DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20211723

Profile of use of benzodiazepines and mental distress in patients cared in a public health unit

Livia de Oliveira Kawano, Edimar Cristiano Pereira, Glaucia Luciano da Veiga, Beatriz da Costa Aguiar Alves, Ligia Ajaime Azzalis, Fernando Adami, Luiz Vinicius de Alcantara Sousa, Fernando Luiz Affonso Fonseca

Abstract


Background: Benzodiazepines are a class of drugs especially used in the treatment of insomnia and anxiety. The short-term use is considered safe, but the long-term treatment is associated with drug dependence and loss of efficacy due to the development of tolerance. Given the lack of mental health management services in primary healthcare, benzodiazepines have been prescribed to be used for undetermined periods of time, resulting in distress for patients and representing an important issue in the public health context.

Methods: This is a transversal study with a descriptive quantitative approach, which aimed to characterize the profile of patients served by the Basic Health Unit Pharmacy Taboão in São Bernardo do Campo, São Paulo, Brazil, and correlate the different studied variables with the mental distress of these patients. A questionnaire including demographic, socioeconomic and physical and mental health variables was applied to the pharmacy customers.

Results: It was revealed that among female patients (p=0.042, β=0.61, 95% CI: 0.38-0.98), suicidal ideation (p<0.001, β=1.53, 95% CI: 1.22-1.92), perceptions regarding their own health condition (p<0.001, β=0.48, 95% CI: 0.34-0.67), occurrences of polypharmacy (p=0.137, β=1.19, 95% CI: 0.94-1.50), knowledge on the risks associated with the use of benzodiazepines (p=0.176, β=0.85, 95%CI: 0.067-1.07) and engagement in physical activities (p=0.685, β=0.93, 95% CI: 0.68-1.27) are significantly associated with mental distress.

Conclusions: Therefore, after these findings were obtained, errors that contribute to the occurrence of this scenario were identified and possible strategies to deal with the issue were suggested.


Keywords


Benzodiazepines, Misuse, Public healthcare, Mental distress, Brazil

Full Text:

PDF

References


Lora A, Hanna F, Chisholm D. Mental health service availability and delivery at the global level: an analysis by countries' income level from WHO's Mental Health Atlas. Epidemiol Psychiatr Sci. 2017:1-12.

Prado MAMBD, Francisco PMSB, Barros MBA. Use of psychotropic medications in adults and elderly living in Campinas, São Paulo, Brazil: cross-sectional population-based study. Epidemiol Serv Saude. 2017;26(4):747-58.

Miasso AI, Telles Filho PC, Borges TL, Pereira Junior AD, Vedana KG, Shasanmi RO, et al. Quality of Life in Brazil's Family Health Strategy: Common Mental Disorders, Use of Psychotropic Drugs and Sociodemographic Factors. Arch Psychiatr Nurs. 2017;31(1):68-72.

Razzouk D, Kayo M, Sousa A, Gregorio G, Cogo-Moreira H, Cardoso AA, et al. The impact of antipsychotic polytherapy costs in the public health care in Sao Paulo, Brazil. PLoS One. 2015;10(4):0124791.

Liebrenz M, Gehring MT, Buadze A, Caflisch C. High-dose benzodiazepine dependence: a qualitative study of patients' perception on cessation and withdrawal. BMC Psychiatry. 2015 May;15:116.

Griffin CE, Kaye AM, Bueno FR, Kaye AD. Benzodiazepine pharmacology and central nervous system-mediated effects. Ochsner J. 2013;13(2):214-23.

Hood SD, Norman A, Hince DA, Melichar JK, Hulse GK. Benzodiazepine dependence and its treatment with low dose flumazenil. Br J Clin Pharmacol. 2014;77(2):285-94.

Lader M. Benzodiazepines revisited-will we ever learn?. Addiction. 2011;106(12):2086-109.

Billioti GS, Pariente A, Bégaud B. Is there really a link between benzodiazepine use and the risk of dementia? Expert Opin Drug Saf. 2015;14(5):733-47.

Anthierens S, Habraken H, Petrovic M, Christiaens T. The lesser evil? Initiating a benzodiazepine prescription in general practice: a qualitative study on GPs' perspectives. Scand J Prim Health Care. 2007;25(4):214-9.

Kurko TA, Saastamoinen LK, Tähkäpää S, Tuulio-Henriksson A, Taiminen T, Tiihonen J, et al. Long-term use of benzodiazepines: Definitions, prevalence and usage patterns - a systematic review of register-based studies. Eur Psychiatry. 2015;30(8):1037-47.

Sanitária AANDV. Boletim Farmacoepidemiologia ANVISA, 2018. Available at: http://www.anvisa. gov.br/sngpc/boletins/2011/boletim_sngpc_2edatualizada.pdf. Accessed on 20 December 2020.

Tanguay BMM, Luc M, Carrier JD, Fournier L, Duhoux A, Côté E, et al. Patterns of benzodiazepines use in primary care adults with anxiety disorders. Heliyon. 2018;4(7):00688.

Weisberg RB, Dyck I, Culpepper L, Keller MB. Psychiatric treatment in primary care patients with anxiety disorders: a comparison of care received from primary care providers and psychiatrists. Am J Psychiatry. 2007;164(2):276-82.

Barros AJ, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol. 2003;3:21.

Fan LB, Blumenthal JA, Watkins LL, Sherwood A. Work and home stress: associations with anxiety and depression symptoms. Occup Med (Lond). 2015;65(2):110-6.

Shaltout HA, Chappell MC, Rose JC, Diz DI. Exaggerated sympathetic mediated responses to behavioral or pharmacological challenges following antenatal betamethasone exposure. Am J Physiol Endocrinol Metab. 2011;300(6):979-85.

Nascimento RCRMD, Álvares J, Guerra AA, Gomes IC, Silveira MR, Costa EA, et al. Polypharmacy: a challenge for the primary health care of the Brazilian Unified Health System. Rev Saude Publica. 2017;51(2):19.

Mari JJ, Williams P. A validity study of a psychiatric screening questionnaire (SRQ-20) in primary care in the city of Sao Paulo. Br J Psychiatry. 1986;148:23-6.

Cochen V, Arbus C, Soto ME, Villars H, Tiberge M, Montemayor T, et al. Sleep disorders and their impacts on healthy, dependent, and frail older adults. J Nutr Health Aging. 2009;13(4):322-9.

Hein M, Lanquart JP, Loas G, Hubain P, Linkowski P. Objective sleep alterations and long-term use of short or intermediate half-life benzodiazepine receptor agonists are risk factors for high blood pressure in individuals with insomnia: a study in 1272 individuals referred for sleep examinations. Sleep Med. 2019;53:115-23.

Gondim AP, Nogueira RR, Lima JG, Lima RA, Albuquerque PL, Veras MD, et al. Suicide attempts by exposure to toxic agents registered in a Toxicological Information and Assistance Center in Fortaleza, Ceará, Brazil. Epidemiol Serv Saude. 2017;26(1):109-19.

Parr JM, Kavanagh DJ, Young RM, McCafferty K. Views of general practitioners and benzodiazepine users on benzodiazepines: a qualitative analysis. Soc Sci Med. 2006;62(5):1237-49.

Cotton BP, Lohman MC, Brooks JM, Whiteman KL, Bao Y, Greenberg RL, et al. Prevalence of and Factors Related to Prescription Opioids, Benzodiazepines, and Hypnotics Among Medicare Home Health Recipients. Home Healthc Now. 2017;35(6):304-13.