[Gender and psychiatric drugs: a qualitative study to find the views of prescription-fillers]. / Género y psicofármacos: la opinión de los prescriptores a través de una investigación cualitativa.

OBJECTIVES: To find the views of those filling out prescriptions on the factors that affect differential prescription of psychiatric medication, and on reducing the prescription; and to analyse their discourse for possible implicit gender bias. DESIGN: Qualitative methodology. Semi-structured interviews conducted in 2002-2003. SETTING: Urban and rural health centres. PARTICIPANTS: Family and community medicine and psychiatry professionals working in the public health services of Andalusia, the Community of Madrid, and the Basque Country. Segmentation criteria: community of residence, age, sex, medical speciality, and location of centre. METHODS: Structural sample. Interviews conducted by the research team. Strategy of analysis in two distinct processes: contents analysis with agreed categories and gender analysis of the discourse. RESULTS. The prescribers found that taking psychiatric medication was associated with sex, age, social and economic category, and social expectations. In the discourses we found consumer profiles emerging that were not found in the epidemiological literature. Discourse analysis showed implicit gender bias in the beliefs of some prescribers. CONCLUSIONS. To minimise the growing offer and demand for psychiatric medication, prescribers thought training in diagnosis and psychotherapy should be improved, case-loads should be reduced, co-ordination between services improved and alternative treatments favoured. To minimise gender bias in the diagnosis and prescription of psychiatric medication, we think training is needed on the influence of cultural and gender factors on the process of construction of identities.

Género y psicofármacos: la opinión de los prescriptores a través de una investigación / Gender and psychiatric drugs: a qualitative study to find the views of prescription-fillers

Objetivos. Conocer la opinión de los prescriptores en relación con los factores que influyen en la prescripción diferencial y sus propuestas para disminuir la prescripción de psicofármacos, así como analizar los discursos con el objeto de mostrar los posibles sesgos de género implícitos. Diseño. Metodología cualitativa. Entrevistas semiestructuradas realizadas durante los años 2002 y 2003. Emplazamiento. Centros de salud urbanos y rurales. Participantes. Profesionales de medicina familiar y comunitaria y psiquiatría que trabajan en los servicios públicos de salud de Andalucía, Comunidad de Madrid y País Vasco. Criterios de segmentación: comunidad de residencia, edad, sexo, especialidad médica y ubicación del centro. Métodos. Muestra estructural. Entrevistas realizadas por el equipo investigador. Estrategia de análisis en dos procesos diferenciados: análisis de contenido con categorías consensuadas y análisis del discurso desde la perspectiva de género. Resultados. En los prescriptores se observa una asociación entre el consumo de psicofármacos y el sexo, la edad, el nivel socioeconómico y las expectativas sociales. En los discursos encontramos perfiles emergentes de consumidores que no aparecen en la bibliografía epidemiológica. El análisis del discurso pone de manifiesto sesgos de género implícitos en las creencias de algunos prescriptores. Conclusiones. Para minimizar la creciente oferta y demanda de psicofármacos, los prescriptores consideran necesario mejorar la formación en diagnosis y psicoterapia, rebajar la presión asistencial, mejorar la coordinación entre servicios y favorecer tratamientos alternativos. Para minimizar los sesgos de género en el diagnóstico y la prescripción de psicofármacos consideramos necesaria la formación en cuestiones relacionadas con la influencia de los factores culturales y generalizadas en el proceso de construcción de las identidades

Objectives. To find the views of those filling out prescriptions on the factors that affect differential prescription of psychiatric medication, and on reducing the prescription; and to analyse their discourse for possible implicit gender bias. Design. Qualitative methodology. Semi-structured interviews conducted in 2002-2003. Setting. Urban and rural health centres. Participants. Family and community medicine and psychiatry professionals working in the public health services of Andalusia, the Community of Madrid, and the Basque Country. Segmentation criteria: community of residence, age, sex, medical speciality, and location of centre. Methods. Structural sample. Interviews conducted by the research team. Strategy of analysis in two distinct processes: contents analysis with agreed categories and gender analysis of the discourse. Results. The prescribers found that taking psychiatric medication was associated with sex, age, social and economic category, and social expectations. In the discourses we found consumer profiles emerging that were not found in the epidemiological literature. Discourse analysis showed implicit gender bias in the beliefs of some prescribers. Conclusions. To minimise the growing offer and demand for psychiatric medication, prescribers thought training in diagnosis and psychotherapy should be improved, case-loads should be reduced, co-ordination between services improved and alternative treatments favoured. To minimise gender bias in the diagnosis and prescription of psychiatric medication, we think training is needed on the influence of cultural and gender factors on the process of construction of identities