Uso de antidepressivos e benzodiazepínicos em mulheres atendidas em unidades de saúde da família e sua dimensão psicossocial

Abstract

Introduction: Concerns about irrational use of psychotropic drugs has been observed in many countries, becoming an important issue for global public health. In Brazil, the promotion of rational use of psychotropic drugs is a challenge for primary care, therefore it is important to characterize its psychosocial dimension. Objectives This dissertation consists of two articles. Article 1, with descriptive characteristics, aims to characterize the use of psychotropic drugs in family health units, according to major socioeconomic and demographic characteristics and according to the presence of common mental disorders (CMD). Article 2, with an analytical character, aims to evaluate the role of social networks in the use of each of these psychotropic drugs, according to the presence of CMD. Methods The study has a cross-sectional design and integrates baseline data from two previous studies on mental health in primary care . Data collection took place in 2006/2007 for the study 1 (Petropolis, n = 2.104) and in 2009/2010 for the study2 (São Paulo, n = 410, Rio de Janeiro, n = 703, Fortaleza - n = 149 and Porto Alegre, n = 163 participants). Although performed in different periods, both studies have the same format as regards data collection, processing and review, resulting in a sample of 3293 women attending family health units from five different cities. An objective questionnaire with closed questions was used to collect socioeconomic and demographic information. Psychotropic use was assessed through an open-ended question based on self-reporting of drug use. The presence of CMD was investigated by the General Health Questionnaire in its reduced version (GHQ-12). The level of social integration was evaluated through the social network index (IRS), calculated from questions about social network added to the general questionnaire. In the descriptive study (Article 1), the frequency of antidepressants and benzodiazepines use in the study population were calculated for each city, such as the frequency of the use of psychotropic drugs among patients with common mental disorders. The distribution of the use of each of these psychoactive drugs according to major socioeconomic and demographic characteristics and according to the presence of common mental disorders was assessed by Pearson´s chi-square test. In the analytical study (Article 2), the association between the level of social integration and the exclusive use of each of psychotropic drugs was analyzed by multivariate logistic regression, stratified according to the presence of TMC. Results: The frequency of psychotropic medication´ use was quite heterogeneous among cities, emphasizing, however, the importance of the use of benzodiazepines against the use of antidepressants in most of the cities. The proportion of use of psychotropic medication, particularly antidepressants, was predominantly low among patients with CMD. Among these, antidepressants use was positively associated with social isolation, while benzodiazepines use was negatively associated. Conclusion: This study collaborates to characterize the use of antidepressants and benzodiazepines in family health units and to discuss about their rationality. The results highlight the importance of assessing the psychosocial dimension that involves the use of these substances in order to develop strategies to promote its rational use in primary care.