Abstract
Objective
This study investigated the rates of and change in past-year antidepressant use from 1999 to 2017 among a representative sample of Ontario adults and past-year alcohol users and problem drinkers. It examined whether alcohol use and problem drinking are associated with antidepressant use over time, whether gender moderated the effect of problem drinking on antidepressant use, and the potential correlates of past-year antidepressant use.
Method
This study utilized data from the Centre for Addiction and Mental Health Monitor study, a repeat cross-sectional telephone survey of the Ontario general adult population. Data are from 15 annual cycles of the survey 1999–2017 (where relevant variables were included), resulting in a sample size of N = 35,210. Variables of interest included demographic variables, past-year antidepressant use, past-year alcohol use, and past-year problem drinking (e.g., 8+ on the Alcohol Use Disorders Identification Test).
Results
Past-year antidepressant use increased from 1999 to 2017 similarly among the full sample, past-year alcohol users, and past-year problem drinkers. Approximately 9% of Ontarians reported past-year antidepressant use in 2017. Overall, past-year problem drinkers were 1.5 times more likely to use antidepressants than non-problem drinkers. Past-year alcohol use was not associated with antidepressant use. Gender moderated the association between past-year problem drinking and antidepressant use.
Conclusion
This study determined that past-year antidepressant use increased from 1999 to 2017, that past-year problem drinkers are more likely to use antidepressants than non-problem drinkers, and that past-year problem drinking is associated with past-year antidepressant use among women but not among men.
Résumé
Objectif
Cette étude a examiné les taux et l’évolution de la consommation d’antidépresseurs au cours de la dernière année de 1999 à 2017 parmi un échantillon représentatif d’adultes de l’Ontario et de consommateurs d’alcool et de buveurs problématiques au cours de l’année précédente. Il a examiné si la consommation d’alcool et la consommation problématique d’alcool sont associées à la consommation d’antidépresseurs au fil du temps, si le sexe modère l’effet de la consommation problématique d’alcool sur l’utilisation d’antidépresseurs, et les corrélats potentiels de l’utilisation d’antidépresseurs au cours de l’année précédente.
Méthode
Cette étude a utilisé les données de l’étude Monitor du Centre de toxicomanie et de santé mentale, une enquête téléphonique transversale répétée auprès de la population adulte générale de l’Ontario. Les données proviennent de 15 cycles annuels de l’enquête 1999–2017 (où les variables pertinentes ont été incluses), ce qui donne une taille d’échantillon de N = 35 210. Les variables d’intérêt comprenaient les variables démographiques, la consommation d’antidépresseurs au cours de la dernière année, la consommation d’alcool au cours de la dernière année et la consommation excessive d’alcool au cours de la dernière année (par exemple, 8+ au Alcohol Use Disorders Identification Test).
Résultats
La consommation d’antidépresseurs au cours de la dernière année a augmenté de 1999 à 2017 de la même manière parmi l’échantillon complet, les consommateurs d’alcool de l’année précédente et les buveurs à problèmes de l’année précédente. Environ 9 % des Ontariennes et Ontariens ont déclaré avoir utilisé des antidépresseurs au cours de l’année précédente en 2017. Dans l’ensemble, les buveurs à problèmes au cours de la dernière année étaient 1,5 fois plus susceptibles de prendre des antidépresseurs que les buveurs sans problème. La consommation d’alcool au cours de la dernière année n’a pas été associée à l’utilisation d’antidépresseurs. Le sexe a modéré l’association entre la consommation abusive d’alcool et l’utilisation d’antidépresseurs au cours de l’année précédente.
Conclusion
Cette étude a déterminé que l’utilisation d’antidépresseurs au cours de la dernière année a augmenté de 1999 à 2017, que les buveurs à problèmes de l’année précédente sont plus susceptibles d’utiliser des antidépresseurs que les buveurs sans problème, et que la consommation excessive d’alcohol au cours de la dernière année est associée à l’utilisation d’antidépresseurs au cours de la dernière année pour les femmes mais pas pour les hommes.
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Data and code availability
It is our policy that external researchers require a user agreement and approval to use our data. Contact Yeshambel Nigatu (Yeshambel.Nigatu@camh.ca) to inquire about obtaining the data. Contact Jesus Chavarria (jesus.chavarria@camh.ca) to inquire about obtaining the analysis code.
References
Alegría, A. A., Hasin, D. S., Nunes, E. V., Liu, S.-M., Davies, C., Grant, B. F., & Blanco, C. (2010). Comorbidity of generalized anxiety disorder and substance use disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. The Journal of Clinical Psychiatry, 71(9), 1187–1253. https://doi.org/10.4088/JCP.09m05328gry.
Bauer, M., Monz, B. U., Montejo, A. L., Quail, D., Dantchev, N., Demyttenaere, K., et al. (2008). Prescribing patterns of antidepressants in Europe: Results from the Factors Influencing Depression Endpoints Research (FINDER) study. European Psychiatry, 23(1), 66–73. https://doi.org/10.1016/j.eurpsy.2007.11.001.
Beck, C. A., Patten, S. B., Williams, J. V. A., Wang, J. L., Currie, S. R., Maxwell, C. J., & El-Guebaly, N. (2005). Antidepressant utilization in Canada. Social Psychiatry and Psychiatric Epidemiology, 40(10), 799. https://doi.org/10.1007/s00127-005-0968-0.
Blanco, C., Alegría, A. A., Liu, S.-M., Secades-Villa, R., Sugaya, L., Davies, C., & Nunes, E. V. (2012). Differences among major depressive disorder with and without co-occurring substance use disorders and substance-induced depressive disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. The Journal of Clinical Psychiatry, 73(6), 865–873. https://doi.org/10.4088/jcp.10m06673.
Breslow, R. A., Dong, C., & White, A. (2015). Prevalence of alcohol-interactive prescription medication use among current drinkers: United States, 1999 to 2010. Alcoholism: Clinical and Experimental Research, 39(2), 371–379.
Burns, L., & Teesson, M. (2002). Alcohol use disorders comorbid with anxiety, depression and drug use disorders: Findings from the Australian National Survey of Mental Health and Well Being. Drug and Alcohol Dependence, 68(3), 299–307. https://doi.org/10.1016/S0376-8716(02)00220-X.
Chick, J., Aschauer, H., & Hornik, K. (2004). Efficacy of fluvoxamine in preventing relapse in alcohol dependence: A one-year, double-blind, placebo-controlled multicentre study with analysis by typology. Drug and Alcohol Dependence, 74(1), 61–70. https://doi.org/10.1016/j.drugalcdep.2003.11.012.
Coffino, J. A., Udo, T., & Grilo, C. M. (2019). Rates of help-seeking in US adults with lifetime DSM-5 eating disorders: Prevalence across diagnoses and differences by sex and ethnicity/race. In Mayo Clinic Proceedings (Vol. 94, No. 8, pp. 1415–1426). Elsevier.
Fan, W., & Yan, Z. (2010). Factors affecting response rates of the web survey: A systematic review. Computers in Human Behavior, 26(2), 132–139. https://doi.org/10.1016/j.chb.2009.10.015.
Graham, K., & Massak, A. (2007). Alcohol consumption and the use of antidepressants. CMAJ, 176(5), 633–637.
Grant, B. F., Dawson, D. A., Stinson, F. S., Chou, S. P., Dufour, M. C., & Pickering, R. P. (2004). The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, 1991–1992 and 2001–2002. Drug and Alcohol Dependence, 74(3), 223–234. https://doi.org/10.1016/j.drugalcdep.2004.02.004.
Hansen, D. G., Søndergaard, J., Vach, W., Gram, L. F., Rosholm, J. U., Mortensen, P. B., & Kragstrup, J. (2004). Socio-economic inequalities in first-time use of antidepressants: A population-based study. European Journal of Clinical Pharmacology, 60(1), 51–55. https://doi.org/10.1007/s00228-003-0723-y.
Hasin, D. S., Stinson, F. S., Ogburn, E., & Grant, B. F. (2007). Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. JAMA Psychiatry, 64(7), 830–842. https://doi.org/10.1001/archpsyc.64.7.830.
Health Canada. (2017). Canadian Tobacco, Alcohol, and Drugs Survey, 2013. https://www.canada.ca/en/health-canada/services/canadian-tobacco-alcohol-drugs-survey/2017-summary.html#n4. Accessed 6 Oct 2020.
Hemels, M. E., Koren, G., & Einarson, T. R. (2002). Increased use of antidepressants in Canada: 1981–2000. Annals of Pharmacotherapy, 36(9), 1375–1379. https://doi.org/10.1345/aph.1A331.
Ialomiteanu, A., Hamilton, H., Adlaf, E., & Mann, R. (2018). CAMH Monitor e-report: substance use, mental health and well-being among Ontario adults, 1977–2017. CAMH Research Document Series, (48).
Jalnapurkar, I., Allen, M., & Pigott, T. (2018). Sex differences in anxiety disorders: A review. Journal of Psychiatry Depression & Anxiety, 4(12), 3–16.
Keel, P. K., Mitchell, J. E., Miller, K. B., Davis, T. L., & Crow, S. J. (1999). Long-term outcome of Bulimia Nervosa. JAMA Psychiatry, 56(1), 63–69. https://doi.org/10.1001/archpsyc.56.1.63.
Kempf, A. M., & Remington, P. L. (2007). New challenges for telephone survey research in the twenty-first century. Annual Review of Public Health, 28(1), 113–126. https://doi.org/10.1146/annurev.publhealth.28.021406.144059.
Kessler, R. C., Brown, R. L., & Broman, C. L. (1981). Sex differences in psychiatric help-seeking: Evidence from four large-scale surveys. Journal of Health and Social Behavior, 49–64.
Koopman, C., Wanat, S. F., Whitsell, S., Westrup, D., & Matano, R. A. (2003). Relationships of alcohol use, stress, avoidance coping, and other factors with mental health in a highly educated workforce. American Journal of Health Promotion, 17(4), 259–268.
Kranzler, H. R., Burleson, J. A., Brown, J., & Babor, T. F. (1996). Fluoxetine treatment seems to reduce the beneficial effects of cognitive-behavioral therapy in type B alcoholics. Alcoholism: Clinical and Experimental Research, 20(9), 1534–1541. https://doi.org/10.1111/j.1530-0277.1996.tb01696.x.
Lee, E. S., & Forthofer, R. N. (2005). Analyzing complex survey data (Vol. 71). Sage Publications.
Liddon, L., Kingerlee, R., & Barry, J. A. (2018). Gender differences in preferences for psychological treatment, coping strategies, and triggers to help-seeking. British Journal of Clinical Psychology, 57(1), 42–58.
Mojitabai, R., & Olfson, M. (2011). Proportion of antidepressants prescribed without a psychiatric diagnosis is growing. Health Affairs, 30(8), 1434–1442.
National Institute on Alcohol Abuse and Alcoholism. (2014). Harmful interactions: Mixing alcohol with medicines. NIH Publication No. 13-5329. National Institutes of Health, US Department of Health and Human Services. Available at: http://pubs.niaaa.nih.gov/publications/Medicine/medicine.html. Accessed 26 Jan 2021.
Patten, S. B., Esposito, E., & Carter, B. (2007). Reasons for antidepressant prescriptions in Canada. Pharmacoepidemiology and Drug Safety, 16(7), 746–752. https://doi.org/10.1002/pds.1385.
Patten, S. B., Williams, J. V. A., Lavorato, D. H., Fiest, K. M., Bulloch, A. G. M., & Wang, J. (2014). Antidepressant use in Canada has stopped increasing. The Canadian Journal of Psychiatry, 59(11), 609–614. https://doi.org/10.1177/070674371405901107.
Pearson, C., Janz, T., & Ali, J. (2013). Health at a glance: Mental and substance use disorders in Canada. Statistics Canada Catalogue (82–624).
Raymond, C. B., Morgan, S. G., & Caetano, P. A. (2007). Antidepressant utilization in British Columbia from 1996 to 2004: Increasing prevalence but not incidence. Psychiatric Services, 58(1), 79–84.
Saunders, J. B., Aasland, O. G., Babor, T. F., De La Fuente, J. R., & Grant, M. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption-II. Addiction, 88(6), 791–804. https://doi.org/10.1111/j.1360-0443.1993.tb02093.x.
Sinokki, M., Hinkka, K., Ahola, K., Koskinen, S., Kivimäki, M., Honkonen, T., et al. (2009). The association of social support at work and in private life with mental health and antidepressant use: The Health 2000 Study. Journal of Affective Disorders, 115(1), 36–45. https://doi.org/10.1016/j.jad.2008.07.009.
Smith, J. P., & Book, S. W. (2010). Comorbidity of generalized anxiety disorder and alcohol use disorders among individuals seeking outpatient substance abuse treatment. Addictive Behaviors, 35(1), 42–45. https://doi.org/10.1016/j.addbeh.2009.07.002.
StataCorp. (2017). STATA Statistical Software: Release 15. College Station, TX: StataCorp LLC.
Sundbom, T. L., Bingefors, K., Hedborg, K., & Isacson, D. (2017). Are men under-treated and women over-treated with antidepressants? Findings from a cross-sectional survey in Sweden. BJPsych Bulletin, 41(3), 145–150.
Von Soest, T., Bramness, J. G., Pedersen, W., & Wichstrøm, L. (2012). The relationship between socio-economic status and antidepressant prescription: A longitudinal survey and register study of young adults. Epidemiology and Psychiatric Sciences, 21(1), 87–95.
Weissman, M. M., Bland, R., Joyce, P. R., Newman, S., Wells, J. E., & Wittchen, H. U. (1993). Sex differences in rates of depression: Cross-national perspectives. Journal of Affective Disorders, 29(2-3), 77–84.
Wright, G. (2015). An empirical examination of the relationship between nonresponse rate and nonresponse bias. Statistical Journal of the IAOS, 31(2), 305–315.
Funding
Dr. Jürgen Rehm and Dr. Tara Elton-Marshall acknowledge funding from Canadian Institutes of Health Research (CIHR) for the Ontario CRISM Node Team (grant # SMN-139150).
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All authors contributed to the study conception and design. Jesus Chavarria conducted the analyses and developed the full draft of the manuscript. Dr. Jürgen Rehm conducted the analyses and provided edits on all drafts. Drs. Tara Elton-Marshall and Samantha Wells provided feedback on all drafts.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at both CAMH (#305-2009) and York University (#2019-017) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Verbal informed consent was provided by all participants in the current study.
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Chavarria, J., Wells, S., Elton-Marshall, T. et al. Associations of antidepressant use with alcohol use and problem drinking: Ontario population data from 1999 to 2017. Can J Public Health 112, 919–926 (2021). https://doi.org/10.17269/s41997-021-00526-3
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DOI: https://doi.org/10.17269/s41997-021-00526-3
Keywords
- Ontario
- Antidepressant use
- Alcohol use
- Problem drinking
Mots-clés
- Ontario
- utilisation d’antidépresseurs
- consommation d’alcool
- problème d’alcool