Are men under-treated and women over-treated with antidepressants? Findings from a cross-sectional survey in Sweden.

Aims and method To examine gender differences in self-reported depression and prescribed antidepressants (ADs). The Hospital Anxiety and Depression Scale was used to assess depression, and information on prescribed ADs was obtained from the Swedish Prescribed Drug Register. Results Depression was reported by 11.7% of the participants (12.3% men and 11.2% women). ADs were prescribed for 7.6% of the participants (5.3% men, 9.8% women). Among men, 1.8% reported depression and used ADs, 10.5% reported depression but did not use ADs, and 3.6% used ADs but did not report depression. The corresponding figures for women were 2.6%, 8.6% and 7.2%. Clinical implications Men report depression to a greater extent than women but are prescribed ADs to a lesser extent, possibly a sign of under-treatment. Women are prescribed ADs without reporting depression more often than men, possibly a sign of over-treatment. Although the causes remain unclear, diagnostic and treatment guidelines should benefit from considering gender differences in these respects.

Self-reported skin diseases, quality of life and medication use: a nationwide pharmaco-epidemiological survey in Sweden.

The aim of this study was to determine self-reported consumption of dermatological pharmaceuticals and quality of life (QoL), measured with Short Form 36, in relation to eczema, acne, psoriasis and other inflammatory skin conditions in the Swedish population. A questionnaire containing questions on the occurrence of skin diseases, health-related QoL and the use of pharmaceuticals was sent to a cross-sectional sample of the Swedish population, age range 18-84 years (n = 8,000). The response rate was 61%. The 1-year prevalence of skin diseases was 30-35%, with females reporting a higher prevalence. The prevalence was 11.5% for eczema other than hand eczema, 10.2% for acne, 7.5% for hand eczema, 3.9% for psoriasis and 3.1% for urticaria. QoL was significantly affected and 25% of females and 19% of males had used a dermatological drug. Compared with hand eczema, persons with psoriasis and other eczema reported significantly more use of topical steroids on prescription and more use of dermatological pharmaceuticals in total. Skin conditions are common; they affect QoL and lead to a high consumption of dermatological drugs; which deserves increased awareness in the society.

The influence of symptoms of anxiety and depression on medication nonadherence and its causes: a population based survey of prescription drug users in Sweden.

PURPOSE: The purpose of this study was to evaluate the associations between self-reported symptoms of anxiety and/or depression, nonadherent (NA) behaviors, and reasons for NA to medication regimens. METHODS: A population based cross-sectional study with questionnaire was performed in the general Swedish population. The participants were 2,802 prescription drug users aged 18-84 years. The questionnaire covered use of prescription drugs, symptoms of anxiety and/or depression, based on the Hospital Anxiety and Depression Scale (HADS), various NA behavior types, intentional and unintentional, and various reasons for NA. RESULTS: Symptoms of anxiety and depression, independently and in combination, were associated with unintentional and intentional NA, with a stronger association with intentional NA. Regarding the reasons given for NA, for example anxiety, independently or in combination with depression, was associated with a fear of developing adverse drug reactions (ADRs). Depression, independently or in combination with anxiety, on the other hand, was associated with the actual development of ADRs. CONCLUSION: A cross-sectional design such as this does not allow assessment of causality derived from the results. However, the results indicate that patients experiencing symptoms of psychological distress are at increased risk of NA, especially intentional NA, and could therefore benefit from extra attention from the health care professional. Patients with symptoms of anxiety and/or depression should be identified and monitored for the development and/or fear of ADRs, in order to improve adherence to medication regimens.

Hand eczema and health-related quality of life; a comparison of EQ-5D and the Dermatology Life Quality Index (DLQI) in relation to the Hand Eczema Extent Score (HEES).

BACKGROUND: Health-related quality of life (HRQoL) is associated with the extent and severity of hand eczema. We still lack a consensus about which HRQoL instrument to use as the standard, and how to measure the extent and severity of hand eczema. OBJECTIVES: To compare the Dermatology Life Quality Index (DLQI) with EQ-5D (a standardized instrument for use as a measure of health outcome), and to evaluate how the Hand Eczema Extent Score (HEES) relates to these instruments. METHODS: Ninety-three patients (61 females) were included. The HEES was recorded by a dermatologist, and the DLQI and EQ-5D by the patients. The results were analysed with factor analysis and non-parametric statistics. RESULTS: The DLQI and EQ-5D showed decreased HRQoL. Using factor analysis, we could not establish an association between the DLQI and EQ-5D. There were, however, correlations between the DLQI and the HEES (0.31), the EQindex and the HEES (-0.32), the DLQI and the EQVAS (-0.62), and the DLQI and the EQindex (-0.67) (the EQVAS and the EQindex are calculated from EQ-5D). CONCLUSIONS: We could not link factors in the DLQI to EQ-5D, which has previously been done for SF-36 (Short Form 36). On the basis of this, we cannot recommend EQ-5D over SF-36 for hand eczema studies. The DLQI correlates with the EQVAS and the EQindex, and can probably be used as an approximation for EQ-5D. Our findings with the HEES are interesting, as it can be used by patients.

Self-reported lifetime prevalence of atopic dermatitis and co-morbidity with asthma and eczema in adulthood: a population-based cross-sectional survey.

Atopic dermatitis and its co-morbidity with asthma and allergy is well described in younger age groups. However, population-based studies on adults with atopic dermatitis in childhood are sparse. The aims of this study were to determine: (i) the prevalence of self-reported childhood atopic dermatitis in the population; and (ii) its association with present self-reported hand eczema, eczema, allergy, urticaria and asthma. A questionnaire was sent to a cross-sectional random sample of the Swedish population (n=7,985), age range 18-84 years (response rate 61.1%). The questionnaire included the question "Have you had childhood eczema?" and questions on 5 other medical problems (hand eczema, other eczema, asthma, urticaria and allergy). Persons reporting eczema in childhood reported increased odds ratios (OR) for hand eczema (4.01), other eczema (3.88), urticaria (2.50), allergy (2.98), and asthma (2.06) as adults. The combination of eczema, allergy and asthma had an OR of 14.10 (95% confidence interval 8.44-23.54). Adults in the age range 18-84 years reporting childhood atopic dermatitis still have high co-morbidity with eczema, asthma, urticaria and allergy.

Gender differences of axis I and II comorbidity in subjects diagnosed with attention-deficit hyperactivity disorder as adults.

OBJECTIVE: To investigate gender differences in psychiatric comorbidity patients diagnosed with attention-deficit hyperactivity disorder (ADHD) as adults. METHODS: Interviews about current ADHD symptoms and psychiatric comorbidity on axis I and II (Structured Clinical Interview for DSM-IV axis I and axis II) were conducted in a clinical cohort of 168 patients (78 women, 90 men). Independent information on childhood and current symptoms was collected from parents, partners and patient files. RESULTS: The lifetime prevalence of psychiatric comorbidity on axis I reached 92%, and current comorbidity, including autism spectrum disorders and Tourette's syndrome, was 47%. Women had a higher lifetime prevalence of mood and eating disorders compared with men, where substance-use disorders were more frequent. Ten per cent of patients fulfilled diagnostic criteria for a personality disorder. When excluding the general diagnostic criteria, 46% of the patients endorsed the specific criteria for at least one personality disorder. Gender differences were identified with predominance of histrionic personality traits in women and conduct disorder in men. CONCLUSION: Patients diagnosed with ADHD as adults display an extremely high lifetime axis I comorbidity with a gender-specific pattern similar to the general population. No gender differences were identified with regard to personality disorders; however, an increased prevalence of deviant personality traits was confirmed. This study stresses the importance of evaluating comorbidity among patients diagnosed with ADHD as adults to secure optimal treatment.

Women and men report different behaviours in, and reasons for medication non-adherence: a nationwide Swedish survey.

OBJECTIVE: The aim of the present study was to analyse gender differences in self-reported non-adherence (NA) to prescribed medication in the Swedish general population. We aimed to study unintentional and intentional NA as well as the reasons given for NA. METHODS: A questionnaire was mailed to a cross-sectional, random, national sample of people aged 18-84 years in Sweden (n=7985). The response rate was 61.1% (n=4875). The questionnaire covered use of prescription drugs, NA behaviour and reasons for NA. RESULTS: Use of prescription drugs was reported by 59.5% (n=2802) of the participants, and 66.4% (n=1860) of these participants did not adhere to the prescribed regimen. No overall gender differences in reporting NA were found. However, when analysing the various types of NA behaviour and the reasons for NA, different gender patterns emerged. Men were more likely to report forgetting [OR=0.77 (95%CI 0.65:0.92)], changing the dosage [OR=0.64 (95%CI 0.52:0.79)] and that they had recovered [14.3%, (OR=0.71 (95%CI 0.56:0.90)] as a reason. In contrast, more women than men reported filling the prescription but not taking the drug [OR=1.25 (95%CI 1.02:1.54)] and reported the development of adverse drug reactions (ADRs) [OR=1.89 (95%CI 1.37:2.59)] as a reason more commonly. The gender differences remained, in most cases, after controlling for confounders such as age, socioeconomic factors, medical problems and attitudes toward drugs. CONCLUSIONS: Women and men have different patterns of NA behaviour and different reasons for NA. Therefore, if adherence is to be improved, a wide knowledge of all the reasons for NA is required, along with an understanding of the impact of gender on the outcomes.

Quality of life, use of topical medications and socio-economic data in hand eczema: a Swedish nationwide survey.

Hand eczema is common and has an adverse impact on the lives of patients. There is a need for population-based surveys on the pharmacoepidemiological aspects, quality of life and impact of socioeconomic factors in hand eczema. The aim of this cross-sectional study was to investigate these factors. A questionnaire-based nationwide survey of health was performed, including questions on hand eczema, use of pharmaceuticals and socioeconomic factors. Quality of life was estimated with the generic instrument Short Form 36 (SF-36). The questionnaire was sent to 7,985 persons (age range 18-84 years), response rate 61.1% (n = 4,875). The 1-year prevalence of hand eczema in the study population was 7.5%. In this group, quality of life was lower. All dimensions of SF-36 were affected, most markedly general health and those dimensions reporting on mental health. In the group with self-reported hand eczema, 51% reported using topical pharmaceuticals. Hand eczema was more common among women (9.1%, n = 2,630) than among men (5.6%, n = 2,245) and in the age group below 65 years (8.5%, n = 3,274) compared with those aged 65 years and over (4.3%, n = 1,151). This survey clearly demonstrates the impact of hand eczema on several dimensions of life and also highlights age, gender and socioeconomic differences.

ADHD-related symptoms among adults in out-patient psychiatry and female prison inmates as compared with the general population.

OBJECTIVE: To compare the prevalence of symptoms consistent with attention deficit hyperactivity disorder (ADHD) and related problems in adults in the general population, out-patient psychiatry (where females are in majority), and female convicts. METHOD: A questionnaire based on the DSM-IV criteria of ADHD, reported childhood symptoms, reading and spelling problems, difficulties and suffering, and general assessment of functioning (GAF) was distributed to samples of the general population, open care psychiatry, and female prison inmates. Completed questionnaires were received from 517/1000, 349/400, and 50/65 of the three samples, respectively. RESULTS: Symptoms consistent with ADHD were more than three times higher in out-patient psychiatry than in the general population (6.6% versus 2.1%), with a male-to-female ratio of 1.6-1.7. The severity of symptoms and frequencies of associated disabilities were similar in men and women. ADHD symptoms and related problems occurred in 50% of the female prisoners, which is similar to male prisoners according to the literature. CONCLUSION: The high prevalence of symptoms and disabilities of ADHD in women should lead to awareness of the disorder in both sexes and be addressed in terms of diagnostic work-up, treatment, and rehabilitation.

Short-term cost and health consequences of duodenal levodopa infusion in advanced Parkinson's disease in Sweden: an exploratory study.

Levodopa is the cornerstone treatment for Parkinson's disease, but the short half-life of levodopa limits its usefulness in late stages of the disease. Duodenal levodopa infusion (DLI) allows more stable plasma levels and better motor symptom control. To explore the costs and health benefits of replacing conventional oral polypharmacy with DLI in patients with advanced Parkinson's disease, from a Swedish healthcare payer perspective. Based on a clinical, randomized, crossover study with 24 patients (DIREQT), a decision analytic model predicted 2-year drug costs and QALYs for conventional oral therapy and for DLI. Health-related quality of life (HR-QOL) was recorded using a 15-dimensional (15D) utility instrument at baseline and during the two 3-week trial periods, and then at eight follow-up visits during the subsequent 6 months. Use of medication was based on data from DIREQT and previous studies. Unit costs were based on market prices (drugs) and customary charges in Sweden. All costs were expressed in Swedish kronor (SEK), year 2004 values euro 1.00 approximately SEK9.17, $US1.00 = SEK7.47). Future costs and outcomes were discounted at 3%. One-way and probabilistic sensitivity analyses were conducted. The mean utility scores were 0.77 for DLI and 0.72 for conventional therapy (p = 0.02). A considerable variation in the scores was observed during the study. The expected per-patient 2-year cost of DLI was SEK562 000 while it was SEK172 000 for conventional therapy. The mean number of QALYs was 1.48 and 1.42, respectively, representing an incremental cost of SEK6.1 million per QALY for DLI (all values discounted at 3%). Using other assumptions in sensitivity analyses, the cost per QALY could be as low as SEK456 000. This analysis can be considered exploratory only; it is based on very limited data. Nevertheless, our findings suggest that DLI results in a significant improvement in HR-QOL. However, the cost per QALY is likely to be higher than customary cost-effectiveness thresholds. Whether these benefits justify the additional costs depends on how the health benefits are measured and how these benefits are valued by society.

Nationwide survey of subjectively reported adverse drug reactions in Sweden.

BACKGROUND: Adverse drug reactions (ADRs) and the safety of drugs continue to be widely discussed. However, information on the prevalence of subjectively experienced ADRs (SADRs) and their subsequent burden in the general population is largely lacking. OBJECTIVE: To analyze, from an epidemiologic perspective, SADRs with respect to occurrence and health status. METHODS: A cross-sectional mail survey to a random national sample in Sweden of inhabitants aged 18-84 years was conducted; 61% (N = 4875) of the sample answered the questionnaire. Self-reported SADRs occurring during a 2-week period of using prescription, over-the-counter (OTC), or herbal drugs were classified according to Meyler's classification of ADRs. Self-perceived health status was assessed with a visual analog scale graded from 0 (worst possible health/death) to 1 (perfect health). RESULTS: SADRs were reported by 6.4% of the total study sample, 10.2% of the 2851 users of prescription drugs, 1.0% of the 2862 users of OTC drugs, and 0.1% of the 1352 users of herbal drugs. Of the total sample, 3.3% reported SADRs of the nervous system, 2.6% of the gastrointestinal system, and 0.6% of the cardiovascular system. Users of prescription drugs with SADRs reported a mean health status score of 0.655, while those who did not report SADRs scored 0.744. Among users of OTC and herbal drugs, the corresponding scores were 0.720 and 0.818, respectively. Those in the population who did not use any drugs rated their health status as 0.846. CONCLUSIONS: Both the prevalence of SADRs and the magnitude of the decrease in subjective health status in respondents experiencing them reflect the importance of individual subjective perceptions for public health. However, in a cross-sectional study like this, causal relationships cannot be firmly established. Further, other factors, such as comorbidity or disappointment with treatment outcomes, could be associated with the decrease in health status.

Mortality among persons with schizophrenia in Sweden: an epidemiological study.

The objective of the study was to analyse 10-year mortality among persons with schizophrenia from an epidemiological perspective. This cohort study included all persons with schizophrenia (n=255) living in the northern catchment area in Uppsala in 1991, and 1275 subjects from the national population register matched for sex, age and living area. The prevalence of schizophrenia was 0.37% and the mortality rate for individuals with schizophrenia was higher than for referents: 23.0% vs. 11.2%. The higher mortality among those with schizophrenia was mainly the result of unnatural causes and cardiovascular disease, especially in men. Excess mortality from cardiovascular disease was more pronounced in middle age, irrespective of gender. Multivariate analysis revealed higher mortality among individuals with schizophrenia living in the city than among those living in less urbanized areas. People with schizophrenia die more often than those without schizophrenia from unnatural causes or circulatory diseases. Individuals with schizophrenia die sooner from circulatory diseases than those without schizophrenia. Having schizophrenia and living in the city also results in higher mortality than having schizophrenia and living in other areas. The risk of early death from circulatory disease needs to be studied in more detail to reveal the potential respective contributions of intrinsic patient vulnerability, lifestyle factors and side-effects from psychotropic drugs.

Using EQ-5D to derive general population-based utilities for the quality of life assessment of growth hormone deficiency in adults (QoL-AGHDA).

OBJECTIVE: Disease-oriented quality of life (QoL) measures that are not preference-based lack legitimacy for direct use in cost-utility analyses. This has prompted the search for other methods for deriving utilities. The QoL Assessment of Growth Hormone Deficiency in Adults questionnaire (QoL-AGHDA) is a disease-oriented measure used to assess impairment in QoL in adults with growth hormone deficiency. The present study was designed to generate a model for deriving utilities from the QoL-AGHDA. METHODS: The EQ-5D, the QoL-AGHDA, and demographic questions were mailed to a random sample (n = 3005) of the Swedish population (response rate 65%). Multiple regression analysis was used to obtain cross-validated parameters of QoL-AGHDA-based utilities. Two models were developed (simple and full versions). The simple version used the EQ-5D(index) (derived from European values) as the dependent variable, and age, sex, and QoL-AGHDA score as independent variables in a regression analysis. The full model utilized all available demographic information. The QoL-AGHDA scores were thus transformed into a single score (0-1), corresponding to the QoL-AGHDA-based utility. RESULTS: The simple transformation algorithm was U (QoL-AGHDA-based utilities) = 1.05 - 0.0189 x QoL-AGHDA score - 0.00238 x age - 0.0127 x sex (male = 0; female = 1). The mean of the weighted estimate for the population (n = 1752) was 0.85 (SD 0.10). The estimate for men (n = 861; mean 0.86; SD 0.10) was higher (P < 0.001) than for women (n = 891; mean 0.84; SD 0.10). CONCLUSION: For practical reasons, the simple model can be recommended for deriving utilities directly from the QoL-AGHDA for the Swedish population.

The impact of depression is unevenly distributed in the population.

AIMS: The aim of this study was to evaluate the impact of depression on quality of life in the general population by studying its effects on i) health-related quality of life (HRQoL), ii) health state utilities, and iii) the burden of disease in the population according to age, sex, marital status, education, economy and employment. METHOD: Cross-sectional survey in the County of Uppsala, Sweden. A statistical sample of the general population aged 20-64 years (N=4506) was used. Information on current state of depression was obtained by self-report. HRQoL was measured using Short Form 36 (SF-36). The time trade-off (TTO) method was used to measure health state utilities. The decrease of total health state utilities associated with depression in the population was used as a measure of burden of disease. RESULTS: Depression was reported by 4.0% of the population. Those with depression scored significantly lower (P<0.001) than those without on all eight of the SF-36 domains. The depressed group also rated their health state utilities significantly lower than the others: 0.796 versus 0.933 (P<0.001). In the multivariate analysis of decrease in utilities with various medical disorders, depression was associated with the greatest decrease (-0.090, P<0.001). Persons with depression accounted for 10.9% of the total decrease in utilities in the whole population, but this proportion varied according to the specific subgroup. For example, 16.4% and 8.6% of the total burden of disease was linked to depression among single and married people, respectively. The corresponding figures for those with the lowest and highest incomes were 15.0% and 7.9%, respectively. Among the unemployed, persons reporting depression accounted for 15.3% of the decrease in utilities in contrast to 4.9% among the employed. CONCLUSIONS: Depression has a strong impact on the quality of life and total disability in the general population. Further, the impact of depression is unevenly distributed in the population.

Paternal laboratory work and congenital malformations.

Animal studies indicate male-mediated teratogenicity for certain carcinogens/mutagens. Nevertheless, paternal occupational determinants of malformations in humans have been sparsely investigated. Data on male employees at Swedish universities from 1970 to 1989 were linked to the Medical Birth Register. The relationship between major malformations and exposure to laboratory work and to specific laboratory agents/techniques before the third trimester were analyzed using logistic regression. For major malformations, "laboratory work in general" (n = 3237) gave an adjusted odds ratio (OR) of 1.3 (95% CI = 0.8-2.1) and carcinogenic solvent use (n = 2489) of 2.0 (95% CI = 0.8-4.9) around the time of conception. For carcinogenic solvents and neural crest malformations, OR was 4.9 (95% CI =1.5-15.8). In conclusion, the prevalence of congenital malformations was not increased in offspring of males with laboratory work in general (1970-1989). Paternal work with agents such as carcinogens could, however, be of concern.

Epidemiology, co-morbidity, and impact on health-related quality of life of self-reported headache and musculoskeletal pain--a gender perspective.

BACKGROUND: Headache and musculo-skeletal pain are major public health problems. Substantial proportions of the general population report that they experience pain problems that affect their work, daily living and social life. Epidemiological studies have consistently shown that the prevalence of most pain conditions is higher in women than in men. DESIGN: Cross-sectional survey in the county of Uppland, Sweden, 1995. Five thousand four hundred and four completed the questionnaire (response rate=68%). In these analyses for persons aged 20-64 years 4506 were included. RESULTS: Back pain (22.7%) and shoulder pain (21.0%) were the most commonly reported medical problems in the population with pain in arms/legs (15.7%) in fifth and headache (12.5%) in eight place. Major gender differences were found. The prevalence of pain conditions, especially headache, was higher among women. Women reported more severe pain. Co-morbidity between pain conditions and psychiatric and somatic problems was higher among women. Health-related quality of life (SF-36) differed by gender and type of pain condition. The physical dimensions of HRQoL were more affected by headache among men; psychological dimensions were more affected among women. Among both men and women, pain conditions were associated with poorer socioeconomic conditions and life-style factors but there were gender differences. Education and unemployment were important only among men while economical difficulties, half-time work and being married were associated with pain among women. Obesity, early disability retirement, long time sick-leave and lack of exercise were associated with pain conditions generally. Factors associated with pain conditions were unevenly distributed between genders. CONCLUSION: There are major differences between men and women in the prevalence and severity of self-reported pain in the population. Biological factors may explain some of the differences but the main explanation is presumably gender disparities in work, economy, daily living, social life and expectations between women and men. Although improved working conditions are of importance, deeper societal changes are needed to reduce the inequities in pain experiences between women and men.

Self-reported dermatological problems and preferences for health: an epidemiological survey.

Patient preferences for health can be assessed and expressed in quantitative terms known as health state utilities. In this epidemiological study, we demonstrate the importance of dermatological problems for health state utilities. A cross-sectional survey including 5,404 individuals aged 20-84 years was conducted in the County of Uppland, Sweden. Information on dermatological problems and use of prescription-only topical drugs was obtained by self-report. Dermatological problems were reported by 20.5%. A rating scale used to assess utilities showed that persons reporting dermatological problems had lower health state utilities than those not reporting such problems (p<0.001). Persons using prescription-only topical drugs had lower health state utilities than others with dermatological problems. Dermatological problems had an independent and statistically significant effect on health state utilities when age, sex, somatic and psychiatric co-morbidity, and pain were included in the multivariate analysis. It is shown that skin disorders are a considerable problem in the population and results in a significant decrease in health state utilities.

A Swedish population-based study on the relationship between the SF-36 and health utilities to measure health in hypertension.

The aim of this study was to determine the relationship between a psychometric health-related quality-of-life instrument (the SF-36)-and two health utility measures [the time trade-off (TTO) and rating scale (RS) methods) among hypertensives in a general population. In the analyses were adjusted for comorbidity. The study was based on a postal questionnaire that was sent to a random sample of 8000 inhabitants aged 20-84 years (response rate 68%) in Uppsala County, Sweden, in 1995. The results showed only a moderate correlation between the TTO and the RS methods. The different dimensions of SF-36 were overall lower correlated with the TTO method than with the RS method. Co-morbidity was not associated with the RS or the TTO method among hypertensives. The regression equations explained 58% of the variance in RS among hypertensives. The corresponding value for the TTO method was about 20%. In conclusion, our study found that among hypertensives the SF-36 is low to moderate correlated to the TTO and RS methods. Health utilities and psychometric measures represent different attributes of health. It is therefore important to be aware of the differences between psychometric and utility measures when interpreting results from studies using different methods. More work is needed to explicate if health utilities can be obtained from the SF-36.

Dosage patterns of antipsychotic drugs for the treatment of schizophrenia in Swedish ambulatory clinical practice--a highly individualized therapy.

OBJECTIVE: To analyse the dosage pattern of antipsychotic drugs for schizophrenia in ambulatory care in Sweden. METHOD: The study was based on a nationwide consecutive weekly random sample of physicians during the period 1991-98 comprising 265,331 visits. RESULTS: In 515 visits (0.19%), antipsychotics were prescribed for schizophrenia. More than one antipsychotic (50 different combinations) was prescribed in 20% of the visits. Patients received higher total daily doses when prescribed more than one antipsychotic drug; mean dose in monotherapy was 210.7 chlorpromazine equivalents (CPZeq) and in polytherapy 406.8 CPZeq. CONCLUSION: Antipsychotics, in contrast to current recommendations, were prescribed as highly individualized therapies in a wide variety of doses and with a high frequency of polypharmacy. The combinations used are often unsuitable and may lead to unnecessary adverse effects.

On the measurement of relative and absolute income-related health inequality.

In recent work on international comparisons of income-related inequalities in health, the concentration index has been used as a measure of health inequality. A drawback of this measure is that it is sensitive to whether it is estimated with respect to health or morbidity. An alternative would be to use the generalized concentration index that is based on absolute rather than relative health differences. In this methodological paper, we explore the importance of the choice of health inequality measure by comparing the income-related inequality in health status and morbidity between Sweden and Australia. This involves estimating a concentration index and a generalized concentration index for the eight-scale health profile of the Short Form 36 (SF-36) health survey. We then transform the scores for each scale into a measure of morbidity and show that whether the concentration index is estimated with respect to health or morbidity has an impact on the results. The ranking between the two countries is reversed for two of the eight dimensions of SF-36 and within both countries the ranking across the eight SF-36 scales is also affected. However, this change in ranking does not occur when the generalized concentration index is compared and we conclude with the implications of these results for reporting comparisons of income-related health inequality in different populations.