Gender differences in the management of acute psychiatric episodes in the emergency department: a cross-sectional analysis of the 2017-2019 triennium.
Antidepressants
Anxiety Disorders
Benzodiazepines
Emergency Department
Gender
Psychopathology
Journal
Archives of women's mental health
ISSN: 1435-1102
Titre abrégé: Arch Womens Ment Health
Pays: Austria
ID NLM: 9815663
Informations de publication
Date de publication:
12 2023
12 2023
Historique:
received:
07
04
2023
accepted:
02
08
2023
medline:
9
11
2023
pubmed:
25
8
2023
entrez:
24
8
2023
Statut:
ppublish
Résumé
There is growing evidence that gender is an important determinant of mental health and well-being. In this sense, both biological and socio-economic factors play a key role in how people experience psychological disturbances. This study examine whether there were sex- and gender-based differences in the management of psychiatric disorders in the emergency department (ED). A cross-sectional retrospective study was conducted in the ED over the 2017-2019 period. Sex was codified as female/male and socio-economic deprivation index was compiled to address the impact of social determinants. Episodes were reclassified according to four major clusters. Psychotropic drug prescription was categorized according to the ATC classification. Poisson regression models, adjusted for age and socioeconomic status, were used. A total of 9789 episodes (53.9% females) of individuals who required an acute-related psychiatric intervention were retrieved. Age distribution and socioeconomic quintiles revealed gender differences. Anxiety-related consultations accounted for up to 50% of all episodes. Female gender was found to be overrepresented in anxiety and stress-related disorders, mood disorders, and personality disorders. In contrast, Males accounted for 70% of all psychoactive substance use disorders. Considering main clinical syndromic clusters, analysis showed that female patients were more likely to be prescribed with anxiolytic treatment in ED treatment than men in the categories of "Common mental disorders" (PR = 1.122 [1.014-1.242; p = 0.025), "Severe Mental Disorders" (PR = 1.217[1.054-1.406] p = 0.007) and "Personality disorders" (PR = 1.398 (1.038 - 1.884); p = 0.028). This study highlights the relevance of considering sex and gender as potential determinants in both the clinical presentation and management of psychiatric emergencies.
Identifiants
pubmed: 37620657
doi: 10.1007/s00737-023-01360-x
pii: 10.1007/s00737-023-01360-x
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
777-783Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.
Références
Bacigalupe A, Martín U (2021) Gender inequalities in depression/anxiety and the consumption of psychotropic drugs: Are we medicalising women’s mental health? Scand J Public Health 49(3):317–324. https://doi.org/10.1177/1403494820944736
doi: 10.1177/1403494820944736
pubmed: 32755295
Boyd A, Van de Velde S, Pivette M, Ten Have M, Florescu S, O’Neill S, Caldas-de-Almeida JM, Vilagut G, Haro JM, Alonso J, Kovess-Masféty V, EU-WMH investigators (2015) Gender differences in psychotropic use across Europe: Results from a large cross-sectional, population-based study. Eur Psychiatry 30(6):778–788. https://doi.org/10.1016/j.eurpsy.2015.05.001
doi: 10.1016/j.eurpsy.2015.05.001
pubmed: 26052073
Domínguez-Berjón MF, Borrell C, Cano-Serral G, Esnaola S, Nolasco A, Pasarín MI, Ramis R, Saurina C, Escolar-Pujolar A (2008) Construcción de un índice de privación a partir de datos censales en grandes ciudades españolas (Proyecto MEDEA) [Constructing a deprivation index based on census data in large Spanish cities(the MEDEA project)]. Gac Sanit 22(3):179–187. https://doi.org/10.1157/13123961
doi: 10.1157/13123961
pubmed: 18579042
Fernández A, Mendive JM, Salvador-Carulla L, Rubio-Valera M, Luciano JV, Pinto-Meza A, Haro JM, Palao DJ, Bellón JA, Serrano-Blanco A (2012) Adjustment disorders in primary care: prevalence, recognition and use of services. Br J Psychiatry 201:137–142. https://doi.org/10.1192/bjp.bp.111.096305
doi: 10.1192/bjp.bp.111.096305
pubmed: 22576725
Franconi F, Campesi I (2014) Pharmacogenomics, pharmacokinetics and pharmacodynamics: interaction with biological differences between men and women. Br J Pharmacol 171(3):580–594. https://doi.org/10.1111/bph.12362
doi: 10.1111/bph.12362
pubmed: 23981051
pmcid: 3969074
Keers R, Aitchison KJ (2010) Gender differences in antidepressant drug response. Int Rev Psychiatry (Abingdon, England) 22(5):485–500. https://doi.org/10.3109/09540261.2010.496448
doi: 10.3109/09540261.2010.496448
Kroenke K, Spitzer RL, Williams JB, Monahan PO, Löwe B (2007) Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med 146(5):317–325. https://doi.org/10.7326/0003-4819-146-5-200703060-00004
doi: 10.7326/0003-4819-146-5-200703060-00004
pubmed: 17339617
Kuehner C (2017) Why is depression more common among women than among men? Lancet Psychiatry 4(2):146–158. https://doi.org/10.1016/S2215-0366(16)30263-2
doi: 10.1016/S2215-0366(16)30263-2
pubmed: 27856392
Mauvais-Jarvis F, Bairey Merz N, Barnes PJ, Brinton RD, Carrero JJ, DeMeo DL, De Vries GJ, Epperson CN, Govindan R, Klein SL, Lonardo A, Maki PM, McCullough LD, Regitz-Zagrosek V, Regensteiner JG, Rubin JB, Sandberg K, Suzuki A (2020) Sex and gender: modifiers of health, disease, and medicine. Lancet (London, England) 396(10250):565–582. https://doi.org/10.1016/S0140-6736(20)31561-0
doi: 10.1016/S0140-6736(20)31561-0
pubmed: 32828189
National Institute on Drug Abuse. Sex and gender differences in substance use [Internet]. National Institute on Drug Abuse. [cited 2022 May 20]. Available from: https://nida.nih.gov/publications/research-reports/substance-use-in-women/sex-gender-differences-in-substance-use
Observatorio Español de las Drogas y las Adicciones (2021) Informe 2021 Alcohol, tabaco y drogas ilegales en España. Madrid: Ministerio de Sanidad. Delegación del Gobierno para el Plan Nacional sobre Drogas; 243. Available from: https://pnsd.sanidad.gob.es/profesionales/sistemasInformacion/informesEstadisticas/pdf/2021OEDA-INFORME.pdf
Oram S, Khalifeh H, Howard LM (2017) Violence against women and mental health. Lancet Psychiatry 4(2):159–170. https://doi.org/10.1016/S2215-0366(16)30261-9
doi: 10.1016/S2215-0366(16)30261-9
pubmed: 27856393
PLOS Medicine Editors (2013) The paradox of mental health: over-treatment and under-recognition. PLoS Med 10(5):e1001456. https://doi.org/10.1371/journal.pmed.1001456
Rabinowitz J, Werbeloff N, Caers I, Mandel FS, Stauffer V, Ménard F, Kinon BJ, Kapur S (2014) Determinants of antipsychotic response in schizophrenia: implications for practice and future clinical trials. J Clin Psychiatry 75(4):e308–e316. https://doi.org/10.4088/JCP.13m08853
doi: 10.4088/JCP.13m08853
pubmed: 24813414
Riecher-Rössler A (2017) Sex and gender differences in mental disorders. Lancet Psychiatry 4(1):8–9. https://doi.org/10.1016/S2215-0366(16)30348-0
doi: 10.1016/S2215-0366(16)30348-0
pubmed: 27856397
Roca M, Gili M, Garcia-Garcia M, Salva J, Vives M, Garcia Campayo J, Comas A (2009) Prevalence and comorbidity of common mental disorders in primary care. J Affect Disord 119(1–3):52–58. https://doi.org/10.1016/j.jad.2009.03.014
doi: 10.1016/j.jad.2009.03.014
pubmed: 19361865
Sardinha L, Maheu-Giroux M, Stöckl H, Meyer SR, García-Moreno C (2022) Global, regional, and national prevalence estimates of physical or sexual, or both, intimate partner violence against women in 2018. Lancet (London, England) 399(10327):803–813. https://doi.org/10.1016/S0140-6736(21)02664-7
doi: 10.1016/S0140-6736(21)02664-7
pubmed: 35182472
Seedat S, Scott KM, Angermeyer MC, Berglund P, Bromet EJ, Brugha TS, Demyttenaere K, de Girolamo G, Haro JM, Jin R, Karam EG, Kovess-Masfety V, Levinson D, Medina Mora ME, Ono Y, Ormel J, Pennell BE, Posada-Villa J, Sampson NA, Williams D, … Kessler RC (2009) Cross-national associations between gender and mental disorders in the World Health Organization World Mental Health Surveys. Arch Gen Psychiatry 66(7):785–795. https://doi.org/10.1001/archgenpsychiatry.2009.36
Seeman MV (2020) Men and women respond differently to antipsychotic drugs. Neuropharmacology 163:107631. https://doi.org/10.1016/j.neuropharm.2019.05.008
doi: 10.1016/j.neuropharm.2019.05.008
pubmed: 31077728
Tannenbaum C, Greaves L, Graham ID (2016) Why sex and gender matter in implementation research. BMC Med Res Methodol 16(1):145. https://doi.org/10.1186/s12874-016-0247-7
doi: 10.1186/s12874-016-0247-7
pubmed: 27788671
pmcid: 5084413
Torres-Bondia F, de Batlle J, Galván L, Buti M, Barbé F, Piñol-Ripoll G (2020) Trends in the consumption rates of benzodiazepines and benzodiazepine-related drugs in the health region of Lleida from 2002 to 2015. BMC Public Health 20(1):818. https://doi.org/10.1186/s12889-020-08984-z
doi: 10.1186/s12889-020-08984-z
pubmed: 32487058
pmcid: 7268471
Valls-Llobet C (2001) Desigualdades de género en Salud Pública. Quadern CAPS 30:34–40
Woodall A, Howard L, Morgan C (2011) Barriers to participation in mental health research: findings from the Genetics and Psychosis (GAP) Study. Int Rev Psychiatry (Abingdon, England) 23(1):31–40. https://doi.org/10.3109/09540261.2010.546777
doi: 10.3109/09540261.2010.546777
World Health Organization. Gender and health [Internet]. Who.int. [cited 2022 Jul 17]. Available from: https://www.who.int/health-topics/gender