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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)
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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 

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