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Articles
Published Online: 1 October 2014

Educational Gradients in Psychotropic Medication Use Among Older Adults in Costa Rica and the United States

Marisa Elena Domino, Ph.D., William H. Dow, Ph.D., and Fernando Coto-Yglesias, M.D.Authors Info & Affiliations
Publication: Psychiatric Services
Volume 65, Number 10
https://doi.org/10.1176/appi.ps.201300092
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Abstract

Objective

The relationship of education, psychiatric diagnoses, and use of psychotropic medication has been explored in the United States, but little is known about this relationship in poorer countries, despite the high burden of mental illness in these countries. This study estimated educational gradients in diagnosis and psychotropic drug use in the United States and Costa Rica, a middle-income country with universal health insurance.

Methods

Analyses were conducted by using data of older adults (≥60) from the 2005 U.S. Medical Expenditure Panel Survey (N=4,788) and the 2005 Costa Rican Longevity and Healthy Aging Study (N=2,827). Logistic regressions examined the effect of education level (low, medium, or high) and urban residence on the rates of self-reported mental health diagnoses, screening diagnosis, and psychotropic medication use with and without an associated psychiatric diagnosis.

Results

Rates of self-reported diagnoses were lower in the United States (12%) than in Costa Rica (20%), possibly reflecting differences in survey wording. In both countries, the odds of having depression were significantly lower among persons with high education. In Costa Rica, use of psychotropic medication among persons with self-reported diagnoses increased by education level.

Conclusions

The educational gradients in medication use were different in the United States and Costa Rica, and stigma and access to care in these countries may play an important role in these differences, although type of insurance did not affect educational gradients in the United States. These analyses increase the evidence of the role of education in use of the health care system.

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Information & Authors

Information

Published In

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Cover: Shamrock Ranch, by Peter Hurd, 1962. Watercolor, 12 × 16 inches. New Mexico Museum of Art, Santa Fe. Gift of the family of Edythe C. Mattone, 2005.

Psychiatric Services
Volume 65 • Number 10 • October 2014
Pages: 1218 - 1225
PubMed: 24932755

History

Published online: 1 October 2014
Published in print: October 2014

Authors

Details

Marisa Elena Domino, Ph.D.
Dr. Domino is with the Department of Health Policy and Management, University of North Carolina, Chapel Hill (e-mail: [email protected]). Dr. Dow is with the Division of Health Policy and Management, University of California, Berkeley. Dr. Coto-Yglesias is with the Department of Geriatric Medicine, National Geriatrics and Gerontology Hospital, Caja Costarricense de Seguro Social, San Jose, Costa Rica.
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William H. Dow, Ph.D.
Dr. Domino is with the Department of Health Policy and Management, University of North Carolina, Chapel Hill (e-mail: [email protected]). Dr. Dow is with the Division of Health Policy and Management, University of California, Berkeley. Dr. Coto-Yglesias is with the Department of Geriatric Medicine, National Geriatrics and Gerontology Hospital, Caja Costarricense de Seguro Social, San Jose, Costa Rica.
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Fernando Coto-Yglesias, M.D.
Dr. Domino is with the Department of Health Policy and Management, University of North Carolina, Chapel Hill (e-mail: [email protected]). Dr. Dow is with the Division of Health Policy and Management, University of California, Berkeley. Dr. Coto-Yglesias is with the Department of Geriatric Medicine, National Geriatrics and Gerontology Hospital, Caja Costarricense de Seguro Social, San Jose, Costa Rica.
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