ISSN
1916-694X

2010;
Volume 1 (Number 2): Pages 48-57

ORIGINAL
RESEARCH

Psychotropic medication consumption in Spain:
influence of gender and perception of health status

Pilar CARRASCO-GARRIDOa, Rodrigo
JIMÉNEZ-GARCÍAa, Valentín HERNÁNDEZ-BARRERAa, Paloma
ASTASIO-ARBIZAb, Paloma ORTEGA-MOLINAb, Ana LÓPEZ DE
ANDRÉSa, Ángel GIL DE MIGUELa

aUnit of Preventive Medicine and Public Health,
Universidad Rey Juan Carlos, and bDepartment of Preventive Medicine,
Public Health & History Science, Faculty of Medicine, Universidad
Complutense; Madrid, Spain

*Corresponding author. [email-masked]

ABSTRACT

Objective: This study aimed to identify the factors associated with
psychotropic medication consumption in the Spanish adult population. Methods: Descriptive, cross-sectional
study covering the Spanish adult population aged 16 years and over, using data
drawn from the 2001 Spanish National Health Survey. A total of 21,067 interviews were analyzed. The independent
variables were socio-demographic and health-related, and the dependent variable
was total consumption of psychotropic medication. To estimate the effect of
each of the independent variables on consumption of such medications, we also
obtained the corresponding Odds Ratio (ORs) adjusted by means of a multivariate
analysis, using a logistic regression model. Results: The prevalence of consumption was significantly higher in
women than in men (11.5% vs. 5.0%; P <0.001). Multivariate analysis, based
on logistic regression, showed an association between increased psychoactive
drug intake and age. Anxiety, depressive and sleep disorders displayed a strong
association with consumption of psychoactive drugs across the sexes, as did
negative perception of health and medical visits. Conclusions: In Spain, the prevalence of psychoactive drug
consumption is higher in women than in men, and increases with age and negative
perception of health outcomes.

Key words

Drug
prescription; Gender; Prevalence; Psychoactive drugs

RÉSUMÉ

Objectif: Le but de cette étude était d’identifier les
facteurs de consommation de médicaments psychotropes dans une population espagnole
adulte. Méthodes: Etude descriptive
transversale couvrant la population espagnole adulte d’âge supérieur à 16 ans
et utilisant les données de l’enquête sur la santé en Espagne de 2001. Un total
de 21,067 données ont été analysées. Les variables indépendantes étaient
socio-démographiques et relatives à l’état de santé et la variable dépendante
était la consommation de médicaments psychotropes. Pour estimer l’impact de
chacune des variables indépendantes sur la consommation de ces médicaments,
nous avions déterminé les Odds Ratios (ORs) ajustés à l’aide d’une analyse
multivariée utilisant un modèle de régression logistique. Résultats: La prévalence de consommation était significativement
plus élevée chez les femmes que chez les hommes (11,5% vs 5,0%; P<0,001).
L’analyse multivariée, basée sur une régression logistique, a montré une
association entre une augmentation de la consommation de médicaments
psychotropes et l’âge. L’anxiété, la dépression, les troubles du sommeil de
même qu’une perception négative des visites chez le médecin étaient associées à
la consommation de médicaments dans les 2 sexes. Conclusions: En Espagne, la consommation de médicaments
psychotropes est plus élevée chez les femmes que chez les hommes et augmente
avec l’âge et une perception négative de son état de santé.

Mots clés

Ordonnance;
Genre; Prévalence; Médicaments psychotropes

RESUMEN

Objetivo: Identificar los factores asociados al consumo
de medicamentos psicotrópicos en la población española adulta. Métodos: Este es un estudio
descriptivo, transversal, en población española adulta mayor de 16 años,
utilizando los datos obtenidos en la Encuesta Nacional de Salud de España. Un
total de 21,067 entrevistas fueron analizadas. Las variables independientes
fueron aspectos sociodemográficos y de salud, mientras que la variable
dependiente fue el consumo total de medicamentos psicotrópicos. Para estimar el
efecto de cada una de las variables independientes en el consumo total de
medicamentos, obtuvimos las correspondientes razones de momio (Odds Ratio: OR)
ajustados mediante un análisis de varianza, usando un modelo de regresión
logística. Resultados: La prevalencia
en el consumo de medicamentos fue mayor en las mujeres que en los hombres
(11.5% vs. 5.0%; P <0.001). En el análisis multivariado, basado en una
regresión logística, se observó una asociación entre un incremento en el
consumo de medicamentos psicoactivos y la edad de los sujetos. Los trastornos
de ansiedad, depresivos, y del sueño fueron los más fuertemente asociados al
consumo de medicamentos psicoactivos en ambos sexos, al igual que una
percepción negativa de la salud y visitas al médico. Conclusiones: En España, la prevalencia de consumo de medicamentos
psicoactivos es mayor en mujeres que en hombres, e incrementa con la edad y la
percepción negativa de la salud.

Palabras clave

Prescripción
de medicamentos; Género; Prevalencia; Medicamentos psicoactivos

INTRODUCTION

In the last ten years, psychotropic drugs
have become one of the most widely used pharmacological groups [1] [2] [3] [4] [5] [6] [7]. Although the therapeutic value of psychotropic drugs
is well established, there is evidence to suggest that these drugs are being
used in ways of which the health professions may be unaware [8] [9] [10] [11]. This pharmacologic group registers substantial
levels of consumption without medical prescription, something that can have
serious consequences on individual and collective health [12] [13].

Currently, psychoactive drugs can, as a
whole, be considered as medications that are susceptible to abuse [14] [15]. This is complicated by the fact that, in Spain,
antidepressants (N06A) [16] have consistently ranked as the third most consumed
therapeutic subgroup in recent years [17] [18].

Considerable research and a number of studies
have targeted the use of psychoactive drugs in the general population [1] [6] [7] [19] [20] [21] [22], in an effort to provide a representative profile of
the consumer of these medications, by observing possible factors and characteristics,
whether socio-demographic or health-related, that might be linked to the consumption
of such substances.

Bearing in mind the considerable prevalence
of depressive disorders in the community, some studies rank depression as the
fourth most common and disabling disease worldwide [23]. Combined with the frequency of insomnia in the
general population [24], consumption of anxiolytics, hypnotics and
antidepressants runs parallel to such pathologies [25] [26]. Indeed, this is the reason why ascertaining the
epidemiologic characteristics linked to the consumption of these substances and
fostering their rational use is relevant.In this context, our study aimed to determine the prevalence of consumption, both prescribed and self-medicated,
of psychotropic drugs in the Spanish population; and to identify the factors associated with
such consumption in this population.

METHODS

We conducted a descriptive, cross-sectional
epidemiologic study on the consumption of psychotropic medication by the
Spanish population. We used individual secondary data collected by the Spanish
National Health Survey (SNHS) in 2001 [27], from the Ministry of Health. This survey was carried
out on a wide sample of the non-institutionalized Spanish population by direct
interview at home. We used a multi-stage, stratified cluster sampling
procedure, with proportional random selection of primary  (towns and cities) and secondary sampling
units (census sections), and selection of end units (individuals) by means of
random routes and sex and age group.

The survey included data from 21,067 adults,
and required weighting. Details on the methodology are described elsewhere [27]. Our study population was made up of a total of
21,067 subjects of both sexes aged 16 and over, resident in Spain.

The following dependent variables were
analyzed as dichotomous variables (‘yes’ or ‘no’): ‘Overall consumption of psychoactive
drugs’ (defined as the answer to the question, ‘What type of medication have
you taken in the last two weeks?’, referring to the intake of tranquilizers,
sedatives, sleeping pills and/or antidepressants or stimulants); ‘Consumption
of psychoactive drugs due to medical prescription’ (where consumption was a
consequence of medical prescription); and ‘Consumption of psychoactive drugs
due to self-medication’ (defined as consumption of these medications without
medical prescription [28]). As independent variables, we first analyzed a
number of socio-demographic characteristics, chief among which were age, sex,
marital status, educational level and occupational status (‘employed’,
‘unemployed’, and ‘inactive’ including housewives and pensioner).

In addition, we studied the following
lifestyle and health-related variables: alcohol consumption in the two weeks
immediately preceding the survey; smoking habit (both defined as dichotomous
variables for analysis purposes); number of hours of sleep per day (categorized
as ‘less than seven’ and ‘seven or more’ hours per day); physical activity
(‘intensive’ several times a week, ‘moderate’ few times every month or
“inactive’); body mass index (BMI); chronic disease of any type; anxiety,
depressive or sleep disorder (defined as the cause that forced interviewees to
restrict their principal activity in the preceding two weeks); self-assessment
of health status (dichotomous variable recording interviewees’ positive or
negative perception of their health); and medical consultation in the preceding
two weeks, defined as a dichotomous variable.

For the purpose of data analysis, we
calculated the prevalence of total (defined as both prescribed and
self-medicated) consumption of medicines for the year 2006 by the study population. For bivariate comparison of proportions
Pearson's c2 method or Fisher's exact test was applied,
with values of P <0.05 taken as significant. The
association between the independent variables studied and medication use was calculated, using the odds ratio (OR) and its 95% confidence
interval.All estimates were computed separately for men and women, in view of
the fact that different sex-specific consumption patterns have been identified [3] [21].

To estimate the independent effect of each
of these variables on consumption of such medications, we also obtained the
corresponding OR adjusted by means of multivariate analysis, using logistic
regression models. Estimates were generated by incorporating the sampling
weights, using the “svy” (survey command) functions of STATA, which enabled the
sampling design to be incorporated into all our statistical calculations
(descriptive, chi-squared, logistic regression).

RESULTS

For study purposes, we used data on 21,024
subjects aged 16 years and over who answered the question referring to
consumption of some type of medication in the two weeks immediately preceding
the survey. They accounted for 99.8% of the total of 21,067 subjects covered by
the 2001 SNHS.

An analysis of the characteristics of the
study population showed that 51.5% (10,856) were women and 48.5% (10,211) men;
47.0% (9,910) were over 45 years of age (mean age 45.3 years; SD ± 18.8); the
majority (58%) were married; the inactive population (pensioners and
housewives) represented 48.5% (10,168) of the sample; 51.3% (10,761) reported
having consumed alcohol and 34.2% (7,185) were smokers. It should be noted that
70.3% (14,767) of the Spanish population interviewed had a positive perception
of their state of health. The 2001 SNHS data revealed that 51% (10,746) of
subjects affirmatively reported having taken some type of medication. When this
consumption was confined to psychotropic medication, we observed an intake
prevalence of 8.2% (1,719), 7.6% of which was attributed to medical
prescription and the remaining 0.6% (128) to self-medication. Extrapolating the
data to the general Spanish population in 2001, this would mean that there were
2,812,488 persons consuming this type of drug; 209,420 of whom could be assumed
to be on self-medication.

In terms of overall consumption of these drugs, women registered
significantly higher (P <0.001) prevalence values than did men: 11.1%
(1,206) for women versus 5.0% (513) for men; and it was again women who
registered higher percentages of both prescribed (10.4%) (P <0.001) and
self-medicated psychotropic agents (0.8%) (P <0.05).

The prevalence of consumption of
psychoactive drugs, broken down by the socio-demographic characteristics of the
population, together with the crude odds ratios and their corresponding 95%
confidence intervals are shown in Table 1. Consumption
of these medications increased significantly with age across the sexes, with
women in all cases registering higher crude OR values than men, particularly in
the over-75 age group. The multivariate analysis, which was performed using
logistic regression, showed the independent effect of each of the study
variables, duly adjusted for the remainder, on the overall consumption of
psychoactive drugs in our sample. These estimates were made for both sexes (Table 2).

Table
1

Prevalence of consumption of
psychoactive drugs in men and women, by various socio-demographic, lifestyle
and health profile variables of the study population (SNHS 2001)

OVERALL
CONSUMPTION OF PSYCHOACTIVE DRUGS

Men

Women

%  (N)

Crude OR (95% CI)

%  (N)

Crude OR (95% CI)

Age (years)

16-24

1.3 (22)

1.00

2.5 (39)

1.00

25-44

2.8 (112)

2.19 (1.38 - 3.47)

5.7 (223)

2.39 (1.69 - 3.38)

45-64

6.9 (186)

5.52 (3.53 - 8.62)

15.8 (452)

7.42 (5.31 - 10.36)

65-74

9.4 (107)

7.76 (4.87 - 12.36)

18.3 (287)

8.85 (6.28 - 12.46)

75 and over

12.1 (85)

10.33 (6.41 - 16.67)

22.5 (202)

11.48 (8.05 - 13.36)

Marital status

Married

5.5 (325)

1.00

11.2 (702)

1.00

Single

3.2 (118)

0.57 (0.46 - 0.70)

5.0 (142)

0.42 (0.34 - 0.50)

Separated/Divorced

9.4 (27)

1.78 (1.18 - 2.69)

17.4 (71)

1.66 (1.27 - 2.17)

Widowed

12.8 (43)

2.52 (1.79 - 3.54)

22 (291)

2.23 (1.92 - 2.60)

Educational level

University & higher
education

3.6 (52)

1.00

5.7 (75)

1.00

High school

2.8 (62)

0.77 (0.53 - 1.12)

5.7 (106)

1.00 (0.74 - 1.36)

Junior school

5.2 (286)

1.49 (1.10 - 2.02)

11.4 (689)

2.14 (1.67 - 2.63)

No formal education

10.9 (112)

3.30 (2.35 - 4.64)

21.4 (336)

4.53 (3.49 - 5.90)

Occupational status

Employed

2.6 (155)

1.00

6.7 (224)

1.00

Unemployed

6.4 (40)

2.54 (1.78 - 3.64)

7.0(60)

1.04 (0.77 - 1.40)

Inactive (housewives,
retired)

8.8 (313)

3.62 (2.97 - 4.41)

13.8 (907)

2.20 (1.89 - 2.57)

Alcohol consumption

Yes

3.6 (247)

1.00

7.1 (274)

1.00

No

8.1 (264)

2.37 (1.98 - 2.83)

13.4 (927)

2.01 (1.75 - 2.32)

Smoking habit

Yes

4.9 (206)

1.00

8.3 (244)

1.00

No

5.2 (307)

1.07 (0.89 - 1.28)

12.2 (960)

1.52 (1.31 - 1.77)

Number of hours of sleep per
day

≥7

4.3 (349)

1.00

8.5 (698)

1.00

<7

7.5 (157)

1.78 (1.46 - 2.16)

19.7 (493)

2.64 (2.33 - 2.99)

Physical activity

Intense

2.2 (44)

1.00

5.9 (62)

1.00

Moderate

4.8 (196)

3.11 (2.25 - 4.29)

9.3 (391)

2.46 ( 1.88 - 3.22)

Inactive

6.6 (273)

2.23 (1.60 - 3.10)

13.5 (741)

1.62 (1.23 - 2.14)

Body Mass Index

< 25

4.0 (165)

1.00

6.9 (377)

1.00

25-29

5.3 (224)

1.36 (1.10 - 1.67)

14.2 (369)

2.24 (1.92 - 2.60)

30 or over

6.0 (68)

1.55 (1.16 - 2.08)

18.8 (227)

3.14 (2.62 - 3.75)

Presence of chronic disease

No

3.1 (264)

1.00

7.3 (629)

1.00

Yes

15.0 (245)

5.50 (4.58 - 6.61)

25.8 (568)

4.39 (3.88-4.98)

Anxiety, depressive or sleep
disorder

No

3.6 (335)

1.00

8.2 (756)

1.00

Yes

74.4 (58)

77.08
(45.83- 129.64)

73.9 (139)

31.84 (22.80 - 44.46)

Medical consultation

No

3.2 (261)

1.00

7.6 (596)

1.00

Yes

13.0 (252)

4.56 (3.80 - 5.46)

20.4 (610)

3.12 (2.76 - 3.52)

Self-assessment of health
status

Very good/Good

2.0 (158)

1.00

4.0 (280)

1.00

Fair/Poor/Very poor

14.4 (352)

8.04 (6.62 - 9.76)

24.4 (921)

7.75 (6.73 - 8.93)

TOTAL

5.0 (513)

11.1 (1206)

* The percentages calculated
excluding missing/blanks for each independent variable analyzed

Table
2

Association between overall consumption
of psychoactive drugs in men and women and socio-demographic, lifestyle and
health profile variables.

MEN

WOMEN

Adjusted OR

95% CI

Adjusted OR

95% CI

AGE

16-24

1.00

1.00

25-44

2.69

1.44 - 5.04

1.89

1.18 - 3.03

45-64

4.80

2.51 - 9.17

4.00

2.45 - 6.52

65-74

3.34

1.65 - 6.78

3.47

2.06 - 5.84

75 and over

4.35

2.10 - 9.02

3.99

2.26 - 7.05

MARITAL STATUS

NS

Married

1.00

Single

1.23

0.90 - 1.67

Separated/Divorced

1.52

1.01 - 2.30

Widowed

1.47

1.13 - 1.92

OCCUPATIONAL STATUS

Employed

1.00

NS

Unemployed

2.00

1.21 - 3.28

Inactive

2.66

1.87 - 3.77

ALCOHOL CONSUMPTION

Yes

1.00

1.00

No

1.70

1.32 - 2.18

1.37

1.12 - 1.69

SMOKING HABIT

Yes

1.00

1.00

No

1.42

1.08 - 1.86

1.37

1.08 - 1.74

NUMBER OF HOURS OF SLEEP PER
DAY

NS

≥ 7

1.00

< 7

1.30

1.07 - 1.58

BODY MASS INDEX

NS

< 25

1.00

25-29

1.36

1.10 - 1.68

30 or over

1.17

0.90 - 1.53

PRESENCE OF CHRONIC DISEASE

No

1.00

1.00

Yes

1.60

1.31 - 1.97

1.60

1.31 - 1.97

ANXIETY, DEPRESSIVE OR SLEEP
DISORDER

No

1.00

1.00

Yes

15.85

8.51 - 29.51

10.39

6.67 - 16.18

SELF-ASSESSMENT OF HEALTH
STATUS

Very good/Good

1.00

1.00

Fair/Poor/Very poor

2.75

2.06 - 3.66

3.94

3.19 - 4.86

MEDICAL CONSULTATION

No

1.00

1.00

Yes

2.27

1.75 - 2.93

1.80

1.49 - 2.17

Odds
ratio adjusted by all the variables included in the table

NS:
Not statistically significant association

Upon analyzing the results for men, we observed
that there was statistically significant association across all age categories
(with this association being stronger for the 45-64 (adjusted OR: 4.80) than
for the 16-24 age group) and that occupational situations, such as unemployment
and inactivity (adjusted OR: 2.00 and adjusted OR: 2.66, respectively), were
associated with a level of psychoactive drug consumption that was double that
of economically active subjects.

In relation to lifestyle, it should be
stressed that non-consumption of alcohol and tobacco acted as a risk factor for
psychotropic drug consumption, with a statistically significant association in
evidence (adjusted OR: 1.70). Similarly, male non-smokers registered a
statistically significant association with intake of such medications (adjusted
OR: 1.42).

In the case of health profiles, presence of
chronic disease, medical consultation and a negative perception of health were
all significantly associated with higher consumption of psychoactive drugs. Men
who reported anxiety, depression, or difficulty in initiating and maintaining
sleep, registered an intake that was 15.85-fold higher than that of men who did
not suffer these symptoms.

When adjustment was made for the different
study variables in the female population, we likewise observed a statistically
significant association with the consumption of psychoactive drugs across all
age categories, with a stronger association (adjusted OR: 4.00) again being
registered for the 45-64 versus the 16-24 age group. Unlike men, however, marital
status proved to be significantly associated with consumption among widowed,
separated and divorced versus married women.

Alcohol consumption and smoking habit
registered an identical pattern of association to that observed for men. Women
who reported not consuming alcohol had a 1.37-fold higher likelihood of being
consumers of these medications than did drinkers and female non-smokers showed
a significant association with the consumption of psychoactive drugs. Special
mention should be made of the statistically significant association that
appeared in women between the dependent variable and overweight status (a BMI
of 25-29), as compared to the under-25 BMI category.

As in the case of men, health-profile
analysis showed that the presence of chronic disease, medical consultation and
negative perception of health were all significantly associated with higher
consumption of psychoactive drugs. Similarly, the variable that registered the
highest values of association among women was (once again) the presence of
anxiety, depression or difficulty in initiating and maintaining sleep (adjusted
OR: 10.39).

DISCUSSION

Reliance on national health surveys from
different countries has become a valid and widely used tool for ascertaining
patterns of medical drug use in the general population [1] [29]. In Spain, the series of National Health Surveys
issued have been used to study a number of health-related aspects, including
use of medications by Spanish people [30] [31] [32].

Reduction in the consumption of psychoactive
drugs is something that already appeared as goal number 17 in the WHO ‘Health for All
in 2000’ Program directed to the public and health authorities of all states
members [33].

In 2001, psychotropic drug consumption
prevalence in Spain was 8.2%, a figure appreciably lower than that reported by
the recently published European Study of the Epidemiology of Mental Disorders
(ESEMeD). According to ESEMeD, 12.3% of the European population had consumed
some type of psychoactive drug in the preceding twelve months [7]: though the ESEMeD has a different methodology, we
consider it valid as a reference. In contrast, the study undertaken by Nielsen
et al. in Denmark reported values of 5.6% [19], while the general population studies conducted in
the United Kingdom by Ohayon et al. reported lower figures [6] [22]. Similarly, the latest data furnished by the American
National Health and Nutrition Examination Survey indicate that 5.5% of the
adult US population had received some psychoactive drug prescribed in the
preceding month [1].

However, when we focused our analysis
exclusively on the results recorded by earlier national-survey-based Spanish
population studies that had addressed psychotropic drug consumption, we
observed that intake has gradually decreased since 1993 [21] [34].

Gender appears to be a common denominator in
the results of studies on psychoactive drug consumption. Our study determined
the prevalence of consumption to be higher in women than in men, a finding in
line with other reports [1] [3] [6] [7] [14].

The fact that women experience greater
exposure to psychotropic drug consumption than do men has been well documented [35] [36], with some studies even analyzing the extent to which
these types of substances may be abused by the female population [15] [30]. This higher intake may possibly be due to a greater
readiness among women to acknowledge and express their symptoms, and thus seek
medical care more often [4] [8] [41].

Consumption of psychoactive drugs was found
to rise with age in both sexes, with higher prevalence figures for women,
corroborating the trend already reported by other researchers [1] [4] [5] [38]. In our study, this increase in psychotropic
consumption with age is maintained when different socio-demographic and
health-profile factors are taken into consideration, as indeed was the case
with the United Kingdom data reported by Ohayon et al. [22].

We observed that consumption frequencies
tended to rise from age 45 years onwards [3], with high figures being reached at the age of 75
years or older, a finding in line with data on psychoactive drug consumption
among the elderly reported by Preville et al. in a study based on Québec Health
Survey data [39].

This circumstance is particularly relevant
in view of the high consumption of medications in the elderly population [40], among whom hypnotics and anxiolytics are regularly
used at very high intake prevalence [1] [6] [41], often for long periods of time, and not always as
prescribed [9]. This can lead to chronic and improper use of
psychotropic drugs, a serious public health problem in this Spain [7]. Evidence indicates a similar situation exists in
Canada, where 35% of the elderly population was observed to be taking such
medication for approximately 206 days per year [42].

It should be pointed out that some widely
used medical drugs, such as benzodiazepines [43] [44], pose the risk of dependence that is necessarily
entailed in uninterrupted consumption, as well as additional risk factors,
including an influence on cognitive deterioration in elderly patients [45].

Other factors such as marital status or
occupational situation were previously reported to affect the use of
psychotropic drugs. However, these factors did not appear to play a relevant
role in the Spanish population.

The interactions between consumption of
psychoactive drugs and substances such as alcohol are well known. Unlike other
studies that report a positive association between alcohol consumption and
psychotropic drug use [41], our results show that consumers of these medications
are not drinkers, a finding that is in line with the ESEMeD project [7], and could either be construed as a proper
appreciation of the risk involved in the joint use of these substances or a
reduced need for psychoactive drugs among consumers of alcohol.

There also appears to be a connection
amongst smokers with the appearance of episodes of anxiety and depression [46] [47]. Consumption of psychoactive drugs is reported to be
more frequent among smokers, with tobacco acting as a risk factor [22]. In our study, however, no such association was found
[5] [41]; non-smokers registered a higher consumption of
psychoactive drugs.

Depressive episodes, possibly related to
chronic health problems or aging, may be associated with consumption of
psychotropic drugs [4] [5] [44]. Depression is unquestionably a major public health
issue, and has been highlighted recently by the European Outcome of Depression
International Network (ODIN) Study [48] and the Global Burden of Depressive Disorders in the
Year 2000 sponsored by the World Health Organization (WHO) [49].

In agreement with other studies, our results
indicate a clear association between consumption of psychotropic drugs and suffering
from mental-health-related episodes such as anxiety, depression, or difficulty
in initiating and maintaining sleep [4] [5] [6] [8] [24] [32].

Indeed, it is these variables that were
observed to display the highest magnitude of association for psychoactive drug
consumption; obviously these are situations where the consumption of
psychotropic drugs is indicated by a physician. Data from the Epidemiologic
Catchment Area (ECA) study have already indicated that approximately 31% of
adults with depression did not receive treatment [50]. Despite under-diagnosis of depression in Spain [25], we determined that consumption of these medications
was associated with medical visits, a fact that has been described in a number
of studies [4] [6] [21] [34].

Thought should therefore be given to the
proper prescription of psychotropic medications in our population, by stressing
the need for appropriate continuous education, which would then be reflected in
standard medical practice [51], as well as fluid physician-patient communication.
Based on our results, it is clear that consumers of psychoactive drugs perceive
their health negatively [4] [5] [44]. This poor perception is potentially influenced by
the negative connotations conveyed in the word ‘depression’ [52].

With respect to study limitations, a possible
drawback to health surveys stems from their reliance on self-report data. This
may lead to the prevalence of psychotropic drug consumption being
underestimated. Another possible limitation of the Spanish National Health
Surveys lies in the fact that, rather than identifying specific active
pharmaceutical ingredients, they instead identify groups of medicines for
specific diseases or disorders. Finally, we did not analyze the missing values
for each independent variable; a non-response to a specific question might be
related to the consumption of psychotropic drugs.

CONCLUSION

The consumption of psychotropic medications
in Spain is still very considerable, with women registering the highest
consumption prevalence and the greatest number of associated risk factors. It
is especially relevant to emphasize the fact that psychoactive drug consumption
by both men and women tends to increase with age and a negative perception of
health.

AUTHORS’ PARTICIPATION

P C-G and R J-G conceived of the study, drafted
the manuscript, and supervised all aspect of its implementation; V H-B analyzed
the information; A Lde A, P O-M and A GdeM contributed drafting the manuscript.
All authors helped to conceptualize ideas, interpret findings, and reviewed the
manuscript.

ACKNOWLEDGEMENTS

This study forms part of a research project
funded by F.I.S. (Fondo de Investigaciones Sanitarias-Health Research Fund)
from the Carlos III Institute of Public Health.

CONFLICT OF INTERESTS/DISCLAIMERS

P C-G is member of the Editorial Board of
the journal. There is no other conflict of interests to declare.

REFERENCES

[1]
Paulose-Ram R, Jonas BS, Orwig
D, Safran MA. Prescription psychotropic medication use among the U.S. adult
population: results from the third National Health and Nutrition Examination
Survey, 1988-1994. J Clin Epidemiol 2004; 57: 309-317.

[2]
Verger P, Aulagnier M,
Protopopescu C, Villani P, Gourrheux JC, Bouvenot G, Paraponaris A. Hypnotic
and tranquillizer use among general practitioners in south-eastern France and
its relation to occupational characteristics and prescribing habits. Fundam
Clin Pharmacol 2004; 18: 379-385.

[3]
Villena Ferrer A, Tellez
Lapeira JM, Morena Rayo S, Donato Gallart E, Almar Marques E. Consumption of
psychodrugs. Influence of family dysfunction. Actas Esp Psiquiatr 2004; 32:
143-148.

[4]
Voyer P, Cohen D, Lauzon S,
Collin J. Factors associated with psychotropic drug use among
community-dwelling older persons: A review of empirical studies. BMC Nurs 2004;
13: 3.

[5]
Empereur F, Baumann M, Alla F,
Briancon S. Factors associated with the consumption of psychotropic drugs in a
cohort of men and women aged 50 and over. J Clin Pharm Ther 2003; 28: 61-68.

[6]
Ohayon MM, Lader MH. Use of
psychotropic medication in the general population of France, Germany, Italy,
and the United Kingdom. J Clin Psychiatry 2002; 63: 817-825.

[7]
Alonso J, Angermeyer MC,
Bernert S, Bruffaerts R, Brugha TS, Bryson H, et al. Psychotropic drug
utilization in Europe: results from the European Study of the Epidemiology of
Mental Disorders (ESEMeD) project. Acta Psychiatr Scand 2004: 109 (Suppl. 420): 55–64.

[8]
Kisely S, Linden M,
Bellantuono C, Simon G, Jones J. Why are patients prescribed psychotropic drugs
by general practitioners? Results of an international study. Psychol Med 2000;
30: 1217-1225.

[9]
Mort JR, Aparasu RR.
Prescribing potentially inappropriate psychotropic medications to the
ambulatory elderly. Arch Intern Med 2000; 9: 2825-2831.

[10]
Mort JR, Aparasu RR.
Prescribing of psychotropics in the elderly: why is it so often inappropriate?
CNS Drugs 2002; 16: 99-109.

[11]
Van Dijk KN, de Vries CS, ter
Huurne K, van den Berg PB, Brouwers JR, de Jong-van den Berg LT. Concomitant
prescribing of benzodiazepines during antidepressant therapy in the elderly. J
Clin Epidemiol 2002; 55: 1049-1053.

[12]
Sanz
Yagüez F, López Corbalán JC. Abuse
of psychoactive drugs among health professionals [in Spanish]. Rev Esp
Anestesiol Reanim 1999; 46: 354-358.

[13]
Cabrita J, Ferreira H,
Iglesias P, Baptista T, Rocha E, Lopes da Silva A, Pereira Miguel J. Patterns
and determinants of psychoactive drug use in Lisbon University students — a
population-based study. Pharm World Sci 2004; 26: 79-82.

[14]  Sans S, Paluzie G, Puig T, Balaña L, Balaguer-Vintró I
I. Prevalence of drug utilization in the adult population of Catalonia, Spain
[in Spanish]. Gac Sanit 2002; 16: 121-130.

[15]
Simoni-Wastila L. The use of
abusable prescription drugs: the role of gender. J Womens Health Gend Based Med
2000; 9: 289-297.

[16]
WHO Collaborating Centre for
Drug Statistics Methodology. Anatomical Therapeutic Chemical (ATC) classification
and DDD assignment. Oslo: WHO Collaborating Centre for Drug Statistics
Methodology, 2002.

[17]  Ministerio de Sanidad y Consumo. Grupos Terapéuticos y
Principios activos de mayor consumo en el Sistema Nacional de Salud durante
2001. Información Terapéutica del Sistema Nacional de Salud 2002; 26: 78-83.

[18]  Ministerio de Sanidad y Consumo. Grupos Terapéuticos y
Principios activos de mayor consumo en el Sistema Nacional de Salud durante
2002. Información Terapéutica del Sistema Nacional de Salud 2004; 28: 50-53.

[19]
Nielsen
MW, Hansen EH, Rasmussen NK. Patterns
of psychotropic medicine use and related diseases across educational groups:
national cross-sectional survey. Eur J Clin Pharmacol 2004; 60: 199-204.

[20]
Hansen DG, Sondergaard J, Vach
W, Gram LF, Rosholm JU, Mortensen PB, Kragstrup J. Socio-economic inequalities
in first-time use of antidepressants: a population-based study. Eur J Clin
Pharmacol 2004; 60: 51-55.

[21]
Carrasco P, Astasio P, Ortega
P, Jimenez R, Gil A. Factors related to psychotropic drugs consumption among
the Spanish adult population. Data from the Spanish National Health Surveys for
1993, 1995 and 1997 [in Spanish]. Med Clin (Barc) 2001; 116: 324-329.

[22]
Ohayon MM, Caulet M, Priest RG,
Guilleminault C. Psychotropic medication consumption patterns in the UK general
population. J Clin Epidemiol 1998; 51: 273-283.

[23]
Ustun TB, Ayuso-Mateos JL,
Chatterji S, Mathers C, Murray CJ. Global burden of depressive disorders in the
year 2000. Br J Psychiatry 2004; 184: 386-392.

[24]
Ohayon MM, Lemoine P. Daytime
consequences of insomnia complaints in the French general population [in
French]. Encephale 2004; 30: 222-227.

[25]
Gabarron
Hortal E, Vidal Royo JM, Haro Abad JM, Boix Soriano I, Jover Blanca A, Arenas
Prat M. Prevalencia de los trastornos depresivos en atención primaria [in
Spanish]. Aten
Primaria 2002 15; 29: 329-335.

[26]
Hemels ME, Koren G, Einarson
TR. Increased use of antidepressants in Canada: 1981-2000. Ann Pharmacother
2002; 36: 1375-1379.

[27]  Ministerio de Sanidad y Consumo. Subdirección General
de Epidemiología, Promoción y Educación para la Salud. Encuesta Nacional de
Salud de España 2001 [Spanish Nacional Health Survey 2001]. Madrid
(Spain), 2003 [http:// www.msc.es/estadEstudios/estadisticas/encuestaNacional/encuestaNac2001/home.htm].

[28]
Laporte
JR, Castel JM. El médico ante la automedicación. Med Clin (Barc) 1992;
99: 414-416.

[29]
Simoni-Wastila L, Ritter G,
Strickler G. Gender and others factors associated with the nonmedical use
abusable prescription drugs. Subst Use Misuse 2004; 39: 1-23.

[30]
Del
Rio MC, Prada C, Alvarez FJ. The
use of medication by the Spanish population. Pharmacoepidemiol Drug Saf 1997;
6: 41-48.

[31]  Guzmán Quilo C, Del Castillo Sainz A, Carrasco Garrido
P, Gil de Miguel A. Estudio epidemiológico del consumo de medicamentos
antihipertensivos a partir de los datos obtenidos en las Encuestas Nacionales
de Salud de España de los años 1993, 1995 y 1997. Hipertensión 2002; 19:
206-214.

[32]
Figueiras
A, Caamaño F, Gestal-Otero JJ. Sociodemographics
factors related to self-medication in Spain. Eur J Epidemiol 2002; 16: 19-26.

[33]  Regidor E, Rodríguez C, Gutiérrez-Fisac JL.
Indicadores de Salud. Tercera evaluación en España del programa regional
europeo de Salud para todos. Ministerio de Sanidad y Consumo. Madrid 1995;47-48
[http://www.msc.es/biblioPublic/ publicaciones/listadoPublicaciones.jsp]

[34]
Carrasco
P, Regidor E, Astasio P, Gil A. Estudio epidemiológico del consumo de
psicotropos a partir de los datos obtenidos de la Encuesta Nacional de Salud de
España del año 1993. Medicina
Preventiva 1998; 4: 6-14.

[35]
Simoni-Wastila L. Gender and
psychotropic drug use. Med Care 1998; 36: 88-94.

[36]  Maggini M, Spila S. The prescription of
psycho-pharmaceutical in general medicines: Gender differences [in Italian].
Epidemiologia & Prevenzione 1996; 20: 261-262.

[37]
Ruiz-Cantero
MT, Verdú-Delgado M. Gender bias in treatment. Gac
San 2004; 18 (Suppl. 1): 118-125.

[38]
Paterniti S, Bisserbe JC,
Alperoviich A. Psychotropics drug, anxiety and depression in the elderly
population. The EVA Study [in French]. Rev Epidemiol Sante Publique 1998; 46:
253-262.

[39]
Preville M, Hebert R, Boyer R,
Bravo G. Correlates of psychotropics drug use in the elderly compared adults
aged 18-64: result from the Québec Health Survey. Aging Ment Health 2001; 5:
216-224.

[40]
Pedrera JD, Macías ML, Lavado
JM, Postigo S, Durán N. Study of the Health of the elderly in Extremadura:
medication and most frequent chronic diseases [in Spanish]. Rev Esp Salud
Pública 1999; 73: 677-686.

[41]
Lechevallier N, Fourrier A,
Berr C. Benzodiazepine use in the elderly. The EVA Study [in French]. Rev
Epidemiol Sante Publique 2003; 51: 317-323.

[42]
Preville M, Ducharme C, Fortin
D, Hebert R, Gregoire JP, Berard A, et al. Anxiolytic, sedative and hypnotic
medication use in the elderly living in the community: developing a conceptual
framework [in French]. Sante Ment Que 2003; 28: 165-182.

[43]
Jeantaud I, Haramburu F,
Bégaud B. Benzodiazepine use: survey of community pharmacies in south-western
France. Thérapie 2001; 56: 415-419.

[44]
Fourrier A, Letenneur L,
Dartigues JF, Moore N, Begaud B. Benzodiazepine use in an elderly
community-dwelling population. Characteristic of users and factors associated
with subsequent use. Eur J Clin Pharmacol 2001; 57: 419-425.

[45]
Paterniti S, Dufouil C,
Alperovitch A. Long-term benzodiazepine use and cognitive decline in the
Epidemiology of Vascular Aging Study. J Clin Psychopharmacol 2002; 22: 285-293.

[46]
Fakhfakh
R, Aouina H, Gharbi L, Hsairi H, Achour N, Lagrue G, et al. Smoking dependence and
symptoms of anxiety and depression among Tunisian smokers [in French]. Rev Mal
Respir 2003; 20: 850-857.

[47]
Breslau N, Johnson EO.
Predicting smoking cessation and major depression in nicotine-dependent
smokers. Am J Public Health 2000; 90: 1122-1127.

[48]
Ayuso-Mateos
JL, Vázquez-Barquero JL, Dowrick C, Lehtinen V, Dalgard OS, Casey P, et al. Depressive disorders in
Europe: prevalence figures from the ODIN study. Br J Psychiatry 2001; 179:
308-316.

[49]
Üstün TB, Ayuso-Mateos JL,
Chatterji S, Mathers C, Murria CJL. Global burden of depressive disorder in the
year 2000. Br J Psychiatry 2004; 184: 386-392.

[50]
Weissman MM, Bruce ML, Leaf
PJ, Florio LP, Holzer C III. Affective disorders. In: Robins LN, Regier DA,
eds. Psychiatric disorders in America: the epidemiologic catchment area study.
New York: Free Press. 1991: 53-80.

[51]
Legrain M, Lecomte T.
Psychotropic drugs consumption in France and some European countries [in
French]. Ann Pharm Fr 1998; 56: 65-75.

[52]
Karla EK. Can a change in the
name of depression result in its reduced negativity? Med Hypotheses 2003; 60:
897-899.

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