 37(1):89–109

    Article  PubMed  Google Scholar 

  8. Morris S, Sutton M, Gravelle H (2005) Inequity and inequality in the use of health care in England: an empirical investigation. Soc Sci Med 60(6):1251–1266

    Article  PubMed  Google Scholar 

  9. Mechanic D, McAlpine DD (2010) Sociology of health care reform: building on research and analysis to improve health care. J Health Soc Behavior 51 (1_suppl):S147–S159

  10. Missinne S (2015) Moving towards a better understanding of socioeconomic inequalities in preventive health care use: a life course perspective. A life course perspective on health trajectories and transitions 111–131

  11. Cockerham WC (2005) Health lifestyle theory and the convergence of agency and structure. J Health Soc Behav 46(1):51–67

    Article  PubMed  Google Scholar 

  12. Cockerham WC (2007) The social causes of health and disease. Policy Press, Cambridge

    Google Scholar 

  13. Conrad P (1992) Medicalization and social control. Ann Rev Sociol 18(1):209–232

    Article  Google Scholar 

  14. Conrad P (2005) The shifting engines of medicalization. J Health Soc Behav 46(1):3–14

    Article  PubMed  Google Scholar 

  15. Conrad P, Leiter V (2004) Medicalization, markets and consumers. J Health Soc Behav 158–176

  16. Clarke AE, Shim JK, Mamo L, Fosket JR, Fishman JR (2010) Biomedicalization technoscientific transformations of health, illness, and US biomedicine. Biomedicalization 47–87

  17. Zheng H (2015) Why has medicine expanded? The role of consumers. Soc Sci Res 52:34–46

    Article  PubMed  Google Scholar 

  18. Boffin N, Bossuyt N, Declercq T, Vanthomme K, Van Casteren V (2012) Incidence, patient characteristics and treatment initiated for GP-diagnosed depression in general practice: results of a 1-year nationwide surveillance study. Fam Pract 29(6):678–687

    Article  PubMed  Google Scholar 

  19. Fraeyman J, Van Hal G, De Loof H, Remmen R, De Meyer G, Beutels P (2012) Potential impact of policy regulation and generic competition on sales of cholesterol lowering medication, antidepressants and acid blocking agents in Belgium. Acta Clin Belgica 67(3):160–171

  20. Butterworth P, Olesen SC, Leach LS (2013) Socioeconomic differences in antidepressant use in the PATH Through Life Study: evidence of health inequalities, prescribing bias, or an effective social safety net? J Affect Disord 149(1–3):75–83

    Article  PubMed  Google Scholar 

  21. Comino EJ, Harris E, Silove D, Manicavasagar V, Harris MF (2000) Prevalence, detection and management of anxiety and depressive symptoms in unemployed patients attending general practitioners. Aust N Z J Psychiatry 34(1):107–113

    Article  CAS  PubMed  Google Scholar 

  22. Rijksinstituut voor ziekte- en invalideitsverzekering (RIZIV) (2021) Start van een toegankelijker psychologisch zorgmodel met geleidelijke uitrol in het hele land [Start of a more accessible psychological care model with gradual roll-out across the country]. Retrieved from https://www.riziv.fgov.be/nl/nieuws/Paginas/versterkt-psychologisch-zorgaanbod-voor-iedereen-september.aspx

  23. Johnson CF, Williams B, MacGillivray SA, Dougall NJ, Maxwell M (2017) ‘Doing the right thing’: factors influencing GP prescribing of antidepressants and prescribed doses. BMC Fam Pract 18(1):1–13

    Article  Google Scholar 

  24. Shavers VL (2007) Measurement of socioeconomic status in health disparities research. J Natl Med Assoc 99(9):1013

    PubMed  PubMed Central  Google Scholar 

  25. Psacharopoulos G, Patrinos HA (2018) Returns to investment in education: a decennial review of the global literature. Educ Econ 26(5):445–458

    Article  Google Scholar 

  26. Goldberg D, Williams P (2000) General health questionnaire (GHQ). NferNelson, Swindon, Wiltshire, UK

  27. del Pilar S-López M, Dresch V (2008) The 12-Item General Health Questionnaire (GHQ-12): reliability, external validity and factor structure in the Spanish population. Psicothema 20(4):839–843

    Google Scholar 

  28. Jylhä M (2009) What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Soc Sci Med 69(3):307–316

    Article  PubMed  Google Scholar 

  29. Halford C, Wallman T, Welin L, Rosengren A, Bardel A, Johansson S, Eriksson H, Palmer E, Wilhelmsen L, Svärdsudd K (2012) Effects of self-rated health on sick leave, disability pension, hospital admissions and mortality. A population-based longitudinal study of nearly 15,000 observations among Swedish women and men. BMC Public Health 12(1):1–11

  30. Pu C, Bai YM, Chou YJ (2013) The impact of self-rated health on medical care utilization for older people with depressive symptoms. Int J Geriatr Psychiatry 28(5):479–486

    Article  PubMed  Google Scholar 

  31. Wauters M, Elseviers M, Peeters L, De Meester D, Christiaens T, Petrovic M (2019) Reducing psychotropic drug use in nursing homes in Belgium: an implementation study for the roll-out of a practice improvement initiative. Drugs Aging 36(8):769–780

    Article  CAS  PubMed  Google Scholar 

  32. Lindsey PL (2009) Psychotropic medication use among older adults: what all nurses need to know. J Gerontol Nurs 35(9):28–38

    Article  PubMed  PubMed Central  Google Scholar 

  33. Ćurković M, Dodig-Ćurković K, Petek Erić A, Kralik K, Pivac N (2016) Psychotropic medications in older adults: a review. Psychiatria Danubina 28(1):24

  34. Téllez-Lapeira J, López-Torres Hidalgo J, García-Agua Soler N, Gálvez-Alcaraz L, Escobar-Rabadán F, García-Ruiz A (2016) Prevalence of psychotropic medication use and associated factors in the elderly. Eur J Psychiatry 30(3):183–194

    Google Scholar 

  35. Popelier K, Peeters L (2018) Psychofarmaca in woonzorgcentra. Samen op weg naar minder [Psychotropic medication in residential care. Together on the road to less]. Retrieved from https://www.vad.be/assets/vad026_a4_psychofarmaca_in_woonzorgcentra

  36. Belgian Psychotropics Experts Platform (BelPEP) (2014) Globale visienota en actieplan van de drie werkgroepen [Global vision statement and action plan of the three working groups]. Retrieved from https://www.health.belgium.be/sites/default/files/uploads/fields/fpshealth_theme_file/visienota_nl_april_2015.pdf

  37. Belgian Health Care Knowledge Center (KCE) (2019) Organisation of mental health care for adults in Belgium. Retrieved from https://kce.fgov.be/sites/default/files/atoms/files/KCE_318_Mental_Health_care_Report_0.pdf

  38. Ohayon MM, Lader MH (2002) Use of psychotropic medication in the general population of France, Germany, Italy, and the United Kingdom. J Clin Psychiatry 63(9)

  39. Hansen DG, Søndergaard J, Vach W, Gram LF, Rosholm J-U, Kragstrup J (2003) Antidepressant drug use in general practice: inter-practice variation and association with practice characteristics. Eur J Clin Pharmacol 59(2):143–149

    Article  PubMed  Google Scholar 

  40. Mercier A, Benichou J, Auger-Aubin I, Lebeau J-P, Houivet E, Van Royen P, Peremans L (2015) How do GP practices and patient characteristics influence the prescription of antidepressants? A cross-sectional study. Ann Gen Psychiatry 14(1):1–10

    Article  Google Scholar 

  41. Anthierens S, Habraken H, Petrovic M, Christiaens T (2007) The lesser evil? Initiating a benzodiazepine prescription in general practice: a qualitative study on GPs’ perspectives. Scand J Prim Health Care 25(4):214–219

    Article  PubMed  PubMed Central  Google Scholar 

  42. Anrys PM, Strauven GC, Foulon V, Degryse J-M, Henrard S, Spinewine A (2018) Potentially inappropriate prescribing in Belgian nursing homes: prevalence and associated factors. J Am Med Dir Assoc 19(10):884–890

    Article  PubMed  Google Scholar 

  43. Mayeur T (2017) Wie teveel voorschrijft krijgt boete van De Block (Minister van Volksgezondheid) [Anyone who prescribes too much will be fined by De Block (Minister of Health)]. Retrieved from https://www.knack.be/nieuws/gezondheid/artsen-die-te-veel-voorschrijven-strenger-bestraft/article-normal-74368.html?msclkid=bff3f323bb4511ecb9324e1bbd43bdbc

  44. Buffel V, Beckfield J, Bracke P (2017) The institutional foundations of medicalization: a cross-national analysis of mental health and unemployment. J Health Soc Behav 58(3):272–290

    Article  PubMed  Google Scholar 

  45. Goldberg JF, Ernst CL (2018) Managing the side effects of psychotropic medications. American Psychiatric Association Publishing, Washington D.C.

  46. Cummings NA, Wiggins JG (2016) a collaborative primary care/behavioral healthcare model for the use of psychotropic medication with children and adolescents: the report of a national retrospective study. In: Psyche's Prophet. Routledge, pp 103–115

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Author information

Authors and Affiliations

  1. Department of Sociology, HeDeRa (Health and Demographic Research), Ghent University, Sint-Pietersnieuwstraat 41 B1, Korte Meer 5, 9000, Ghent, Belgium

    Lisa Colman, K. Delaruelle & P. Bracke

Authors
  1. Lisa Colman
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  2. K. Delaruelle
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  3. P. Bracke
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Contributions

The first author (LC) designed the study, had primary responsibility for the writing and editing of the manuscript and performed the data analysis. The co-authors critically reviewed the manuscript. All authors gave final approval for the article to be published.

Corresponding author

Correspondence to Lisa Colman.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethics approval

No ethics committee approval needed.

Appendices

Appendices

Appendix 1: Respondent selection criteria

The initial sample size of the BHIS included 73,681 respondents. After excluding year 1997, because there was no data on the dependent variable (N = 10,786), and respondents not aged between 25 and 85 years old (N = 20,285), 42,610 respondents remained. After further excluding missing values on the dependent and independent variables (N = 11,117), the presents study holds data from 31,493 respondents.

Appendix 2

See Table 3.

Table 3 Weighted APRs and corresponding P-values for psychotropic medication use in the past two weeks among the entire sample, according to characteristics of relevance
Full size table

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Colman, L., Delaruelle, K. & Bracke, P. The stratified medicalisation of mental health symptoms: educational inequalities in the use of psychotropic medication in Belgium. Soc Psychiatry Psychiatr Epidemiol 58, 833–842 (2023). https://doi.org/10.1007/s00127-022-02283-1

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  • DOI: https://doi.org/10.1007/s00127-022-02283-1

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