The Association between Antidepressant Medications and Coronary Heart Disease in Brazil: A Cross-Sectional Analysis on the Brazilian Longitudinal Study of Adult Health (ELSA-Brazil)

Kemp, Andrew H.; Brunoni, André R.; Bittencourt, Márcio; Nunes, Maria Lúcia Tiellet; Lotufo, Paulo A

doi:10.3389/fpubh.2015.00009

Cited by 8 publications

(7 citation statements)

References 35 publications

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“…Tricyclic users mostly obtained the medication by the government, while selective serotonin reuptake inhibitor (ISRR), selective norepinephrine reuptake inhibitor (SNRI) users and others bought the drugs from its own resources. Tricyclic are effective as inhibitors and other in the treatment of depression and anxiety [ 47 ], but cause significant side effects and are associated to Coronary heart disease [ 48 , 49 ]. Moreover, despite increased access to free medication and the fact that these are most commonly prescribed by psychiatrists, the treatment gap remains high.…”

Section: Discussionmentioning

confidence: 99%

Psychotropic Drug Use in São Paulo, Brazil – An Epidemiological Survey

et al. 2015

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ObjectiveTo estimate the prevalence of one month psychotropic drug use in São Paulo, Brazil, and to assess the gap treatment between the presence of mental disorders and psychotropic drug users.MethodA probabilistic sample of non-institutionalized individuals from the general population of São Paulo (n = 2336; turnout: 84.5%) who were 15 years or older were interviewed by a trained research staff, applying the Composite International Diagnostic Interview 2.1 (CIDI WHO) (depression, anxiety-phobia, OCD\PTSD, alcoholism sections), and an inventory investigating psychotropic drug use during the 12-month and one-month periods immediately preceding the interview. Logistic models were fitted to investigate associations between psychotropic drug use as well as socio-demographic and clinical variables.ResultsThe one month prevalence of psychotropic drug use in São Paulo was 5.89%, the most commonly used drugs were antidepressants (3.15%) and tranquilizers (2.67%). A higher consumption of psychotropic drugs (overall, antidepressants and tranquilizers) was observed among women (OR:2.42), older individuals (OR:1.04), individuals with higher levels of formal education (1.06), and individuals with a family (OR:2.29) or personal history of mental illness (OR:3.27). The main psychotropic drug prescribers were psychiatrists (41%), followed by general practitioners (30%); 60% of psychotropic drugs were obtained through a government-run dispensing program. Most individuals who obtained a positive diagnosis on the CIDI 2.1 during the previous month were not using psychotropic medication (85%). Among individuals with a diagnosis of moderate to severe depression, 67.5% were not on any pharmacological treatment.ConclusionThere is a change in the type of psychotropic more often used in São Paulo, from benzodiazepines to antidepressants, this event is observed in different cultures. The prevalence of use is similar to other developing countries. Most of the patients presenting a psychiatric illness in the month prior to testing were not receiving any sort of psychiatric medication. This may be explained by a failure to identify cases in primary care, which could be improved (and access to treatment could be facilitated) if professionals received more specialized training in managing cases with mental health problems.

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Section: Discussionmentioning

confidence: 99%

Psychotropic Drug Use in São Paulo, Brazil – An Epidemiological Survey

et al. 2015

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“…Given the preliminary results showing changes in Fall-related SE post-participation in CDSMP, researchers may wish to consider exploring a broadened use of CDSMP as an early approach in fall prevention. Currently, the recommended EBPs for older adults include both fall prevention programs and disease self-management programs, such as CDSMP ( 4 ). This research takes an exploratory step toward Beattie’s recommendation ( 21 ) of an “inclusive approach to the effective management of chronic disease and the reduction of fall risk; an approach that values and enfolds the broad spectrum of healthy aging program offerings” (p. 62).…”

Section: Discussionmentioning

confidence: 99%

“…Risk of falls can be further affected by the direct effects of disease as well as indirect effects, such as weakness, limited engagement, and balance issues ( 3 ). Given the negative ramifications associated with chronic disease and falls among older adults, evidence-based programs (EBPs), especially those that focus on disease self-management and fall management and prevention, are key components of health promotion geared toward the older adult population ( 4 ). Stanford’s Chronic Disease Self-Management Program (CDSMP) is an EBP that uses self-efficacy (SE) and mastery experiences to develop skills and SE to manage chronic conditions (SEMCD) ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

Exploring Changes in Two Types of Self-Efficacy Following Participation in a Chronic Disease Self-Management Program

Graham

Smith

Hall

et al. 2016

Front. Public Health

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Chronic conditions and falls are related issues faced by many aging adults. Stanford’s Chronic Disease Self-Management Program (CDSMP) added brief fall-related content to the standardized 6-week workshop; however, no research had examined changes in Fall-related self-efficacy (SE) in response to CDSMP participation. This study explored relationships and changes in SE using the SE to manage chronic disease scale (SEMCD Scale) and the Fall Efficacy Scale (FallE Scale) in participants who successfully completed CDSMP workshops within a Southern state over a 10-month period. SE scale data were compared at baseline and post-intervention for 36 adults (mean age = 74.5, SD = ±9.64). Principal component analysis (PCA), using oblimin rotation was completed at baseline and post-intervention for the individual scales and then for analysis combining both scales as a single scale. Each scale loaded under a single component for the PCA at both baseline and post-intervention. When both scales were entered as single meta-scale, the meta-scale split along two factors with no double loading. SEMCD and FallE Scale scores were significantly correlated at baseline and post-intervention, at least p < 0.05. A significant proportion of participants improved their scores on the FallE Scale post-intervention (p = 0.038). The magnitude of the change was also significant only for the FallE Scale (p = 0.043). The SEMCD Scale scores did not change significantly. Study findings from the exploratory PCA and significant correlations indicated that the SEMCD Scale and the FallE Scale measured two distinct but related types of SE. Though the scale scores were correlated at baseline and post-intervention, only the FallE Scale scores significantly differed post-intervention. Given this relationship and CDSMP’s recent addition of a 10-min fall prevention segment, further exploration of CDSMP’s possible influence on Fall-related SE would provide useful understanding for health promotion in aging adults.

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“…Our study is characterized by a number of strengths including a focus on a relatively large and well-characterized sample of the Brazilian population, consideration of a variety of specific mood and anxiety disorder groupings, application of a structured clinical interview – rather than self-report – to determine psychiatric diagnoses, and adjustment for a host of covariates known to contribute to metabolic and cardiovascular risk. Recently, we reported that that use of tricyclic antidepressants is associated with a twofold increase in prevalent CHD, above and beyond severity of mood and anxiety symptoms ( Kemp et al, 2015 ). Importantly, we demonstrate here that the association between mood and anxiety disorders, and CHD is above and beyond use of antidepressant medications including tricyclic antidepressants.…”

Section: Discussionmentioning

confidence: 99%

The association between mood and anxiety disorders, and coronary heart disease in Brazil: a cross-sectional analysis on the Brazilian longitudinal study of adult health (ELSA-Brasil)

et al. 2015

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Background: Associations between major depressive disorder (MDD) and coronary heart disease (CHD) have been established, and these associations increase risk of future morbidity and mortality. Prior research has been carried out in high-income countries. Here we examine associations between the mood and anxiety disorders, and CHD in a large cohort at baseline from Brazil, a country facing a variety of challenges that may affect these associations.Methods: Participants included 15,105 civil servants aged 35 to 74 at baseline (2008–2010) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). CHD (N = 721) included self-reported angina pectoris (n = 305), myocardial infarction (n = 259) and coronary revascularization (n = 239). Hierarchical logistic regression analyses were conducted to estimate odds ratios and confidence intervals.Results: Major findings indicate that comorbid MDD and anxiety disorders (n = 434) are associated with a threefold increase in CHD, MDD alone (n = 170) with a twofold increase in CHD, while generalized anxiety disorder alone (n = 1,394) and mixed anxiety and depression disorder (n = 1,844) – symptoms present, but diagnostic threshold not reached – are associated with a 1.5-fold increase in CHD, after full adjustment for covariates.Conclusion: The association with CHD is greatest in those with psychiatric comorbidity, while associations were also observed in MDD and generalized anxiety disorder without comorbidity. While findings are limited by the cross-sectional design of the study, given the known risks associated with comorbidity of the mood and anxiety disorders with CHD, findings reinforce the importance of comprehensive health assessment in Brazil.

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The Association between Antidepressant Medications and Coronary Heart Disease in Brazil: A Cross-Sectional Analysis on the Brazilian Longitudinal Study of Adult Health (ELSA-Brazil)

Cited by 8 publications

References 35 publications

Psychotropic Drug Use in São Paulo, Brazil – An Epidemiological Survey

Psychotropic Drug Use in São Paulo, Brazil – An Epidemiological Survey

Exploring Changes in Two Types of Self-Efficacy Following Participation in a Chronic Disease Self-Management Program

The association between mood and anxiety disorders, and coronary heart disease in Brazil: a cross-sectional analysis on the Brazilian longitudinal study of adult health (ELSA-Brasil)

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