Initiation of psychotropic medication after partner bereavement: a matched cohort study.
BACKGROUND
Recent changes to diagnostic criteria for depression in DSM-5 remove the bereavement exclusion, allowing earlier diagnosis following bereavement. Evaluation of the potential effect of this change requires an understanding of existing psychotropic medication prescribing by non-specialists after bereavement.


OBJECTIVE
To describe initiation of psychotropic medication in the first year after partner bereavement.


METHODS
In a UK primary care database, we identified 21,122 individuals aged 60 and over with partner bereavement and no psychotropic drug use in the previous year. Prescribing (anxiolytic/hypnotic, antidepressant, antipsychotic) after bereavement was compared to age, sex and practice matched controls.


RESULTS
The risks of receiving a new psychotropic prescription within two and twelve months of bereavement were 9.5% (95% CI 9.1 to 9.9%) and 17.9% (17.3 to 18.4%) respectively; an excess risk of initiation in the first year of 12.4% compared to non-bereaved controls. Anxiolytic/hypnotic and antidepressant initiation rates were highest in the first two months. In this period, the hazard ratio for initiation of anxiolytics/hypnotics was 16.7 (95% CI 14.7 to 18.9) and for antidepressants was 5.6 (4.7 to 6.7) compared to non-bereaved controls. 13.3% of those started on anxiolytics/hypnotics within two months continued to receive this drug class at one year. The marked variation in background family practice prescribing of anxiolytics/hypnotics was the strongest determinant of their initiation in the first two months after bereavement.


CONCLUSIONS
Almost one in five older people received a new psychotropic drug prescription in the year after bereavement. The early increase and trend in antidepressant use after bereavement suggests some clinicians did not adhere to the bereavement exclusion, with implications for its recent removal in DSM-5. Family practice variation in use of anxiolytics/hypnotics suggests uncertainty over their role in bereavement with the potential for inappropriate long term use.
Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom.
Sunil M
SM
Shah
Iain M
IM
Carey
Tess
T
Harris
Stephen
S
DeWilde
Christina R
CR
Victor
Derek G
DG
Cook
D000368:Aged; D000369:Aged, 80 and over; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001601:Bereavement; D016022:Case-Control Studies; D003863:Depression / Q000188:drug therapy* / Q000523:psychology; D011307:Drug Prescriptions; D006801:Humans; D008016:Life Change Events; D008875:Middle Aged; D016016:Proportional Hazards Models
D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents