Use of Antidepressants

Before and After Road Transport Injury

J. Berecki-Gisolf, A. Collie, B. Hassani Mahmooei, R. McClure
Australasian Compensation Health Research Forum
19th November 2015

Background and study aim

Road traffic injury can have an impact on mental health
Mental health consequences of injury contribute substantially to the
burden of road traffic injury
Among trauma patients, pre-existing mental disorders are more
prevalent than in the general population
The aim of this study was to describe antidepressant use before
and after road traffic injury, in order to examine the assumption
that post injury antidepressant use can be attributed to the
incident injury
Antidepressant prescription use was considered a proxy for prevalence
of treated mental health conditions

Use of Antidepressants Before and After Road Transport Injury

19th November 2014

Medicare and PBS data linkage study

Transport Accident Commission (TAC)
Non-catastrophic injury that occurred between 2010-2012
Informed consent for Medicare & PBS data linkage (8%)

MBS/PBS data provided by the Department of Human Services

Linked to TAC claims and payment records: Compensation Research
Database (CRD), ISCRR
De-identified research database

Use of Antidepressants Before and After Road Transport Injury

19th November 2014

Sample & Data

734 Study participants: 335 men, 399 women.
42,629 Medicare items &
27,755 PBS items used 12 months pre- to 18 months post-injury

Use of Antidepressants Before and After Road Transport Injury

19th November 2014

Antidepressant use: Method

Antidepressants used in the 12 months prior to crash were identified in
the PBS data
Antidepressants used in the 12 months following the crash were
identified in the PBS data and the TAC payment records
ATC codes were added to the PBS item codes: Antidepressants were
identified as starting with N06A.
TAC payments for non-PBS prescriptions were processed manually
Use was expressed as number of antidepressant users as well as
defined daily dosages (DDD) per 1000 person-days
It was assumed that filled prescriptions were consumed

Use of Antidepressants Before and After Road Transport Injury

19th November 2014

Antidepressant use: Findings

12% of study participants used antidepressants in the year before injury
Pre-injury use was 84 DDD / 1000 person-days in the sample
17% used antidepressants in the year after injury

Post-injury use was 114 DDD / 1000 person-days

Pre-injury, non-selective monoamine reuptake inhibitors (NSMRI)
accounted for 7%, selective serotonin reuptake inhibitors (SSRI) for
50% and other antidepressants for 43% of use

Post-injury, NSMRI use increased by 22%, SSRI use increased by 5%

and other antidepressant use increased by 42%

Use of Antidepressants Before and After Road Transport Injury

19th November 2014

Substance name

Subgroup

DDD/1000 p.d.

Imipramine

DDD/1000 p.d.

0.00

0.04

3.89

5.76

0.06

0.10

0.37

0.33

Dosulepin

1.63

1.35

Fluoxtine

6.58

4.81

Citalopram

3.76

3.55

3.92

2.80

10.30

16.46

Fluvoxamine

1.85

0.39

Escitalopram

15.89

16.30

Mirtazapine

6.33

11.81

16.97

22.34

8.83

15.42

3.97

12.65

Amitriptyline
Nortriptyline

Doxepin

Paroxetine

Sertraline

Venlafaxine
Duloxetine
Desvenlafaxine

Non-selective
monoamine
reuptake inhibitors

Selective serotonin
reuptake inhibitors

Other
antidepressants

Use of Antidepressants Before and After Road Transport Injury

19th November 2014

Distribution of first script

Use of Antidepressants Before and After Road Transport Injury

19th November 2014

Distribution of last script

Use of Antidepressants Before and After Road Transport Injury

19th November 2014

Pre and post injury use

Pre-injury
N
All

Row %

Post-injury
DDD/1000
p.d.

Row
%

DDD/1000
p.d.

734

12

84.4

17

114.1

Men

335

54.6(1)

15

90.6(2)

Women

399

17

109.4

20

133.9

<25

69

12

60.9

13

94.1

25-44

222

10

58.4

14

79.2

45-64

277

12

90.2

19

138.1

65

166

16

119.0

21

129.2

Sex

Age

(1) P<0.0001; (2) P=0.05

Use of Antidepressants Before and After Road Transport Injury

19th November 2014

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Pre and post injury use

Pre-injury

Post-injury

Row
%

DDD/1000
p.d.

Row
%

DDD/1000
p.d.

Role in the accident

Car-driver

394

16

109.3(1)

20

143.5(2)

Car-passenger

59

14

69.4

19

91.7

Motor cyclist

93

16.9

12

66.6

Pedestrian

83

16

107.8

23

139.5

Cyclist

94

18.3

11.1

Other

11

18

228.6

27

272.7

(1) P=0.0006; (2) P=0.002

Use of Antidepressants Before and After Road Transport Injury

19th November 2014

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Pre and post injury use

Pre-injury

Post-injury

Row % DDD/1000p.d.

Row %

DDD/1000p.d.

Injury type
Musculoskeletal

200

17

116.1

21

127.8

Orthopaedic

179

11

63.4

18

93.7

Other Injury

223

11

85.5

12

112.6

Other severe

132

11

62.8

20

123.6

Yes

179

17

119.3(1)

21

130.0

No

555

11

73.1

16

109.0

Whiplash injury

(1) P=0.03

Use of Antidepressants Before and After Road Transport Injury

19th November 2014

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New onset post-injury use

There were 128 study participants who used antidepressants in the
year after injury. Among these participants, in the pre-injury year:

Use of Antidepressants Before and After Road Transport Injury

19th November 2014

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Conclusions
Among those taking antidepressant medication in the year after injury,
this could be considered to be a consequence of the injury in only 45%
of cases
For the remaining 55% it was a continuation of pre-injury antidepressant
use
Pre-injury antidepressant use was particularly prevalent amongst
women and among those with whiplash injury
Antidepressant use was rare among injured cyclists
These results highlight the importance of obtaining information on preinjury health status before interpreting post-injury health service use to
be an outcome of injury

Use of Antidepressants Before and After Road Transport Injury

19th November 2014

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The study was funded by the

Transport Accident Commission
(TAC) and the Victorian Workcover
Authority (VWA) Institute for Safety,
Compensation and Recovery
Research (ISCRR)

Use of Antidepressants Before and After Road Transport Injury

19th November 2014

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