We studied all 168 in-patients admitted to the Department of Medicine on December 13th 2011 for AD and BZD prescriptions on admission in patients over the age of 18. The protocol was approved by the HSE Mid-Western Area Research Ethics Committee. 48.2% were male and 51.8% were female. 61.4% were public and 38.6% were private insurance holders, age ranged from 18-97 with a mean age of 67.5 years [SD18]. The prevalence of AD use was 25.9%. and BZD use was 16.3%. 11.3% of males and 39.4% of females were taking ADs (p<0.001). 23.5% of public patients and 29.7% of private patients were on ADs (p=0.378). Patients who did not take ADs were on an average of 5.5 medications [CI 4.8-6.3], and those who did take ADs were on average of 9.5 medications [CI 8.25-10.75] (p<0.001). 17.5% of males and 15.1% of females were taking BZDs (p=0.678). 15.7% of public patients and 17.2% of private patients were taking BZDs (p=0.799). Patients who did not take BZDs were on 5.9 medications [CI 5.2-6.6] and those that did take BZDs were on 9.9 medications [CI 8.3-11.5] (p<0.001). This is the first study of AD (26%) and BZD (16%) prescriptions in an acute hospital with a prevalence six times higher than the community (Irish National Drug Prevalence Study (INDPS) of 2011) The 3 fold higher prevalence of AD use in females reflects international trends3. The prevalence of depression is high in acute general hospitals and in patients with chronic disease3. Rentsch found a prevalence of 26.9% of depression in general hospitalized patients2. This correlates with our results of AD use. The high prevalence are unlikely to be explained by a high background population drug use as the national study showed a lower prevalence of AD and BZD use in the Mid –West.1
Patients on ADs or BZDs were on nearly twice as many medications as those not on them which may indicate a higher burden of organic illness in those treated with depression. This may reflect a greater burden of chronic diseases. We were surprised that prescriptions for ADs and BZDs were similar between public and private patients. One explanation might be that chronic illness overrides the effects of social class in susceptibility to depression. This study should stimulate further research on the role of depression in hospitalised medical patients.
R Keenan, J O'Hare
University Hospital Limerick, Dooradoyle, Limerick
Email: [email protected]
Acknowledgements
A Hannigan, Consultant Biostatistician at University of Limerick for statistical support.
References
1. Drug Use in Ireland and Northern Ireland Drug prevalence Study 2011/11: www.drugs.ie/resoursesfiles/research/.../drug_use_Ireland 2012.pdf
2. Rentsch D, Dumont P, Borgacci S, Carballeira Y, detonnac N, Archinard M, Andreoli. A Prevalence and treatment of depression in a hospital department of internal medicine. Gen Hosp Psychiatry. 2007;29:25-31.
3. Van der Heyden J, Gisle L, Hesse E, Demarest S, Drieskens S, Tafforeau J. Gender differences in the use of anxiolytics and antidepressants: a population based study. Pharmacoepidemiol and Drug Saf. 2009;18:1101-10.