Sociological influences on antidepressant prescribing

doi:10.1016/S0277-9536(02)00132-6

Social Science & Medicine

Volume 56, Issue 6, March 2003, Pages 1335-1344

https://doi.org/10.1016/S0277-9536(02)00132-6 Get rights and content

Abstract

This study examined how patient characteristics, physician characteristics, the physician's interaction with the health care system, and the physician's interaction with the patient influenced whether patients with a depression diagnosis received an antidepressant prescription and whether they received a SSRI antidepressant, a non-SSRI antidepressant, or both.

The 1998 National Ambulatory Medical Care Survey (NAMCS), in the USA, was used for the analysis. Logistic regression was used to examine what characteristics influenced whether a patient with a depression diagnosis received an antidepressant prescription. Next, a multinomial logistic regression model was applied to examine the relative risk of using one type of antidepressant versus another among antidepressant users while correcting for possible sample selections using the Heckman selection model. Sixty-seven percent of patients with a depression diagnosis received an antidepressant. Patients who were seeing providers who were not primary care physicians or psychiatrists, self-paying patients, and patients with neurotic depression were significantly less likely to receive an antidepressant prescription. Patients with depression listed as their first diagnosis were significantly more likely to receive an antidepressant prescription. Patients seeing a psychiatrist were more likely than patients seeing a primary care physician to receive a non-SSRI antidepressant than a SSRI antidepressant. Patients belonging to an HMO that had capitated visits were over four times more likely to receive non-SSRI antidepressants than SSRI antidepressants. Patients with major depression were significantly more likely to receive a non-SSRI antidepressant. Patients with depression as their primary diagnosis and patients who saw psychiatrists were significantly more likely to receive both SSRI and non-SSRI antidepressants rather than just SSRI antidepressants. Patient characteristics, physician characteristics, the physician's interaction with the health care system, and the physician's interaction with the patient all influenced antidepressant prescribing. An especially important finding was that insurance status influenced whether patients received an antidepressant. Health care providers need to take the time to help patients without insurance obtain antidepressant medication if it is needed.

Section snippets

Background

The use of antidepressants in the United States is an increasingly important issue. Antidepressant use increased by 73.4 percent between 1990 and 1995 according to national estimates, with the majority of the increase seen in the use of selective serotonin reuptake inhibitors (SSRIs) (Pincus et al., 1998). This trend is also being seen in other industrialized countries such as the United Kingdom (Martin, Hilton, Kerry, & Richards, 1997). The SSRIs have been found to be as efficacious for

Data and strategy

The 1998 National Ambulatory Medical Care Survey (NAMCS) was used to examine the treatment patterns of depressed patients in ambulatory settings. The NAMCS is a national probability sample administered by the Division of Health Care Statistics, National Center for Health Statistics (NCHS), Center for Disease Control and Prevention (CDC). It is a survey of office-based physician practices evaluating patient office visits. Visits with federally employed physicians, visits occurring outside of an

Results

Table 1 presents the descriptive statistics of the adults being seen for depression. Sixty-seven percent of the visits were female patients and close to 86 percent were non-Hispanic white. Approximately 50 percent of the depression-related ambulatory outpatient visits had private insurance as the primary payer and 29 percent of visits belonged to a health maintenance organization. Sixty-seven percent of patients received antidepressant medications during their visits. Close to 39 percent

Discussion

Our analyses indicated that Eisenberg (1979) was correct in that physician prescribing of antidepressants was influenced by four main factors: patient characteristics, physician characteristics, the physician's interaction with the health care system, and the physician's relationship with the patient. In terms of patient characteristics, a predictor of whether patients received an antidepressant prescription was whether patients were self-paying versus whether they had private insurance.

Acknowledgements

This research was supported in part by a grant from the National Institute of Mental Health (R29 MH 56210).

References (34)

R.R Aparasu et al.
Psychotropic prescribing for the elderly in office-based practice
Clinical Therapeutic
(1998)
J.A Clark et al.
Bringing social structure back into clinical decision making
Social Science & Medicine
(1991)
P Denig et al.
How physicians choose drugs
Social Science & Medicine
(1988)
J Lilja
How physicians choose their drugs
Social Science & Medicine
(1976)
S.J Bartels et al.
Treatment of depression in older primary care patients in health maintenance organizations
International Journal of Psychiatric Medicine
(1997)
Blustein, J. (2000). Drug coverage and drug purchases by Medicare beneficiaries with hypertension. Health Affairs,...
C.P Bradley
Decision-making and prescribing patterns—a literature review
Family Practice
(1991)
R Butler et al.
How do general practitioners select antidepressants for depressed elderly people?
International Journal of Geriatric Psychiatry
(2000)
J Eisenberg
Sociologic influences on decision-making by clinicians
Annals of Internal Medicine
(1979)
L Frank et al.
The economics of selective serotonin reuptake inhibitors in depressionA critical review
CNS Drugs
(2001)

J Gabe

Towards a sociology of tranquilizer prescribing

British Journal of Addiction

(1990)

M Ganguli et al.

Antidepressant use over time in a rural older adult populationThe MOVIES project

Journal of the American Geriatric Society

(1997)

S Green-Hennessy et al.

Demographic differences in medication use among individuals with self-reported major depression

Psychiatric Services

(1999)

Greene, W. H. (1997). Limited dependent variable and duration models. In: Economteric Analysis (3rd Ed.). Upper Saddle...

J Heckman

The common structure of statistical models of truncation, sample selection and limited dependent variables and a simple estimator for such models

Annals of Economic and Social Measurement

(1976)

A Hohmann

Gender bias in psychotropic drug prescribing in primary care

Medical Care

(1989)

E.S Lee et al.

Analysis of complex sample survey dataProblems and strategies

Sociological Methods and Research

(1986)

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Sociological influences on antidepressant prescribing

Abstract

Section snippets

Background

Data and strategy

Results

Discussion

Acknowledgements

Clinical Therapeutic

Social Science & Medicine

Social Science & Medicine

Social Science & Medicine

Treatment of depression in older primary care patients in health maintenance organizations

International Journal of Psychiatric Medicine

Decision-making and prescribing patterns—a literature review

Family Practice

How do general practitioners select antidepressants for depressed elderly people?

International Journal of Geriatric Psychiatry

Sociologic influences on decision-making by clinicians

Annals of Internal Medicine

The economics of selective serotonin reuptake inhibitors in depressionA critical review

CNS Drugs

Towards a sociology of tranquilizer prescribing

British Journal of Addiction

Antidepressant use over time in a rural older adult populationThe MOVIES project

Journal of the American Geriatric Society

Demographic differences in medication use among individuals with self-reported major depression

Psychiatric Services

The common structure of statistical models of truncation, sample selection and limited dependent variables and a simple estimator for such models

Annals of Economic and Social Measurement

Gender bias in psychotropic drug prescribing in primary care

Medical Care

Analysis of complex sample survey dataProblems and strategies

Sociological Methods and Research