ABSTRACT
UNLABELLED: The knowledge of psychotropic medication consumption is a Public Health stake for the armies and their social partners. Indeed, indirectly, it permits not only assessment of the state of health or the mental state of the working militaries, but also the development of actions to increase consumers' and prescribers' awareness of the main effects of psychotropic drugs and their side effects. The evaluation of the consumption of psychotropic drugs is based on the reimbursements requested from the "Caisse nationale militaire de Sécurité sociale", a particular scheme of the health fund, to which every working military is affiliated. MATERIAL AND METHOD: A retrospective inquiry was led on elements of reimbursement for antidepressants, anxiolytics, hypnotics, neuroleptics, lithium salts and medicines used in alcoholic weaning during the year 2005. RESULTS: The study concerned 35 365 social insurance contributors, i.e. 8.6% of the working militaries' population. They were mainly men (74.8%) and the mean age was 35.7 years. The refund rate was more important for women (15.6% versus 7.43%) and when the age increased: 6.13% for the 15-24 years versus 15.3% for the 50-59 years. Only 1.4% of the consumers exhibited a long-term psychiatric disorder. A percentage of 21.8% of the consumers had at least four refunds in the year. Anxiolytics, followed by antidepressants and hypnotics, were the medication most often reimbursed. A total of 93,119 prescriptions, including at least one psychotropic medication, were reimbursed in 2005. A percentage of 54.1% of the consumers had only had one prescription in the year. The coprescription of different therapeutic classes represented 41.5% of the prescriptions, the most common being an association between an anxiolytic and an antidepressant (46.8%). The consumers had consulted 49,802 doctors, mainly general practitioners (GPs) (83.6%), and psychiatrists (7.1%). The army doctor, counted with the GPs, was very little sought after (5.3%). Most of the doctors (67.4%) prescribed only once for the same consumer. Compared with GPs, psychiatrists mainly prescribed antidepressants (47.6% versus 35.7% for GPs) and associated more often, another therapeutic class on the same prescription (53.9% versus 30.9% for GPs). CONCLUSION: Our results show that the consumer's profile in the class of the working militaries does not differ from that found in other studies conducted on professionals. The GP is the main prescriber of psychotropic drugs, but this kind of prescription is different from the psychiatrist's. The military doctor is little implicated in the prescription of psychotropics, the link between aptitude and use is obviously the main explanation. The good use of psychotropic medication has to be reinforced for both consumers and prescribers. Other alternatives than the call on medicine have to be reinforced by improving the prevention and the management of psychological disorders and psychiatric affections.
