Gender differences in antipsychotics prescribed to veterans with serious mental illness.
OBJECTIVE
To examine gender differences in prescribing of antipsychotic medications (APMs) according to their liability for weight gain and other metabolic side effects.


METHODS
We identified 4510 patients with schizophrenia or bipolar disorders receiving usual care in a Veterans Affairs (VA) health care network in the U.S. mid-Atlantic region who initiated treatment with an APM between October 2006 and September 2011. We used multivariable logistic regression to examine gender differences in the likelihood of incident prescription of APMs with low versus medium/high metabolic risk, adjusting for fiscal year of prescribing and selected Veteran demographic, mental health and physical health characteristics.


RESULTS
Overall, 58% of women were prescribed an APM with a low risk of metabolic side effects compared to 45% of men (P<.001). In multivariable analysis, women Veterans were 1.47 times as likely as men to be prescribed a low-metabolic-risk APM (95% confidence interval: 1.26-1.73, P<.001). Several demographic and clinical covariates were also independently related to prescribing of APMs by level of metabolic risk.


CONCLUSIONS
The results may suggest that prescribing choices for APMs by VA mental health prescribers and female Veterans reflect a growing awareness of the potential adverse health consequences of these treatments in women.
VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore MD, 21201, USA.
Elana
E
Schwartz
University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, Baltimore MD, 21201, USA.
Melanie
M
Charlotte
VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore MD, 21201, USA; University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, Baltimore MD, 21201, USA.
Eric
E
Slade
VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore MD, 21201, USA; University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, Baltimore MD, 21201, USA.
Deborah
D
Medoff
University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, Baltimore MD, 21201, USA.
Lan
L
Li
Center for Practice Innovations, New York State Psychiatric Institute, Department of Psychiatry, Columbia University, New York, NY, 10032, USA.
Lisa
L
Dixon
Quality Enhancement Research Initiative, VA Health Services Research and Development (HSR&D) Program and Department of Psychiatry, University of Michigan, Ann Arbor, MI, 48109, USA.
Amy
A
Kilbourne
VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore MD, 21201, USA; University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, Baltimore MD, 21201, USA. Electronic address: jkreyenb@psych.umaryland.edu.
Julie
J
Kreyenbuhl
D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000453:epidemiology; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced; D006949:Hyperlipidemias / Q000139:chemically induced / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012559:Schizophrenia / Q000188:drug therapy* / Q000453:epidemiology; D012737:Sex Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans; D015430:Weight Gain
D014150:Antipsychotic Agents
Antipsychotic medication; Serious mental illness; Veterans; Women’s health