Rev. Enferm. UFSM, v.13, e50, p.1-12, 2023

ISSN 2179-7692 •

Submission: 9/18/2023 • Acceptance: 11/6/2023 • Publication: 12/4/2023

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Descrição gerada automaticamente com confiança média

Original article

Psychotropic drugs and socioeconomic and health characteristics of Nursing professionals in an emergency room*

Psicofármacos e características socioeconômicas e de saúde de profissionais de Enfermagem de um pronto atendimento

Psicofármacos y características socioeconómicas y de salud de los profesionales de enfermería en un servicio de urgencia

Carolina Renz Pretto^I

Rosângela Marion da Silva^I

Ana Carolina Cunha Almeida^I

Ana Caroline Cabreira Barreto^I

Flávia Camef Dorneles Lenz^I

^I Universidade Federal de Santa Maria, Santa Maria, RS, Brasil

* Refers to the original article awarded at the IV International Seminar Weaving Networks in Nursing and Health.

Abstract

Objective: To evaluate the association between the use of psychotropic drugs and socioeconomic and health variables among Nursing professionals in an emergency department. Method: a cross-sectional study with Nursing professionals from an emergency room, carried out from January to February 2021, using a sociodemographic and clinical questionnaire, a List of Signs and Symptoms of Stress, and the Pittsburgh Sleep Quality Index. Descriptive and analytical statistics were used. Results: of the 34 participants, 61.8% were under 40, 70.6% practiced physical activity at least twice a week, 70.6% had sleep disorders and 29.4% had high to very high stress. The use of psychotropic drugs was reported by 38.2% of them, mainly antidepressants and anxiolytics, associated with stress and income. Conclusion: Socio-economic and psychological problems can favor the use of psychotropic drugs by nurses. Better working conditions and pay are necessary for health.

Descriptors: Emergency Nursing; Occupational Health; Psychotropic Drugs; Sleep; Stress, Psychological

Resumo

Objetivo: avaliar a associação entre o uso de psicofármacos e as variáveis socioeconômicas e de saúde de profissionais de Enfermagem de um pronto atendimento. Método: estudo transversal com profissionais de Enfermagem de um pronto atendimento, realizado de janeiro a fevereiro de 2021, com questionário sociodemográfico e clínico, Lista de Sinais e Sintomas de Estresse e Índice de Qualidade do Sono de Pittsburgh. Utilizou estatística descritiva e analítica. Resultados: dos 34 participantes, 61,8% tinham menos de 40 anos, 70,6% praticavam atividade física ao menos duas vezes na semana, 70,6% apresentavam distúrbios do sono e 29,4% estresse alto à altíssimo. O uso de psicofármacos foi relatado por 38,2% deles, principalmente antidepressivos e ansiolíticos, associados ao estresse e à renda. Conclusão: problemas socioeconômicos e psíquicos podem favorecer o uso de psicofármacos pela Enfermagem. Melhores condições de trabalho e remuneração são necessárias para a saúde.

Descritores: Enfermagem em Emergência; Saúde Ocupacional; Psicotrópicos; Sono; Estresse Psicológico

Resumen

Objetivo: evaluar la asociación entre el uso de psicofármacos y las variables socioeconómicas y de salud de profesionales de enfermería en un servicio de urgencia. Método: estudio transversal con profesionales de enfermería de un servicio de emergencia, realizado de enero a febrero de 2021, utilizando cuestionarios sociodemográfico y clínico, Lista de Signos y Síntomas de Estrés e Índice de Calidad del Sueño de Pittsburgh. Se utilizó estadística descriptiva y analítica. Resultados: de los 34 participantes, el 61,8% tenía menos de 40 años, el 70,6% practicaban actividad física al menos dos veces por semana, el 70,6% presentaban trastorno del sueño y el 29,4% experimentó estrés alto a muy alto. El uso de psicofármacos fue reportado por el 38,2% de ellos, principalmente antidepresivos y ansiolíticos, asociados al estrés y al ingreso. Conclusión: problemas socioeconómicos y psicológicos pueden favorecer el uso de psicofármacos en enfermería. Mejores condiciones de trabajo y salarios son necesarias para la salud.

Descriptores: Enfermería de Urgencia; Salud Laboral; Psicotrópicos; Sueño; Estrés Psicológico

Introduction

Psychopharmaceuticals, also called psychotropic or psychoactive drugs, are chemical substances characterized by their potential to act on the Central Nervous System and can result in changes in the individual's behavior, perception, and consciousness.¹ Psychopharmaceuticals are known to have the capacity to cause dependence and, as a result, it is understood that the use of these substances should be monitored by specialized professionals.²

Throughout world history, various types of psychotropic drugs have been discovered and subsequently grouped into categories according to their effect on the body, although one class can be used to treat symptoms attributed to another.² Today, the most commonly used psychoactive drugs include antidepressants, anxiolytics, and hypnotic-sedatives.³

Antidepressants act by blocking the reuptake of neurotransmitters such as serotonin, dopamine, and noradrenaline, which increases their levels in the body and makes it possible to treat symptoms of depression, pain disorders, and other dysfunctions.⁴ They are classified as tricyclics, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, serotonin and noradrenaline reuptake inhibitors and noradrenaline and dopamine reuptake inhibitors. Among these, Sertraline, Venlafaxine, and Bupropion are frequently used.⁵

Anxiolytics and hypnotic sedatives, on the other hand, are characterized by their depressant action on the Central Nervous System and can induce sleep, cause sedation, and reduce anxiety and tension. They are classified as benzodiazepines, such as Diazepam and Alprazolam, and non-benzodiazepines, including Zolpidem and Eszopiclone.⁶

The use of psychotropic drugs has been analyzed in several countries due to its significant increase in recent decades and makes up one of the world's biggest public health problems, particularly due to the noted popularization and the irrefutable benefits in the treatment of mental and behavioral disorders.⁷ Nursing professionals are among the people who use these drugs. In this sense, a study of nurses found that 72.4% had used psychotropic drugs at least once in their lives and that more than 35% had used them in the last month, particularly sedatives or tranquilizers.⁸The pandemic caused by the new coronavirus in 2020 has also increased the consumption of psychoactive substances by nurses, related to post-traumatic stress disorder, anxiety, and secondary trauma, linked to cognitive failure.⁹

In the area of urgent and emergency care, one study found that 62.5% of Nursing professionals reported that their work influences the use of psychotropic drugs.¹⁰In this sense, working in urgent and emergency services, such as 24-hour Emergency Care Units (24h ECU), during the pandemic, may have increased the susceptibility of Nursing professionals to the use of psychotropic drugs. This is because these units require agile care in order to restore the vital parameters of individuals at risk of imminent death and because they have been the front line in dealing with the new coronavirus.

It is worth noting that the use of psychoactive drugs can cause adverse effects in individuals, such as headaches, daytime sleepiness, agitation, and tremors.¹¹ In Nursing professionals, the abuse of psychoactive substances can have repercussions in terms of reduced working capacity, absenteeism, and increased chances of accidents at work.¹²

The aim of this study was to assess the association between the use of psychotropic drugs and the socioeconomic and health variables of Nursing professionals in an emergency department.

Method

This is a cross-sectional, analytical study carried out with Nursing professionals at a 24-hour ECU during the coronavirus (COVID-19) pandemic. The unit is located in a municipality in the interior of the state of Rio Grande do Sul, Brazil, responsible for urgent and emergency care for an estimated population of 84,041 inhabitants.¹³

The population of this study comprised 36 Nursing professionals (nurses, technicians, and Nursing assistants) who were invited to take part in the study in person and via WhatsApp. Nursing professionals who had been working in the emergency care unit, the site of the investigation, for at least a month were included, due to the data collection instruments used and the process of adaptation of the worker to the work context. One nurse and one Nursing technician were excluded because they were on maternity leave.

The data was collected between January and February 2021, taking into account current health regulations regarding the prevention of COVID-19 and the guidelines of the place where the research took place. The sociodemographic and clinical questionnaire, the List of Stress Signs and Symptoms (LSS/VAS), and the Pittsburgh Sleep Quality Index were used. Prior to application, the sociodemographic and clinical questionnaire was answered and evaluated by members of the research group, of which the authors of this study are members, and no suggestions for changes or adjustments were made. The instruments were given individually to the participants at their place of work, at a scheduled time, and collected afterwards, as they were self-administered. There were no losses.

The sociodemographic and clinical questionnaire included the following variables: age, partner, per capita family income (monthly), profession, physical activity, and frequency, use of psychoactive drugs, and name of the psychoactive medication. Sleep quality was assessed using the Pittsburgh Sleep Quality Index, a version validated for Brazilian Portuguese, structured from 19 questions related to sleep habits over the last month, with scores ranging from zero to 21. For this instrument, scores higher than 5 were considered to be poor sleep quality.¹⁴

The level of stress was checked using the List of Stress Signs and Symptoms, an instrument constructed by Vasconcelos consisting of 59 signs or symptoms of stress, in which the participant evaluates the frequency of the situations presented using a Likert-type scale, with possible answers ranging from 0 (never) to 3 (always). The score ranges from 0 to 177 and indicates the levels: absence (0 to 11 points); low level (12 to 28 points), medium level (29 to 60 points), high level (61 to 120 points), and very high level (above 120 points).¹⁵

The data was recorded in a Microsoft Excel database and there were variables categorized and expressed as absolute and relative frequencies. The data was then analyzed using SPSS Statistics 21.0 software. Fisher's Exact Test was used to verify associations, and results with p<0.05 were considered significant.

To carry out this research, all the ethical precepts relating to research with people required by Resolutions nº 466/2012, nº 510/2016, and nº 580/2018 of the Ministry of Health were respected. The project was approved by the Ethics Committee of the Federal University of Santa Maria on January 19, 2021, under opinion no. 4.503.318. All participants were instructed to read the Informed Consent Form and, if they agreed, to sign it.

Results

Thirty-four Nursing professionals took part in the survey, predominantly aged under 40 (61.8%). There was a prevalence of professionals who had a partner (67.6%) and an income of R$2,900 or more per month (64.7%).

As for psychotropic drugs, 38.2% were used; of these, 84% were antidepressants, 46.2% were anxiolytics or hypnotic sedatives, and 46.2% were other sleep-inducing drugs. It should be noted that, in some cases, the same professional used more than one class of psychoactive (Table 1).

Table 1 - Classes of psychotropic drugs used by Nursing professionals in an emergency care unit. Rio Grande do Sul, Brazil, 2021 (n=13).

Classes of psychotropic drugs		Total
	n (%)	n (%)
Antidepressants		11 (84.6)
Selective serotonin reuptake inhibitors	8 (72.7)
Selective serotonin and noradrenaline reuptake inhibitors	2 (18.1)
Noradrenaline and dopamine reuptake inhibitors	1 (9.1)
Anxiolytics and hypnotic-sedatives		6 (46.2)
Benzodiazepines	5 (83.3)
Non-benzodiazepines	1 (16.7)
Other sleep inducers		6 (46.2)
Hormone	3 (50)
Muscle relaxants	2 (33.3)
Antihistamines or their derivatives	2 (33.3)

Table 1 shows that among antidepressants, selective serotonin reuptake inhibitors were the most cited (72.7%). With regard to anxiolytics or hypnotic sedatives, benzodiazepines had the highest adherence (83.3%), and with regard to sleep inducers, the use of hormones (melatonin) was preferred (50%).

When analyzing the relationship between the use of psychotropic drugs and socioeconomic characteristics, there was a statistically significant association between having an income of less than R$2,900 and the use of these drugs, as shown in Table 2.

Table 2 - Relationship between the use of psychotropic drugs and socioeconomic characteristics of Nursing professionals working in an emergency care unit. Rio Grande do Sul, Brazil, 2021 (n=34).

Socio-economic characteristics	Use of psychotropic drugs		Total	p-value*
Socio-economic characteristics	Yes	No	Total	p-value*
	n (%)	n (%)	n (%)
Age
< 40 years	7 (53.8)	14 (66.7)	21 (61.8)	0.491
> 40 years	6 (46.2)	7 (33.3)	13 (38.2)
Partner
Yes	9 (69.2)	14 (66.7)	23 (67.6)	>0.05
No	4 (30.8)	7 (33.3)	11 (32.4)
Income
< 2,9 thousand	8 (61.5)	4 (19.0)	12 (35.3)	0.025
> 2,9 thousand	5 (38.5)	17 (81.0)	22 (64.7)
Occupation
Nurse	4 (30.8)	5 (23.8)	9 (26.5)	0.704
Nursing technician or assistant	9 (69.2)	16 (76.2)	25 (73.5)

*Fisher's Exact Test.

With regard to the health characteristics of Nursing professionals, it was noted that 70.6% practiced physical activity at least twice a week, 70.6% had sleep disorders and 29.4% had a high or very high level of stress, as shown in Table 3.

Table 3 - Association between the use of psychotropic drugs and the health characteristics of Nursing professionals working in an emergency care unit. Rio Grande do Sul, Brazil, 2021 (n=34).

Health characteristics	Use of psychotropic drugs		Total	p-value*
	Yes	No
	n (%)	n (%)
Physical activity
< 2x weekly	2 (15.4)	8 (38.1)	10 (29.4)	0.251
> 2x weekly	11 (84.6)	13 (61.9)	24 (70.6)	0.251
Sleep disorders
Yes	11 (84.6)	13 (61.9)	24 (70.6)	0.251
No	2 (15.4)	8 (38.1)	10 (29.4)	0.251
High or very high stress
Yes	7 (53.8)	3 (14.3)	10 (29,4)	0.022
No	6 (46.2)	18 (85.7)	24 (70.6)

*Fisher's Exact Test

Table 3 also shows that among professionals with high or very high stress, a greater number used psychotropic drugs (p<0.05).

Discussion

Among the main results of this study, it was found that a significant percentage of Nursing professionals were using some type of psychotropic drug, mainly from the antidepressant and anxiolytic or hypnotic sedative classes. The use of these substances by Nursing professionals is commonly related to personal and work-related factors,¹² and the context of the COVID-19 pandemic has become an aggravating factor by triggering feelings such as fear, anxiety, depression, anguish, impaired sleep, and others, related to the risk of exposure and transmission of the virus.¹⁶

According to the results of the study, among antidepressants, there was a predominance of selective serotonin reuptake inhibitors, which may be related to their greater acceptance by individuals and the lower occurrence of adverse effects when compared to the other classes.¹⁷ In relation to anxiolytics or hypnotic sedatives, the prevalent use of benzodiazepines can be justified by the low cost of purchase and the ease of acquiring these drugs.¹⁸ As for sleep inducers, the preference for the hormone melatonin chosen by half of the Nursing professionals may be due to the fact that it produces effects similar to the physiological process of sleep and has no significant adverse reactions in adults.¹⁹

When assessing socioeconomic characteristics and the use of psychotropic drugs, it was found that almost half of individuals aged 40 or over were using these substances. Studies of Nursing professionals have shown that older people have higher percentages of stress, anxiety, and depression,²⁰ which may motivate the use of these drugs. In women, this may be associated with menopause, since from this age onwards women can develop physical and psychological changes, such as low self-esteem, changes in sexual patterns, and decreased libido.²¹

Regarding the predominance of Nursing workers with partners who did not use psychoactive drugs, a study in Greece with nurses showed that those without a partner were 4.63 times more likely to develop an anxiety disorder compared to those who were married.²² This can be explained by the fact that relationship satisfaction is associated with social support, which can minimize the effects of daily stressors and promote mental health.²³

Also, in relation to socio-economic characteristics, there was a significant association between having an income of less than R$2,900 and the use of psychotropic drugs. In this sense, one study shows that financial worries directly affect the individual's mental health and can cause high levels of psychological distress.²⁴ In addition, the low pay of Nursing professionals often allows them to work double or triple shifts and experience work overload and exhaustion.²⁵ These factors, together with limited personal and social coping resources, can motivate the use of psychotropic drugs by subjects.

In this study, a high percentage of nursing professionals had a high or very high level of stress, which is in line with the results of a study carried out in Kosovo.²⁶ The exhausting demands of emergency care services, together with the physical conditions and organization of the work environment, increase stress levels among professionals.²⁷

The identification of an association between high stress and the use of psychotropic drugs may be related to the characteristics of the Nursing profession, the relationship between professionals and their work, and their ability to cope with stressors. It should be noted that working in Nursing involves living with situations of imminent death, suffering, long working hours, many demands for care, unfavorable working conditions, and easy access to various drugs, so the way professionals relate to this, their ability to resolve conflicts, cope with stressful situations, prior knowledge and the support they receive can favor the use of psychotropic drugs.²⁸ Often professionals find comfort in these drugs, reducing tension and daily wear and tear.

This study also found a high percentage of sleep disorders, although there was no association with the use of psychotropic drugs. This finding is similar to the results of a study that identified a high rate of sleep disorders among Nursing professionals associated with common mental disorders, working in a public hospital and having worked longer in the institution.²⁹ The same authors pointed out that the use of sleep medication by Nursing staff is related to the search for better quality sleep, experiences, and working conditions, and easier access.

In relation to physical activity at least twice a week, the results showed that more than half of the professionals were adept, although no association was identified with the use of psychotropic drugs. In this regard, one study showed that physical activity is a predictor of psychological health and levels of perceived stress.³⁰ In addition, chronic physical activity can promote metabolic adaptations such as lowering cortisol, reducing inflammation, and improving immune function,³⁰bringing benefits to health in general.

It should be emphasized that stressful situations among Nursing professionals, especially in a 24-hour ECU, can lead to physical and psychological exhaustion, and that working conditions, the ease with which healthcare staff can acquire psychoactive drugs, work overload, exhaustion and fear of contamination by COVID-19 can contribute to the use of psychotropic drugs.

The limitations of this study include the small sample size and the cross-sectional method, which does not allow causality to be inferred. However, the evidence presented contributes to the field of health and Nursing as it stimulates reflection on the form and organization of Nursing professionals' work, recognition, remuneration, and the impact of these factors on their health and on their choices in search of well-being. They also support the actions of managers of emergency care services with a view to workers' health and the mobilization of the professionals themselves for their health, with repercussions on the quality of care provided.

Conclusion

The use of psychotropic drugs by Nursing professionals in emergency care units was related to low income and stress. In this sense, it is clear that socio-economic and psychological problems can make Nursing workers in these services susceptible to the use of psychotropic drugs, as they are a quick and accessible alternative for well-being. Professional movements and management actions related to better pay and healthy working conditions are necessary and have repercussions on workers' quality of life and user satisfaction.

The data presented points to the health of urgent and emergency service workers and motivates further research on the subject in order to contribute to the knowledge currently available and encourage the implementation of measures for the rational use of psychotropic drugs, including among Nursing professionals.

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Support / Acknowledgement: Ao CNPq, Chamada CNPq/MCTI/FNDCT Nº 18/2021 – UNIVERSAL, processo 404263/2021-6.

Author contributions

1 - Carolina Renz Pretto

Nurse, PhD student in Nursing - carol.renzpretto@gmail.com

Conception and development of the research, writing of the manuscript, review and approval of the final version.

2 - Rosângela Marion da Silva

Nurse, Post-Doctorate - rosangela.silva@ufsm.br

Design and development of the research, review and approval of the final version.

3 - Ana Carolina Cunha Almeida

Nursing student - ana.cunha@acad.ufsm.br

Conception and development of the research, writing of the manuscript, revision and approval of the final version.

4 - Ana Caroline Cabreira Barreto

Nursing student - barreto.ana@acad.ufsm

Writing the manuscript and reviewing and approving the final version.

5 - Flávia Camef Dorneles Lenz

Nurse, PhD student in Nursing - flaviacamefd@gmail.com

Writing the manuscript, reviewing and approving the final version.

Scientific Editor-in-Chief: Cristiane Cardoso de Paula

Scientific Editor: Tânia Solange Bosi de Souza Magnago

How to cite this article

Pretto CR, Silva RM, Almeida ACC, Barreto ACC, Lenz FCD. Psychotropic drugs and socioeconomic and health characteristics of Nursing professionals in an emergency room. UFSM. 2023 [Access at: Year Month Day]; vol.13, e50:1-12. DOI: https://doi.org/10.5902/2179769285107