title: Education as a predictor of antidepressant and anxiolytic medication use after bereavement: a population-based record linkage study.
abstract: Educational attainment has been shown to be positively associated with mental health and a potential buffer to stressful events. One stressful life event likely to affect everyone in their lifetime is bereavement. This paper assesses the effect of educational attainment on mental health post-bereavement.
  
  
  
  By utilising large administrative datasets, linking Census returns to death records and prescribed medication data, we analysed the bereavement exposure of 208,332 individuals aged 25-74 years. Two-level multi-level logistic regression models were constructed to determine the likelihood of antidepressant medication use (a proxy of mental ill health) post-bereavement given level of educational attainment.
  
  
  
  Individuals who are bereaved have greater antidepressant use than those who are not bereaved, with over a quarter (26.5 %) of those bereaved by suicide in receipt of antidepressant medication compared to just 12.4 % of those not bereaved. Within individuals bereaved by a sudden death, those with a university degree or higher qualifications are 73 % less likely to be in receipt of antidepressant medication compared to those with no qualifications, after full adjustment for demographic, socio-economic and area factors (OR 0.27, 95 % CI 0.09,0.75). Higher educational attainment and no qualifications have an equivalent effect for those bereaved by suicide.
  
  
  
  Education may protect against poor mental health, as measured by the use of antidepressant medication, post-bereavement, except in those bereaved by suicide. This is likely due to the improved cognitive, personal and psychological skills gained from time spent in education.
authors: Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK. a.maguire@qub.ac.uk.
authors: Aideen
authors: A
authors: Maguire
authors: Administrative Data Research Network, Queen's University Belfast, Belfast, UK.
authors: John
authors: J
authors: Moriarty
authors: Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK.
authors: Dermot
authors: D
authors: O'Reilly
authors: MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
authors: Mark
authors: M
authors: McCann
mesh_terms: D000328:Adult; D000368:Aged; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001601:Bereavement; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D008498:Medical Record Linkage / Q000379:methods*; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D011788:Quality of Life / Q000523:psychology*
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents
keywords: Administrative data; Antidepressant; Bereavement; Education; Mental health; Suicide