1. Antidepressant Use Among Working Age Canadians:
Exploring Interactions Between Gender, Work and Family Roles, and Socioeconomic Position
Ivan W. Kelly, PhD1; William H. Laverty, PhD2; & Bonnie L. Janzen, PhD3
1Department of Educational Psychology & Special Education, 2Department of Mathematics and Statistics, 3Department of Community Health & Epidemiology
University of Saskatchewan
Table II: Multiway Frequency Table Illustrating Five-factor Interaction Effects of Age, Income Adequacy, Gender, Job Status and Education on Antidepressant Use
BACKGROUND
The vast majority of studies examining the social and economic patterning of prescribed psychotropic drug use in general populations utilize only main effects.
On average, these studies have shown use of antidepressants to be greater among women, those who are widowed/divorced/separated, and those of lower socioeconomic positions (SEP).
Few studies have examined how various indicators of SEP (ie., education and income) may interact with family and work roles to influence use of antidepressants.
RESEARCH OBJECTIVE
To examine, using logit models, whether gender, SEP, and work and family role occupancies interact in their association with antidepressant use in a representative sample of working age Canadians.
METHODS
Percent Using Antidepressants in Previous Year
Data source: Statistics Canada’s 2002 Canadian Community Health Survey (Cycle 1.2, Mental Health and Well-being).
Participants: year old men and women (n= 20,974).
Dependent variable: Self-reported use of antidepressants in the previous year.
Independent variables: gender, age, income adequacy, educational attainment, employment , parental status, and partner status.
Analysis: A logit (logistic regression) model was fitted the data to determine statistically significant main effects and interactions (combinations of levels of the independent variables which result in high (and low) anti-depressive use that are masked among the main effects of the variables on anti-depressant use). All analyses were conducted using the sampling weights provided by Statistics Canada.
A post-hoc analysis was utilized to determine the effect of additional factors (e.g. Major Depressive Episode history) on antidepressant use.
In Table III (below) we are examining the effect the MDE history on use of antidepressants. The table provides antidepressant use (%) breakup amongst Major Depressive Episode categories in each of the use categories.
Table III shows an increased usage (61.0%, 61.8%) of antidepressants following MDE’s in the last 12 months in the high use categories ( %, 20+%) compared to usage (33.3%, 36.7%) in the low use categories (<5.0%, %)
To determine the effect of additional factors (e.g. Major depressive Episode history) on antidepressant use
Table III: Antidepressant Use vs Major Depressive Episode Categories for Various Antidepressant Use Categories
RESULTS
The fitting of a logit model predicted anti-depressant use from the demographic independent variables. The generating class included two five-factor interactions among gender by income adequacy by job status by age and education, and the second five factor interaction was the same except job status was replaced with marital status.
The log linear analysis and the multi-way frequency tables have identified cells (combination of levels of the independent variables - income adequacy, job status, age, education, and gender) that are associated with various levels of anti-depressant drug use.
LIMITATIONS
Survey was cross-sectional; antidepressant use was self-reported (and over a one year period).
Even though the sample size was large (20,974), in a multi-way frequency table (or a log-linear analysis), some cells are not adequately represented if either more independent variables or more categories of the present independent variables were included in the analysis.
We don’t have information on frequency of anti-depressive use and MDE’s over the past year.
Table I: Multiway Frequency Table Illustrating Five-factor Interaction Effects of Age, Income Adequacy, Gender, Marital Status and Education on Antidepressant Use
CONCLUSIONS
This analysis showed very complex interaction effects of the demographic variables on antidepressant use as illustrated in Tables I and II. Of note in Table II, the 20+ percent estimated use of antidepressants for:
males, aged 20-39, low income adequacy, unemployed and less than high school education and
females, aged 40-59, low income, unemployed and post secondary graduate.
Many of the very high and very low antidepressant use frequency cells would have been missed by looking at simply main effects. Groups that are particularly vulnerable to high antidepressant use would not have been identified.
Table III shows antidepressant use amongst those who have never suffered an MDE or suffered an MDE in either their lifetime or in the last 12 months. In the demographic cells where increased antidepressant use occurs there is increased antidepressant use that is independent of MDE history.
REFERENCES
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. Soc Psychiatry Psychiatr Epidemiol, 40:
Beck, C.A., Williams, J.V.A., Wang, J.L., Kassam, A., El-Guebaly , N., Currie, S.R., Maxwell, C.J., & Patten, S.B., (2005) Psychotropic medication use in Canada. The Canadian Journal of Psychiatry, 50:
Nielsen, M.W., Hansen, E.B. & Rasmussen, N. K., (2004) Patterns of Psychotropic medicine use and related diseases across education groups: national cross-sectional survey, European Journal of Pharmacology, 60,
Patten, S.B., Wang, J.L., C.A., Williams, Lavorato, D. H. , Beck, J.V.A. & Bullock, A. Gm., (2010) Frequency of Antidepressant use in relation to recent and past major depressive episodes. The Canadian Journal of Psychiatry, 55:
Rao, J.N.K. and Thomas, D.R. (1988). The analysis of cross-classified categorical data from complex sample surveys. Sociological Methodology, 18:
Statistics Canada (2004) Canadian Community Health Survey: Mental Health and Well Being; Catalogue no XIE.
Percent Using Antidepressants in Previous Year