Abstract
To investigate the association of mental health and subjective physical functioning with future antibiotic prescriptions. Prospective cohort study. A rural town in Japan. Participants who completed the baseline survey (2008-2010) of the Locomotive Syndrome and Health Outcomes in the Aizu Cohort Study (LOHAS) were recruited. Participants were limited to those without comorbidities according to the Charlson comorbidity index. Participants using antibiotics at baseline were excluded. Mental health and physical functioning were assessed using the Mental Health and Physical Functioning domains of the Short-Form 12 Health Survey, and depressive symptoms were assessed using the Mental Health Inventories at baseline. The main outcome was antibiotic prescriptions found in claims data during 1 year after the baseline survey. A total of 967 participants were included in the analysis, and 151 (15.6%) participants with at least one missing variable for the confounding factors were excluded, leaving 816 participants for the primary analysis. Among the 816 participants, 65 (8.0%) were newly prescribed at least one antibiotic during the 1-year follow-up period. The most frequently prescribed antibiotics were third-generation cephalosporins (44 prescriptions; 35.5%), macrolides (28 prescriptions; 22.6%), and quinolones (23 prescriptions; 18.6%). A multivariable logistic regression analysis showed an association between higher mental health scores and future antibiotic prescriptions (adjusted odds ratio [AOR], 1.40 per 1 standard deviation [SD] increase; 95% confidence interval [CI], 1.03-1.90), whereas no significant relationship was observed between Physical Functioning scores and future antibiotic prescriptions (AOR, 0.95 per 1 SD increase; 95% CI, 0.75-1.22). During the secondary analysis, adults with depressive symptoms were less likely to be prescribed antibiotics (AOR, 0.27; 95% CI, 0.11-0.70). Better mental health was associated with increased future antibiotic prescriptions for healthy community-dwelling Japanese adults, suggesting that mentally healthier adults could be a target population for reducing antimicrobial use.
Highlights
Antimicrobial resistance (AMR) has become a global problem in recent years
A multivariable logistic regression analysis showed an association between higher mental health scores and future antibiotic prescriptions, whereas no significant relationship was observed between Physical Functioning scores and future antibiotic prescriptions (AOR, 0.95 per 1 SD increase; 95% confidence intervals (CIs), 0.75– 1.22)
Adults with depressive symptoms were less likely to be prescribed antibiotics (AOR, 0.27; 95% CI, 0.11–0.70)
Summary
Antimicrobial resistance (AMR) has become a global problem in recent years. The World Health Organization launched a global action plan to combat antimicrobial-resistant bacteria in 2015, and it asked member countries to approve national action plans within 2 years [2]. In 2016, the government of Japan launched a national action plan, and the goal was to reduce antimicrobial use by 33% by the year 2020 [3]. Reducing antibiotic prescriptions involves understanding associated factors, mainly medical staff factors and patient factors. Medical staff factors include age or sex of the physicians, practice volume, and regional characteristics [4, 5]. Patient factors may include age, sex, smoking status, socioeconomic status, and comorbidities [6,7,8]. Regarding factors associated with mental health, psychological stress might be associated with an increased occurrence of infectious diseases [9, 10], but there have been no studies of whether people with lower quality of life (QOL) are likely to be prescribed antibiotics
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