Socioenvironmental determinants of polypharmacy in mental health disorders: a systematic review.
Over the past decades, the role of socioenvironmental determinants (SEDs) on shaping mental health outcomes has gained increasing attention. However, their relationship with antipsychotic and psychotropic polypharmacy (PP) remains unknown.
This systematic review aimed to synthesise evidence on the association between SEDs and PP, as well as summarising PP prevalence in patients with mental health disorders (MHDs).
A systematic search was conducted in PubMed, Web of Science, CINHAL, PsycINFO and Scopus databases. Literature was also sourced from Google, Google Scholar and the reference lists of included studies. The review included all studies reporting on sociodemographic and SEDs on psychotropic and antipsychotic PP in patients with MHDs. The prevalence rates were computed using medians and interquartile ranges (IQR), while factors associated with PP were summarised in a table.
A total of 65 findings from 57 studies were analysed, 45 examining antipsychotic PP and 20 studied psychotropic PP. The median prevalences of psychotropic and antipsychotic PP were 30.5% (IQR: 18.0-39.5) and 28.1% (IQR: 18.7-42.9), respectively. Additionally, studies targeting inpatients, patients with schizophrenia and those utilising medical records had higher median prevalence rates. Moreover, our review found that family income to poverty ratios, family adverse consequences, Childhood Opportunity Index, social deprivation and area of residence (e.g. rural, metropolitan) were reported to be significant factors of PP in patients with MHDs.
Though the reported PP prevalence estimates varied, our systematic review showed that psychotropic and antipsychotic PPs are widespread in clinical practices. Additionally, a few SEDs were reported to be significantly associated with PP in patients with MHDs. This highlights the importance of investigating these modifiable factors. Hence, further in-depth exploration of the relationships between SEDs and polypharmacy is required. Evidence generated through such studies informs population-level strategies to reduce PP, improve equity in mental healthcare, and ultimately enhance patient outcomes.
This systematic review aimed to synthesise evidence on the association between SEDs and PP, as well as summarising PP prevalence in patients with mental health disorders (MHDs).
A systematic search was conducted in PubMed, Web of Science, CINHAL, PsycINFO and Scopus databases. Literature was also sourced from Google, Google Scholar and the reference lists of included studies. The review included all studies reporting on sociodemographic and SEDs on psychotropic and antipsychotic PP in patients with MHDs. The prevalence rates were computed using medians and interquartile ranges (IQR), while factors associated with PP were summarised in a table.
A total of 65 findings from 57 studies were analysed, 45 examining antipsychotic PP and 20 studied psychotropic PP. The median prevalences of psychotropic and antipsychotic PP were 30.5% (IQR: 18.0-39.5) and 28.1% (IQR: 18.7-42.9), respectively. Additionally, studies targeting inpatients, patients with schizophrenia and those utilising medical records had higher median prevalence rates. Moreover, our review found that family income to poverty ratios, family adverse consequences, Childhood Opportunity Index, social deprivation and area of residence (e.g. rural, metropolitan) were reported to be significant factors of PP in patients with MHDs.
Though the reported PP prevalence estimates varied, our systematic review showed that psychotropic and antipsychotic PPs are widespread in clinical practices. Additionally, a few SEDs were reported to be significantly associated with PP in patients with MHDs. This highlights the importance of investigating these modifiable factors. Hence, further in-depth exploration of the relationships between SEDs and polypharmacy is required. Evidence generated through such studies informs population-level strategies to reduce PP, improve equity in mental healthcare, and ultimately enhance patient outcomes.
Authors
Tegegne Tegegne, Tabatabaei-Jafari Tabatabaei-Jafari, Niyonsenga Niyonsenga, Ghiasvand Ghiasvand, Bagheri Bagheri, Bagheri Bagheri
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