[Analgesic and anti-inflammatory drug prescriptions and number of radiograms predict antidepressant treatment: study of reimbursement data from the Provence health insurance fund].
OBJECTIVE
Physicians frequently fail to detect mental health disorders in patients consulting them. This study tests the hypothesis that patients repeatedly prescribed analgesics or antiinflammatory drugs or X-ray examinations for unexplained somatic symptoms are at higher risk of antidepressant treatment, independent of physical comorbidity.


METHODS
This case-control study is based on health reimbursement data for self-employed artisans and shopkeepers. Cases were subjects who first began antidepressant treatment between January and March 2003. Controls, matched for age, sex, and urban or rural residence, had not been reimbursed for any psychotropic drug in the 18 months before and 6 months after this quarter. Reimbursement data for analgesic and antiinflammatory drugs, and X-rays, temporary disability payments and their reasons, chronic diseases, and hospitalizations over the 18-month period before inclusion were compared for cases and controls with simple and multiple logistic regressions.


RESULTS
The study included 988 cases (36.5% of whom were reimbursed only once for an antidepressant) and 1976 controls. The multiple logistic regressions adjusted for history of psychiatric morbidity and somatic comorbidity showed significant linear associations between starting antidepressant treatment and reimbursements for analgesic and anti-inflammatory drugs or X-rays.


CONCLUSIONS
Severe somatic diseases can induce psychological distress. At the same time, mental disorders may be manifested as unexplained chronic pain, without the individual recognizing the link between them.


CONCLUSIONS
These results confirm the initial hypothesis and suggest signs that may alert physicians to possible undetected psychological distress or mental disorders.
Verger
Pierre
P
Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille. verger@marseille.inserm.fr
Clavaud
Henri
H
Bidaud
Stéphanie
S
Paraponaris
Alain
A
Sauze
Laurent
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D004363:Drug Utilization; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007349:Insurance, Health, Reimbursement; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy / Q000453:epidemiology; D008875:Middle Aged; D011859:Radiography / Q000706:statistics & numerical data*; D020886:Somatosensory Disorders / Q000188:drug therapy / Q000453:epidemiology
D000700:Analgesics; D000893:Anti-Inflammatory Agents; D000928:Antidepressive Agents