Unit for Social Epidemiology, Lund University, Sweden.
Department of Gender Studies, Lund University, Sweden.
Scand J Public Health. 2022 May;50(3):395-403. doi: 10.1177/1403494821993723. Epub 2021 Feb 23.
Antidepressants are among the most commonly prescribed drugs in Sweden. However, we lack detailed knowledge on the socioeconomic and demographic distribution of antidepressant use in the population. To fill this gap, we performed an intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy.
Analysing all Swedish residents older than 10 years (=8,190,990), we measured the absolute risk of antidepressant use across 144 intersectional strata defined by combinations of age, gender, income, country of birth and psychiatric diagnosis. We calculated the strata-specific absolute risk of antidepressant use in a series of multilevel logistic regression models. By means of the variance partitioning coefficient and the area under the receiver operating characteristic curve, we quantified the discriminatory accuracy of the intersectional contexts (i.e. strata) for discerning those who use antidepressants from those who do not.
The absolute risk of antidepressant use ranged between 0.93% and 24.78% among those without a psychiatric diagnosis, and between 21.41% and 77.56% among those with a psychiatric diagnosis. Both the variance partitioning coefficient of 41.88% and the area under the receiver operating characteristic curve of 0.81 were considerable.
Besides overt psychiatric diagnoses, our study shows that antidepressant use is mainly conditioned by age, which might express the embodiment of socioeconomic conditions across the individual life course. Our analysis provides a detailed and highly discriminatory mapping of the heterogeneous distribution of antidepressant use in the Swedish population, which may be useful in public health management.
抗抑郁药是瑞典最常用的处方药物之一。然而，我们缺乏关于该人群中抗抑郁药使用的社会经济和人口分布的详细知识。为了填补这一空白，我们进行了交叉多水平分析，以研究个体异质性和区分准确性。
我们分析了所有年龄在 10 岁以上的瑞典居民（=8190990 人），测量了 144 个交叉层中抗抑郁药使用的绝对风险，这些层是由年龄、性别、收入、出生地和精神诊断的组合定义的。我们在一系列多水平逻辑回归模型中计算了各层特定的抗抑郁药使用绝对风险。通过方差分割系数和接收者操作特征曲线下的面积，我们量化了交叉背景（即层）区分使用抗抑郁药和不使用抗抑郁药的个体的区分准确性。
在没有精神诊断的个体中，抗抑郁药使用的绝对风险在 0.93%至 24.78%之间，而在有精神诊断的个体中，这一比例在 21.41%至 77.56%之间。方差分割系数为 41.88%，接收者操作特征曲线下的面积为 0.81，这两个指标都相当可观。
除了明显的精神诊断外，我们的研究还表明，抗抑郁药的使用主要取决于年龄，这可能反映了个体整个生命历程中社会经济条件的体现。我们的分析提供了瑞典人群中抗抑郁药使用的异质分布的详细和高度区分性的映射，这可能对公共卫生管理有用。
