(313) Influence of unemployment on antidepressant sales in drugstores in Brazil: time series analysis, 2014-2021

Background: Unemployment is a risk factors for mental health, and may also impact the consumption of psychotropic drugs. The effect of unemployment on antidepressant consumption in Brazil is unknown.

Objectives: To assess the relationship between unemployment and antidepressant sales records in Brazil.

Methods: This is a time series analysis based on monthly unemployment data from the Brazilian Institute of Geography and Statistics and antidepressant sales records in the Brazilian System of Controlled Product Management (SNGPC), from 2014 to 2021. We used Getulio Vargas Foundation’ economic uncertainty index as adjustment variable. The defined daily dose (DDD) was calculated for each antidepressant and then divided by the population for each year, per day, to obtain the DDD/1,000 inhabitants/day (DID). Antidepressants were classified according to the availability in the Unified Health System’s (SUS) Essential Medicines List. The time series was closed in October 2021, considering SNGPC records’ stability. The time series was normalized to unify the basis, and percentage variation was calculated. All data were transformed using the natural logarithm. The Hodrick-Prescott filter was used to remove seasonality and stationarity was verified using the augmented Dickey-Fuller unit root and Phillips-Perron tests. The relationship between antidepressant consumption and unemployment was investigated using weighted ordinary least squares regression models. Breusch-Godfrey Lagrangian multiplier test for residual independence, Prais-Winsten and Cochrane-Orcutt regressions were applied to generate corrected residuals, which were subsequently used in weighted least squares regression. All analyzes were performed using Stata 14.2.

Results: In January 2014 the monthly consumption of antidepressants was 26.2 DID, the unemployment rate, 7.2% and political economic uncertainty, 136.7%, and at the end of the history, in October 2021, antidepressant sales was 37.8 DID/month, unemployment, 11.1%, and economic uncertainty index, 260.7%. It was observed that 1% increase in unemployment rate in the previous month led to an increase of 1.12% (95%CI: 0.63-1.77%) in antidepressants sales, being greater in medicines not available in SUS (0.54%; 95%CI: 0.23-0.86%) than those available in the system (0.47%; 95%CI: 0.22-0.73%). The increase in the economic uncertainty index did not influence the sale of antidepressants.

Conclusions: In Brazil, from 2014 to 2021, the sale of antidepressants was potentially increased by the increase in unemployment. This is still initial research and, therefore, there is a promising field to be explored in the use of databases for epidemiological studies in Brazil.