title: Unemployment and initiation of psychotropic medication: a case-crossover study of 2 348 552 Norwegian employees.
abstract: OBJECTIVE
  The study investigated initiation of psychotropic medication in relation to unemployment in the months before, during and after job loss, to detect the period of greatest risk.
  
  
  METHODS
  The Norwegian working population in 2004 (N=2 348 552) was observed from 2005 to 2010 through administrative registries linked to the Norwegian Prescription Database. A case-crossover design was used to analyse within-person relative risk of incident purchases of prescribed psychotropic drugs in relation to timing of unemployment. Control periods were defined 12, 24 and 36 months before the drug purchase. Supplementary analyses were performed on medication for cardiovascular disease, diabetes, obesity, thyroid disorder, pain and musculoskeletal conditions.
  
  
  RESULTS
  Purchases of all psychotropic drugs increased 1-3 months before job loss. Antidepressants had the highest estimate in the month before job loss (OR 2.68, 95% CIs 2.39 to 3.01), followed by hypnotics/sedatives (OR 2.21, 95% CI 1.97 to 2.48), anxiolytics (OR 2.18, 95% CI 1.91 to 2.48) and antipsychotics (OR 2.09, 95% CI 1.76 to 2.48). Rises were greatest in men. Risk of starting psychotropic medication remained raised during a spell of unemployment, but returned to close-to-baseline levels following re-employment. Drugs used to treat somatic and pain conditions showed similar trends but with weaker associations.
  
  
  CONCLUSIONS
  Concerns about impending unemployment may influence mental health several months prior to job loss, especially around the time of notification. The clinical implications of this might be a strengthening of preventive health initiatives early in the unemployment process.
authors.affiliation: Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway Department of Health, SINTEF Technology & Society, Trondheim, Norway.
authors.forename: Silje L
authors.identifier: http://orcid.org/0000-0003-3784-033X
authors.initials: SL
authors.lastname: Kaspersen
authors.affiliation: Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Kristine
authors.initials: K
authors.lastname: Pape
authors.affiliation: Department of Health, SINTEF Technology & Society, Trondheim, Norway.
authors.forename: Solveig O
authors.initials: SO
authors.lastname: Ose
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: David
authors.initials: D
authors.lastname: Gunnell
authors.affiliation: Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway Forensic Department and Research Centre Bröset, St. Olav's University Hospital, Trondheim, Norway.
authors.forename: Johan Håkon
authors.initials: JH
authors.lastname: Bjørngaard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D018592:Cross-Over Studies; D003863:Depression / Q000188:drug therapy*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D010594:Pharmacies; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012042:Registries; D012307:Risk Factors; D017678:Sex Distribution; D013315:Stress, Psychological / Q000188:drug therapy* / Q000523:psychology; D014478:Unemployment / Q000523:psychology*; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D011619:Psychotropic Drugs
keywords: Anxiety; Depression; Job insecurity; Job loss