Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom.
PLoS One. 2013 Nov 5;8(11):e77734. doi: 10.1371/journal.pone.0077734. eCollection 2013.
Recent changes to diagnostic criteria for depression in DSM-5 remove the bereavement exclusion, allowing earlier diagnosis following bereavement. Evaluation of the potential effect of this change requires an understanding of existing psychotropic medication prescribing by non-specialists after bereavement.
To describe initiation of psychotropic medication in the first year after partner bereavement.
In a UK primary care database, we identified 21,122 individuals aged 60 and over with partner bereavement and no psychotropic drug use in the previous year. Prescribing (anxiolytic/hypnotic, antidepressant, antipsychotic) after bereavement was compared to age, sex and practice matched controls.
The risks of receiving a new psychotropic prescription within two and twelve months of bereavement were 9.5% (95% CI 9.1 to 9.9%) and 17.9% (17.3 to 18.4%) respectively; an excess risk of initiation in the first year of 12.4% compared to non-bereaved controls. Anxiolytic/hypnotic and antidepressant initiation rates were highest in the first two months. In this period, the hazard ratio for initiation of anxiolytics/hypnotics was 16.7 (95% CI 14.7 to 18.9) and for antidepressants was 5.6 (4.7 to 6.7) compared to non-bereaved controls. 13.3% of those started on anxiolytics/hypnotics within two months continued to receive this drug class at one year. The marked variation in background family practice prescribing of anxiolytics/hypnotics was the strongest determinant of their initiation in the first two months after bereavement.
Almost one in five older people received a new psychotropic drug prescription in the year after bereavement. The early increase and trend in antidepressant use after bereavement suggests some clinicians did not adhere to the bereavement exclusion, with implications for its recent removal in DSM-5. Family practice variation in use of anxiolytics/hypnotics suggests uncertainty over their role in bereavement with the potential for inappropriate long term use.
DSM-5 中对抑郁症诊断标准的最近修改取消了丧亲除外，允许在丧亲后更早地进行诊断。评估这种变化的潜在影响需要了解非专家在丧亲后开精神药物的情况。
描述在伴侣丧亲后的第一年开始使用精神药物。
在英国初级保健数据库中，我们确定了 21122 名年龄在 60 岁及以上的个体，他们在过去一年中没有伴侣丧亲，也没有使用精神药物。将丧亲后开处方（抗焦虑/催眠药、抗抑郁药、抗精神病药）与年龄、性别和实践匹配的对照进行比较。
丧亲后两个月和十二个月内接受新精神药物处方的风险分别为 9.5%（95%CI 9.1 至 9.9%）和 17.9%（17.3 至 18.4%）；与非丧亲对照组相比，第一年的起始风险增加了 12.4%。在第一个月内，抗焦虑/催眠药和抗抑郁药的起始率最高。在这段时间内，开始使用抗焦虑/催眠药的风险比为 16.7（95%CI 14.7 至 18.9），开始使用抗抑郁药的风险比为 5.6（4.7 至 6.7），与非丧亲对照组相比。在两个月内开始使用抗焦虑/催眠药的患者中，有 13.3%在一年内继续使用该药物类别。背景家庭实践中抗焦虑/催眠药的开具差异最大，是丧亲后两个月内开始使用的最强决定因素。
近五分之一的老年人在丧亲后一年内接受了新的精神药物处方。丧亲后抗抑郁药使用的早期增加和趋势表明，一些临床医生没有遵守丧亲除外，这对 DSM-5 最近取消该除外有影响。家庭实践中抗焦虑/催眠药使用的差异表明，对其在丧亲中的作用存在不确定性，有可能导致长期不当使用。
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