Antidepressant use in Sweden: an intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)

Abstract

Introduction: Antidepressants are among the most commonly prescribed drugs in Sweden. However, we lack detailed knowledge on the socioeconomic and demographic distribution of antidepressant use in the population. To fill this gap, we performed an intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy.

Methods: Analysing all Swedish residents older than 10 years (n=8,190,990), we measured the absolute risk of antidepressant use across 144 intersectional strata defined by combinations of age, gender, income, country of birth and psychiatric diagnosis. We calculated the strata-specific absolute risk of antidepressant use in a series of multilevel logistic regression models. By means of the variance partitioning coefficient and the area under the receiver operating characteristic curve, we quantified the discriminatory accuracy of the intersectional contexts (i.e. strata) for discerning those who use antidepressants from those who do not.

Results: The absolute risk of antidepressant use ranged between 0.93% and 24.78% among those without a psychiatric diagnosis, and between 21.41% and 77.56% among those with a psychiatric diagnosis. Both the variance partitioning coefficient of 41.88% and the area under the receiver operating characteristic curve of 0.81 were considerable.

Conclusions: Besides overt psychiatric diagnoses, our study shows that antidepressant use is mainly conditioned by age, which might express the embodiment of socioeconomic conditions across the individual life course. Our analysis provides a detailed and highly discriminatory mapping of the heterogeneous distribution of antidepressant use in the Swedish population, which may be useful in public health management.

Keywords: Antidepressants; MAIHDA; Sweden; intersectionality; socioeconomic factors.

Figure 1.

Flow chart documenting inclusion criteria, exclusion criteria and the total number of individuals included in the study population.

Figure 2.

(a) Prevalence of antidepressant use (model 1) in individuals without a psychiatric diagnosis by intersectional strata defined by age, gender, country of birth (N for natives, and I for immigrants) and low (L), middle (M) and high (H) income levels. The association between the three levels of income and antidepressant use is illustrated by circles connected by thin lines and crossed by vertical lines representing 95% credible intervals (CIs). (b) Prevalence of antidepressant use (model 1) in individuals with a psychiatric diagnosis by intersectional strata defined by age, gender, country of birth (N for natives, and I for immigrants) and low (L), middle (M), and high (H) income levels. The association between the three levels of income and antidepressant use is illustrated by circles connected by thin lines and crossed by vertical lines representing 95% CIs.