Abstract
ObjectivesResearchers need to be confident about the reliability of epidemiologic studies that quantify medication use through self-report. Some evidence suggests that psychiatric medications are systemically under-reported. Modern record linkage enables validation of self-report with national prescribing data as gold standard. Here, we investigated the validity of medication self-report for multiple medication types. Study Design and SettingParticipants in the Generation Scotland population-based cohort (N = 10,244) recruited 2009–2011 self-reported regular usage of several commonly prescribed medication classes. This was matched against Scottish NHS prescriptions data using 3- and 6-month fixed time windows. Potential predictors of discordant self-report, including general intelligence and psychological distress, were studied via multivariable logistic regression. ResultsAntidepressants self-report showed very good agreement (κ = 0.85, [95% confidence interval (CI) 0.84–0.87]), comparable to antihypertensives (κ = 0.90 [CI 0.89–0.91]). Self-report of mood stabilizers showed moderate-poor agreement (κ = 0.42 [CI 0.33–0.50]). Relevant past medical history was the strongest predictor of self-report sensitivity, whereas general intelligence was not predictive. ConclusionIn this large population-based study, we found self-report validity varied among medication classes, with no simple relationship between psychiatric medication and under-reporting. History of indicated illness predicted more accurate self-report, for both psychiatric and nonpsychiatric medications. Although other patient-level factors influenced self-report for some medications, none predicted greater accuracy across all medications studied.
Highlights
ObjectivesResearchers need to be confident about the reliability of epidemiologic studies that quantify medication use through selfreport
Cohort studies, and other epidemiologic studies using self-reported data, depend on the accuracy of the selfreport to make accurate and reliable conclusions
The first phase of the study used a text-based questionnaire which is not part of this analysis. Those individuals recruited between June 2009 and March 2011 (n 5 10,980, 59.5% female) completed a coded questionnaire where the Medications section was a ‘‘Yes’’ vs. ‘‘No’’ checkbox, with the accompanying question ‘‘Are you regularly taking any of the following medications?’’ The available options were (1) ‘‘cholesterol-lowering medication (e.g., Simvastatin)’’; (2) ‘‘blood pressureelowering medication’’; (3) ‘‘insulin’’; (4) ‘‘hormone replacement therapy’’; (5) ‘‘oral contraceptive pill or mini pill’’; (6) ‘‘Aspirin’’; (7) ‘‘antidepressants’’; and (7) ‘‘mood stabilizers.’’ The completed questionnaires were machine read and electronically recorded using anonymized patient linkers
Summary
Researchers need to be confident about the reliability of epidemiologic studies that quantify medication use through selfreport. Some evidence suggests that psychiatric medications are systemically under-reported. Modern record linkage enables validation of self-report with national prescribing data as gold standard. We investigated the validity of medication self-report for multiple medication types
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