Les recours aux médicaments psychotropes des travailleurs indépendants à l'âge du départ en retraite en France métropolitaine (2011)

FRANÇAIS :
OBJECTIFS. Moment biographique important, le passage à la retraite intervient à un âge où les recours aux médicaments psychotropes sont plus élevés, surtout chez les femmes, qu’aux âges inférieurs.
METHODE. Nous avons procédé à une extraction de la base des prescriptions présentées au remboursement du Régime social des indépendants (RSI) en France métropolitaine sur une période de 12 mois avant le jour de leur retraite et 12 mois après, en vue de calculer des taux de recours - généraux et par classe de médicaments psychotropes - et de rechercher l’influence du sexe, de l’âge, de la dernière profession, d’une affection psychiatrique, de la région de résidence et de la période (avant/après le départ en retraite).
RESULTATS. Le taux de recours aux psychotropes des indépendants à l’âge de la retraite s’élève à 35 % (33 % pour les hommes et 42 % pour les femmes). Les benzodiazépines constituent le premier groupe prescrit (42,5 % des volumes pour 24,8 % des personnes) ; suivent des antidépresseurs (32,1 % des volumes pour 15,3 % des personnes), des somnifères (21,0 % des volumes pour 12,9 % des personnes), des antipsychotiques (3,5 % des volumes pour 2,1 % des personnes) et des traitements de la dépendance alcoolique (1,0 % des volumes pour 0,8 % des personnes). Les groupes qui présentent les plus forts recours sont les personnes présentant une affection psychiatrique de longue durée (ALD 23 - 93,1 %), les bénéficiaires de la couverture maladie universelle (CMU - 48,8 %), les femmes (42,0 %) et les personnes de 60 ans (37,9 %), alors que les anciens artisans (33,2 %) présentent un taux de recours plus faible que les autres professions.
CONCLUSIONS. Les variables ci-dessus, ainsi que la résidence dans le Nord-Pas-de-Calais et le Limousin, sont plus reliées à de forts taux de recours que le départ en retraite ; ce dernier n’induit qu’une très faible diminution du recours aux médicaments psychotropes.
ENGLISH:
INTRODUCTION. Retiring is an important life event and occurs at an age when psychotropic medicines are used more, particularly in women, compared to younger ages. This use is liable to fall after exposure to occupational stress ends although the loss of professional recognition and ageing may cause episodes of anxiety and depression.
METHOD. We have conducted an extraction from the database of the social payments system for self-employed people (craftsmen, shopkeepers and self-employed professions) of prescriptions of psychotropic drugs presented for reimbursement in mainland France over a period of 12 months before and 12 months after retirement, i.e. a period of two years for each of the 28,293 people in the sample in order to calculate levels of use - both general and by class of psychotropic drug - and to examine the influence of sex, age, last occupation, psychiatric disease, low income, region of residence and period (before/after beginning retirement) using bivariate analysis and logistic regression.
RESULTS. Psychotropic drugs were used in self-employed people at the time of retirement by 33% of men and 42% of women (34.9% both sexes combined). 28.1% of recipients were given one prescription, 46.1% between two and five, 17.2% between six and ten and 8.7% more than ten prescriptions during the two years of the study (mean = 4.4 prescriptions per person). The leading group prescribed was benzodiazepines (42.5% of volume - 24.8% of people), followed by antidepressants (32.1% of volume - 15.3% of people), hypnotics (21% of volume - 12.9% of people), antipsychotics (3.5% of volume - 2.1% of people) and treatments for alcohol dependency (1% of volume - 0.8% of people). The greatest users were people with long-term psychiatric disorders (LTD23 - 93.1%; OR = 22.1; P < 0.001), those with low incomes (48.8%; OR = 1.7; P < 0.001), women (42%; OR = 1.4; P < 0.001) and those of 60 years old (37.9%; OR = 1.1 compared to those under 60 years old; P < 0,001), whereas former craftsmen (33.2%) had lower use than other professions. Rates of use were significantly higher in six regions in men, including Nord-Pas-de-Calais and Limousin, which were the only two regions in which rates were also significantly higher in women. Of those who took psychotropic drugs during the observation period, 53.7% continued to take them after they had retired; 21.2% stopped using them once they had retired and a similar proportion (21.5%) began to use them after retiring. The number of prescriptions (21,741 during the year before retirement and 21,337 during the year after retirement) fell very slightly (-2%).
CONCLUSIONS. More than a third of self-employed people in mainland France use psychotropic drugs at retirement age. The end of occupational stress which may be the reason for taking some of these drugs results in few changes in use, possibly because use has become more habitual than necessary. Documented psychiatric disease, low income, living in Limousin, female sex and living in Nord-Pas-de-Calais, emerge in decreasing order of importance in our study as factors most closely related to frequent use.