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2004年至2013年间比利时焦虑症和抑郁症的医学化及药物化进程考察:这两种疾病是如何相互交织的?

An examination of the medicalization and pharmaceuticalization processes of anxiety and depressive disorders in Belgium between 2004 and 2013: how may both disorders be intertwined?

作者信息

Kilian Van Looy, de Velde Sarah Van

机构信息

Centre for Population, Family and Health, Department of Sociology, University of Antwerp, St-Jacobstraat 2-4, 2000, Antwerp, Belgium.

出版信息

Arch Public Health. 2022 Aug 15;80(1):191. doi: 10.1186/s13690-022-00943-x.

Abstract

BACKGROUND

While medicalization and pharmaceuticalization trends of feelings of anxiety and depression have been described in great detail, an empirical examination of these trends is to date lacking. The current study fills this gap in the literature by mapping the use of psychotropic medicines for feelings of anxiety and depression between 2004 and 2013 in Belgium, as well as by examining whether a social gradient might act as a mediator.

METHODS

We analyzed data from three repeated cross-sectional waves (2004, 2008, and 2013) of the Belgian National Health Interview Survey (HIS). Multinomial logistic regression was applied to estimate odds in psychotropic drugs use over the observed period.

RESULTS

Using an ideal-typical distinction between traditional anxiety drugs (psycholeptics) and depression drugs (psychoanaleptics), we found that treatment methods for feelings of anxiety and depression were converging. Persons having feelings of anxiety consumed less psycholeptic drugs, in favor of psychoanaleptic drugs throughout the observed period. Moreover, these results were partially mediated by educational level. Persons with higher education were less likely to consume psychotropic drugs than those with lower education, suggesting a trend of demedicalization for feelings of anxiety and depression.

LIMITATIONS

Our study observes a limited period, makes use of an ideal typical distinction between psycholeptic and psychoanaleptic drugs, and measurements may be biased by response-bias due to psychotropic drugs use.

CONCLUSION

Our study shows that psycholeptics increasingly give way to psychoanaleptics in the treatment of both anxiety and depression, despite several scientists calling their effectiveness for both disorders into question.

摘要

背景

虽然焦虑和抑郁情绪的医学化和药物化趋势已被详细描述,但迄今为止缺乏对这些趋势的实证研究。本研究通过绘制2004年至2013年比利时用于治疗焦虑和抑郁情绪的精神药物使用情况,以及研究社会梯度是否可能作为一个中介因素,填补了文献中的这一空白。

方法

我们分析了比利时国民健康访谈调查(HIS)三个重复横断面波次(2004年、2008年和2013年)的数据。应用多项逻辑回归来估计观察期内使用精神药物的几率。

结果

通过对传统抗焦虑药物(抗精神病药物)和抗抑郁药物(精神振奋药)进行理想类型的区分,我们发现焦虑和抑郁情绪的治疗方法正在趋同。在整个观察期内,有焦虑情绪的人服用的抗精神病药物较少,而倾向于服用精神振奋药。此外,这些结果部分由教育水平介导。与低学历者相比,高学历者服用精神药物的可能性较小,这表明焦虑和抑郁情绪存在去医学化趋势。

局限性

我们的研究观察期有限,使用了抗精神病药物和精神振奋药之间的理想类型区分,并且测量可能因使用精神药物导致的应答偏差而产生偏差。

结论

我们的研究表明,尽管有几位科学家对其对这两种疾病的有效性提出质疑,但在焦虑和抑郁的治疗中,抗精神病药物越来越多地被精神振奋药所取代。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2ed2/9377052/8f3ecd9d151c/13690_2022_943_Fig1_HTML.jpg

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