Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-10T11:08:55.475Z Has data issue: false hasContentIssue false
  • English
  • Français

Mental health medication and service utilisation before, during and after war: a nested case–control study of exposed and non-exposed general population, ‘at risk’, and severely mentally ill cohorts

Published online by Cambridge University Press:  30 January 2015

M. Gelkopf ,
A. Kodesh  and
N. Werbeloff
M. Gelkopf*
Affiliation:
Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
A. Kodesh
Affiliation:
Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
N. Werbeloff
Affiliation:
Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel
*
*Address for correspondence: M. Gelkopf, Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Haifa 31905, Israel. (Email: emgelkopf@013.net)
Get access Rights & Permissions [Opens in a new window]

Abstract

Aims.

To examine changes in service utilisation before, during and after the 2006 Lebanon War – a 34-day military conflict in northern Israel and Lebanon – among three groups: general population, people ‘at risk’ for depression or anxiety and severely mentally ill individuals. Given that exposure to traumatic events is a pathogenic factor known to cause and exacerbate psychiatric distress and disorder, we hypothesised that healthcare service utilisation would increase in populations exposed to war, especially among more vulnerable populations such as those with mental illness.

Method.

A nested case–control design was used to examine changes in health care utilisation and use of psychiatric medication as recorded by the databases of Maccabi Healthcare Services (MHS), one of Israel's largest health maintenance organisations (HMOs). Purchases of benzodiazepines, antidepressants and antipsychotic medications were identified from all the medications purchased in pharmacies by MHS members during 2006. Drug consumption data were expressed as defined daily doses (DDDs), summing all DDDs per person per month. Similarly, number of visits to general practitioners (GPs), psychiatrists and Emergency Rooms (ERs) were summed per person per month. Three-way repeated measures ANOVA was used, including the variables time (12 months), region (north/other) and study group.

Results.

During the war there was a decline in GP visits among people from the general population and people ‘at risk’ for depression/anxiety who resided in northern Israel that was not paralleled among controls. Similarly, in all three study groups, there was a decline in the number of psychiatrist visits during the war among people from northern Israel which did not occur to the same extent in the control group. There were no changes in ER visits or use of psychiatric medication that could be attributed to the war.

Conclusions.

There is less utilisation of community services at times of war among exposed populations, and there is neither evident compensation in use of emergency services, nor any compensation after the war. This may suggest that if there is an efficient medical and mental health infrastructure, people with or without psychiatric risk factors can tolerate a few weeks of a mass stress event, with no need to expand medical service utilisation. However, service utilisation at times of war may be confounded by other variables and may not serve as a direct measure of increased stress.

Keywords

Health care utilisationpsychiatric medicationtraumatic events
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 25 , Issue 1 , February 2016 , pp. 80 - 90
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ben-Dor, A, Gelkopf, M, Sigal, M (1994). Schizophrenic inpatients and the chemical war threat: the Israeli experience of the gulf war. Journal of Nervous and Mental Disease 182, 114–116.CrossRefGoogle Scholar
Bleich, A, Gelkopf, M, Solomon, Z (2003). Exposure to terrorism, stress-related mental health symptoms, and coping behaviors among a nationally representative sample in Israel. JAMA 290, 612–620.Google Scholar
Boscarino, JA, Galea, S, Ahern, J, Resnick, H, Vlahov, D (2003). Psychiatric medication use among Manhattan residents following the World Trade Center disaster. Journal of Traumatic Stress 16, 301–306.CrossRefGoogle ScholarPubMed
Boscarino, JA, Adams, RE, Stuber, J, Galea, S (2005). Disparities in mental health treatment following the World Trade Center Disaster: implications for mental health care and health services research. Journal of Traumatic Stress 18, 287–297.CrossRefGoogle ScholarPubMed
Catalano, RA, Kessell, ER, Mcconnell, W, Pirkle, E (2004). Psychiatric emergencies after the terrorist attacks of September 11, 2001. Psychiatric Services 55, 163–166.Google Scholar
Chodick, G, Porath, A, Alapi, H, Sella, T, Flash, S, Wood, F, Shalev, V (2010). The direct medical cost of cardiovascular diseases, hypertension, diabetes, cancer, pregnancy and female infertility in a large HMO in Israel. Health Policy 95, 271–276.Google Scholar
Cohen, J (1988). Statistical Power Analysis for the Behavioral Sciences. Erlbaum: Hillsdale, NJ.Google Scholar
Cohen, R (2013). Membership in Sick Funds – 2012. In National Insurance Institute: Research and Publications (ed.). National Insurance Institute: Jerusalemr.Google Scholar
Curran, PS (1988). Psychiatric aspects of terrorist violence: Northern Ireland 1969–1988. British Journal of Psychiatry 153, 470–475.Google Scholar
Druss, BG, Marcus, SC (2004). National use of psychotropic medications before and after September 11th, 2001. American Journal of Psychiatry 161, 1377–1383.Google Scholar
Gelkopf, M, Ben-Dor, A, Abu-Zarkah, S, Sigal, M (1995). Hospital at war: treatment changes in mental patients. Social Psychiatry and Psychiatric Epidemiology 30, 256–260.Google Scholar
Goldberg, L, Dreiher, J, Friger, M, Levin, A, Shvartzman, P (2013). Health services utilization under Qassam rocket attacks. IMAJ 15, 482–486.Google Scholar
Gupta, MA (2013). Review of somatic symptoms in post-traumatic stress disorder. International Review of Psychiatry 25, 86–99.Google Scholar
Kilpatrick, DG, Acierno, R (2003). Mental health needs of crime victims: epidemiology and outcomes. Journal of Traumatic Stress 16, 119–132.Google Scholar
Kodesh, A, Goldshtein, I, Gelkopf, M, Goren, I, Chodick, G, Shalev, V (2012). Epidemiology and comorbidity of severe mental illnesses in the community: findings from a computerized mental health registry in a large Israeli health organization. Social Psychiatry and Psychiatric Epidemiology 47, 1775–1782.Google Scholar
Levav, I, Novikov, I, Grinshpoon, A, Rosenblum, J, Ponizovsky, A (2006). Health services utilization in Jerusalem under terrorism. American Journal of Psychiatry 163, 1355–1361.Google Scholar
Lira, YK, Jutta, J (2012). Stress reactivity in social anxiety disorder with and without comorbid depression. Journal of Abnormal Psychology 121, 250–255.Google Scholar
Mccarter, L, Goldman, W (2002). Use of psychotropics in two employee groups directly affected by the events of September 11. Psychiatric Services 53, 1366–1368.Google Scholar
Neria, Y, Nandi, A, Galea, S (2008). Post-traumatic stress disorder following disasters: a systematic review. Psychological Medicine 38, 467–480.Google Scholar
Neria, Y, Besser, A, Kiper, D, Westphal, M (2010). A longitudinal study of posttraumatic stress disorder, depression, and generalized anxiety disorder in Israeli civilians exposed to war trauma. Journal of Traumatic Stress 23, 322–330.Google Scholar
Palmier-Claus, JE, Dunn, G, Lewis, SW (2012). Emotional and symptomatic reactivity to stress in individuals at ultra high risk of developing psychosis. Psychological Medicine 42, 1003–1012.CrossRefGoogle ScholarPubMed
Powell, AE, Davies, HT, Thomson, RG, (2003). Using routine comparative data to assess the quality of health care: understanding and avoiding common pitfalls. Quality & Safety in Health Care 12, 122–128.Google Scholar
Press Association (2006). Mideast War, by the Numbers. The Washington Post.Google Scholar
Rosenheck, R, Fontana, A (2003). Use of mental health services by veterans with PTSD after the terrorist attacks of September 11. American Journal of Psychiatry 160, 1684–1690.Google Scholar
Solomon, Z, Gelkopf, M, Bleich, A (2005). Is terror gender-blind? Gender differences in reaction to terror events. Social Psychiatry and Psychiatric Epidemiology 40, 947–954.Google Scholar
Vlahov, D, Galea, S, Resnick, H, Ahern, J, Boscarino, JA, Bucuvalas, M, Gold, J, Kilpatrick, D (2002). Increased use of cigarettes, alcohol, and marijuana among Manhattan, New York, residents after the September 11th terrorist attacks. American Journal of Epidemiology 155, 988–996.Google Scholar
Wunsch-Hitzig, R, Plapinger, J, Draper, J, Del Campo, E (2002). Calls for help after September 11: a community mental health hot line. Journal of Urban Health 79, 417–428.Google Scholar