Keywords
Self-medication, prescription, anxiety, depression, COVID-19.
This article is included in the Emerging Diseases and Outbreaks gateway.
Self-medication, prescription, anxiety, depression, COVID-19.
Self-medication is a worldwide problem, which when added to the physical and mental damage that coronavirus disease 2019 (COVID-19) has caused in the individual, has motivated a group of the population to self-medicate to calm their anxious state.1 Likewise, the misinformation from the media and the promotion of the intake of drugs without scientific basis have generated a close relationship.2 At the same time, anxiety, the most important psychiatric disorder in the world, has generated feelings of fear as a result of the pandemic because it has affected the economy and the daily life of the population.3
First, it is important to understand self-medication, which is defined as the selection and use of medications to treat self-recognized symptoms or ailments without consulting a physician. Globally, it is a major concern because it affects both developed and developing countries. Numerous studies indicate that self-medication is a common practice with a prevalence of 32.5% to 81.5% worldwide.1,2
In the context of COVID-19 it has generated a collective concern, where the misinformation of the media and the promotion by the intake of medicines without scientific basis have influenced its increase.1
In fact, a study conducted in Spain on self-medication among pharmacy students at the University of Murcia found that 72.5% of those interviewed had a self-medication habit.4 On the other hand, a study conducted in Peru showed that prior to the pandemic, the average age of those who used to self-medicate was 46.5 years; this number has been reduced to 40.8 years in the context of COVID-19.5 Studies conducted in regions such as the coast, highlands and jungle show that factors such as residence, age and work activities are associated with self-medication by the population in these times of pandemic.6 Likewise, a study carried out in Junín on factors associated with self-medication showed that socioeconomic factors are even more frequent in the Peruvian population due to the availability of over-the-counter drugs.7
Self-medication is a health problem that affects different sectors of our population due to multiple factors such as: economic, social and cultural, and has developed a close relationship with anxiety.8 Due to the pandemic it has generated feelings of fear about COVID-19 and the consequences it may bring, causing a general increase in anxiety.3,9
In China, more than 1000 people were evaluated in several cities, and it was shown that 16.5% presented symptoms of stress and 28.8% symptoms of anxiety.10 In the same context, Peru is no stranger to this problem since a study conducted in Chota on anxiety in times of social isolation by COVID-19, showed that 43% of participants had anxiety, of which 20.9% had mild anxiety, 13.4% had moderate anxiety and 9% had severe anxiety.11
Self-medication is a non-responsible act and leads to the inappropriate use of medications, causing low effectiveness and insecurity in treatments, damage to health and patient dissatisfaction.12 On the other hand, COVID-19 has caused unfavorable consequences for the mental health of the Peruvian people and, being one of the countries in Latin America most affected by the pandemic, it has caused anxiety problems in its population and an increase in self-medication.13 In conclusion, both situations have produced diverse health problems, which is why the present research study intends to show how self-medication is related to anxiety symptoms in the context of COVID-19, in users who go to a drugstore in Los Olivos.
The aim of the present work is to investigate the relationship between self-medication and anxiety symptoms in the context of COVID-19 in the district of Los Olivos, which is one of the 9 districts under the jurisdiction of the Directorate of Integrated Networks of Northern Lima (DIRIS Lima Norte) and one with the highest number of positive cases of COVID-19 in a recent study.14 Likewise, the work will provide knowledge that will be a contribution for the institutes, universities, and health centers and related to the subject of study and will allow the future development of a global study to identify people with anxiety disorders and medication problems as a result of the COVID-19 pandemic.
For the elaboration of the study, the norms of the research ethics code of the Norbert Wiener Private University were taken into account, which reviewed and approved the project set forth in Resolution N°134-2021-DFFB/UPNM approved on 18 December 2021, by the Faculty of Pharmacy and Biochemistry of the same university. This research followed the principles of the Declaration of Helsinki, promulgated by the World Medical Association (WMA).15,16
Informed consent was taken from all participants in writing before they responded to the questionnaire, and participants were guaranteed both their anonymity and that the data used will be exclusively for the research, as per the ethical guidelines.
The type of research was basic, the method was deductive, and the approach was quantitative and cross-sectional.17–19
The population for the case of the present study was the users of a drugstore located in Los Olivos, Lima.
This pharmacy was chosen because the district of Los Olivos was one of the districts with the highest number of positive COVID-19 cases at the beginning of the pandemic. In addition, we worked there in the pharmacy located in Los Olivos and we have witnessed how these controlled medicines were requested by users who came to the pharmacy to calm their anxious state.
The pharmacy is registered with the “Direccion General de Medicamentos Insumos y Drogas” (DIGEMID), it also has a chemist-pharmacist in the store.
The pharmacy is located in a central location where there is a large number of people.
The following inclusion and exclusion criteria were used to select the sample:
Inclusion criteria
• Users willing to participate in the research work.
• Users over 18 years of age.
• Male and female users.
• Users entering the pharmaceutical establishment.
Exclusion criteria
• Users under 18 years of age.
• Users who do not agree to participate in the survey.
• Users who do not enter the pharmaceutical establishment.
For the calculation of the sample, an infinite population was considered, where the sample size will be obtained from the following formula:
Where:
n: Sample size
Z: tabulated value 1.96 of the normal distribution at 95% confidence level
p: percentage of the population that has the desired attribute = 50%.
q: percentage of the population that does not have the desired attribute = 1-p
e: Precision (in the research a 5%) = 0.05
Then, replacing values in the formula, we have:
The sample consisted of a total of 384 people to be surveyed.
In order to recruit people, a systematic random sample was used, and it was determined that 740 people attended the drugstore on a weekly basis. Data collection was carried out over of 12 days, from 19 to 31 December 2021. An average of 32 people per day were surveyed and randomly selected to complete the total of 384 respondents. For the application of the survey, we waited for each person to leave the drugstore after shopping, explained the study to them and gave them the informed consent form and then the survey, both in writing, so that they could fill out their questionnaires themselves. The researchers were always available to answer any questions the respondents might have.
The researchers' contact numbers were left with each respondent in case they wished to withdraw from the study.
As a data collection technique, the survey was used to collect information on the behavior of the individual to be studied, using a questionnaire as an instrument,17 which consists of two parts where questions related to the two study variables that were used.
Variable 1: Self-medication
Dimensions: Self-initiated, without medical prescription and medication used.
No. of items: 9
Variable 2: Anxiety symptoms in the context of COVID-19
Dimensions: Physical symptoms, behavioral symptoms, and cognitive symptoms.
No. of items: 13
Scale of measurement for both variables: Never (1), almost never (2), sometimes (3), almost always (4) and always (5).
The instrument was validated by three experts in the research field, who approved the collection tool for its subsequent application.
For the processing of the information, the statistical technique used was as follows: first the answers were tabulated in an Excel 2019 spreadsheet, and all data were exported to SPSS version 24, to be able to perform the reliability of the values by means of Cronbach's Alpha (0.866). Then a descriptive analysis of the results obtained from the indicators grouped by the dimensions was performed, a normality test was performed for both variables, with the result that the two variables are nonparametric. Spearman's Rho test was chosen to test the hypotheses proposed and finally the results were presented in tables and graphs which were interpreted for a better understanding.
No respondent chose not to complete the survey at any time. Therefore, a total of 384 people participated in the research. All of them filled in their surveys correctly, so there was no loss of data.
Table 1 shows the percentages of the general data collected, where 53.4% of the users were female; with respect to age, the highest percentage was between 30-59 years of age (59.6%). 57.8% were single, 42.7% had secondary education, 24.0% had a technical level and 27.1% had higher education.
Table 2 shows the percentage of indicators of anxiety symptoms in the context of COVID-19. 50.5% indicated having problems relaxing or staying asleep during the pandemic (physical symptoms), with the percentage obtained from the sum of the levels: “sometimes”, “almost always” and “always”. Behavioral symptoms such as nervousness or increased movements totaled 40.2%, obtained from the sum between the levels from “sometimes” to “always”, and cognitive symptoms such as worry about catching COVID-19 during the pandemic totaled 70.1% between the levels from “sometimes” to “always”.
Table 3 shows the percentages of anxiety symptoms experienced by the drugstore users, which range from never feeling symptoms to almost always showing them. It can be seen that none of the respondents always felt symptoms of anxiety. Therefore, when making a cross table we observe that as users feel symptoms of anxiety, they sometimes or almost always feel anxious; they opt for self-medication (3.6%).
Table 4 shows that as anxiety symptoms increase, the percentage of surveyed users who “sometimes” self-medicate on their own initiative increases from 7.5% to 33.3% and in the levels of “almost always” the percentage increases from 3.0% to 21.1%. It is also noted that the percentage of users who “sometimes” self-medicate irresponsibly is 36.8%, 42.1% “sometimes” self-medicate on the recommendation of third parties and 26.3% “sometimes” self-medicate under the influence of the media.
Table 5 shows in general terms that as anxiety symptoms increase, the percentages of surveyed users who “sometimes” self-medicate without medical prescription increase from 15.8% to 47.7% and in the levels of “almost always” the percentage increases from 2.5% to 26.3%. The percentage of users who “sometimes” self-medicated due to the time factor was 38.7%, 43.2% “sometimes” self-medicated due to economic deficiency and 29.7% “sometimes” self-medicated using previous prescriptions.
Table 6 shows in general that as anxiety symptoms increase, the percentages of surveyed users who “sometimes” self-medicate with anxiolytics or antidepressants increase from 0.8% to 26.3%, It also stands out that the percentage of users who “sometimes” self-medicated with anxiolytics with a long half-life such as clonazepam was 26.3% and those with an intermediate half-life such as alprazolam was 21.1%, and the highest percentage of self-medication with antidepressants (sertraline) was 15.8%.
General hypothesis test:
H0: Self-medication is not related to anxiety symptoms in the context of COVID-19, in users who go to a drugstore in Los Olivos, Lima in 2021.
H1: Self-medication is related to anxiety symptoms in the context of COVID-19, in users who go to a drugstore in Los Olivos, Lima in 2021.
At P-value (sig. <0.05), a significance value of 0.000 was obtained, rejecting the null hypothesis and accepting the alternative hypothesis, with a Spearman's Rho coefficient of 0.537. According to the correlation test estimation scale, it is indicated that there is a moderate positive correlation, that is to say that an increase in anxiety symptoms is associated with greater self-medication. Therefore, it is concluded that self-medication is related to anxiety symptoms in the context of COVID-19, in users who go to a drugstore in Los Olivos, Lima in 2021.
Specific hypothesis test 1:
H0: The self-initiated dimension of self-medication is not related to anxiety symptoms in the context of COVID-19, in users who go to a drugstore in Los Olivos, Lima in 2021.
H1: The self-initiated dimension of self-medication is related to anxiety symptoms in the context of COVID-19, in users who go to a drugstore in Los Olivos, Lima in 2021.
At P-value (sig. <0.05), a significance value of 0.000 was obtained; rejecting the null hypothesis and accepting the alternative hypothesis, with a Spearman's Rho coefficient of 0.410. According to Spearman's correlation estimation scale, it is indicated that there is a moderate positive correlation, that is to say that an increase in anxiety symptoms is associated with a greater self-medication on one's own initiative; Therefore, it is concluded that the self-initiated self-medication dimension is related to anxiety symptoms in the context of COVID-19, in users who go to a drugstore in Los Olivos, Lima in 2021 (See Tables 7 -10).
Spearman’s Rho | On its own initiative | |
---|---|---|
Anxiety symptoms | Correlation coefficient | 0.410 |
Sig. (bilateral) | 0.000 | |
N | 384 |
Spearman’s Rho | Without medical prescription | |
---|---|---|
Anxiety symptoms | Correlation coefficient | 0.467 |
Sig. (bilateral) | 0.000 | |
N | 384 |
Specific hypothesis test 2:
H0: The dimension without medical prescription of self-medication is not related to anxiety symptoms in the context of COVID-19, in users who go to a drugstore in Los Olivos, Lima in 2021.
H1: The dimension without medical prescription of self-medication is related to anxiety symptoms in the context of COVID-19, in users who go to a drugstore in Los Olivos, Lima in 2021.
At P-value (sig. <0.05), a significance value of 0.000 was obtained; rejecting the null hypothesis and accepting the alternative hypothesis, with a Spearman's Rho coefficient of 0.467. According to Spearman's correlation estimation scale, it is indicated that there is a moderate positive correlation, that is to say that an increase in anxiety symptoms is associated with greater self-medication without medical prescription; Therefore, it is concluded that the dimension without medical prescription of self-medication is related to anxiety symptoms in the context of COVID-19, in users who go to a drugstore in Los Olivos, Lima in 2021.
Specific hypothesis test 3:
H0: The medication dimension of self-medication is not related to anxiety symptoms in the context of COVID-19, in users who go to a drugstore in Los Olivos, Lima in 2021.
H1: The medication dimension of self-medication is related to anxiety symptoms in the context of COVID-19, in users who go to a drugstore in Los Olivos, Lima in 2021.
At P-value (sig. <0.05), a significance value of 0.000 was obtained, rejecting the null hypothesis and accepting the alternative hypothesis, with a Spearman's Rho coefficient of 0.285. According to the Spearman's correlation estimation scale, it is indicated that there is a low positive correlation, this is lower correlation than the other factors analysed, that is to say that an increase in anxiety symptoms is associated with a greater self-medication with the medication used. Therefore, it is concluded that the medication used dimension of self-medication is related to anxiety symptoms in the context of COVID-19, in users who go to a drugstore in Los Olivos, Lima in 2021.
It should be noted that it is not possible to generalise the results obtained, due to the fact that a low percentage of respondents consider that they have signs of anxiety. It is recommended that future studies should recruit patients previously diagnosed with anxiety.
For self-medication and anxiety symptoms in the context of COVID-19, it is evident that as anxiety symptoms increase, the percentages of surveyed users who “almost never” self-medicate increase from 5.0% to 36.8%, a similar case is observed in users who “sometimes” self-medicate, where the percentage increases from 9.0% to 21.1%. These results are similar to the study by Yasif, et al.20 on sleep quality and psychological states of the Bangladeshi population during the COVID-19 pandemic, which found that 39.5% of the population presented with sleep problems, while others had anxiety and severe depression, and showing that 7.14% of the respondents self-medicated with sleeping pills. Likewise, Grigsby,21 who conducted a study on rates of self-reported increases in the use of anxiety-related medications and sleep aids, found that symptoms of major depressive disorder, generalized anxiety disorder and somatization disorder were related to the increase in the use of medications for anxiety and sleep aids.
For self-medication on their own initiative and anxiety symptoms in the context of COVID-19, it is evident that as anxiety symptoms increase the percentages of surveyed users who “sometimes” self-medicate on their own initiative increase from 7.5% to 33.3%, and in the levels of “almost always” the percentage increases from 3.0% to 21.1%. It is also noted that the percentage of users who “sometimes” self-medicate irresponsibly is 36.8%, 42.1% who “sometimes” self-medicate on the recommendation of third parties and 26.3% who “sometimes” self-medicate due to the influence of the media. The results are similar to the study by Huaman and Tamayo22 on self-medication of anxiolytics and antidepressants in adult women during the COVID-19 pandemic. They found that the surveyed population self-medicated on the influence of social networks (31.1%); internet (31.6%); family members (31.1%); friends (30.1%); television (9.7%); and newspaper and/or magazines (12.2%). In addition, Taquia and Aguilar23 conducted a study on the incidence of self-medication with anxiolytics in the population of the district of Huancayo and found that 93% self-medicated due to the influence of the virtual media. Likewise, Cabanillas,24 in a study on self-medication with benzodiazepines and the risk of abuse, found that 23.57% consumed benzodiazepines without a prescription.
For self-medication without medical prescription in the context of COVID-19. it is evident that as anxiety symptoms increase, the percentage of surveyed users who “sometimes” self-medicate without medical prescription increases from 15.8% to 47.7% and in the levels of “almost always” the percentage increases from 2.5% to 26.3%. It also stands out that the percentage of users who “sometimes” self-medicate due to the time factor was 38.7%, 43.2% “sometimes” self-medicate due to economic deficiency and 29.7% “sometimes” self-medicate using previous prescriptions. Results are similar to the study by Marion, et al.25 on the prevalence and characteristics of self-medication behaviors, which found that 51.7% used drugs from a previous prescription, mostly analgesics, antibiotics and anxiolytics (prescription drugs). Likewise, Huaman and Tamayo22 conducted a study on self-medication of anxiolytics and antidepressants in adult women during the COVID-19 pandemic and found that 23.5% went to a health center or hospital; 11.7% to a doctor's office or clinic; and 38.8% to a pharmacy and/or drugstore. In addition, Taquia and Aguilar23 conducted a study on the incidence of self-medication with anxiolytics in the population of the District of Huancayo and found that 68% self-medicated because they did not have time to go to a health center.
For self-medication by the medication used for anxiety symptoms in the context of COVID-19, it is evident that as anxiety symptoms increase, the percentage of surveyed users who “sometimes” self-medicate with anxiolytics or antidepressants increases from 0.8% to 26.3%. The percentage of users who “sometimes” self-medicated with anxiolytics with a long half-life such as clonazepam was 26.3% and those with an intermediate half-life such as alprazolam was 21.1%. The highest percentage of self-medication with antidepressants (sertraline) was 15.8%. The results are similar to those from a study by Tripković, Šantrić and Odalović26 on self-medication with tranquilizers and sleeping pills in a Serbian population. They found that the percentage of self-medication with tranquilizers and sleeping pills was 5.6% in women compared to 2.2% of men. Likewise, Yasif et al.20 found in a study on sleep quality and psychological states of the Bangladeshi population during the COVID-19 pandemic that 7.14% of the respondents self-medicated with sleeping pills. In addition, Gras, et al.27 in a study on adverse reactions linked to self-medication, found that 19.1% of the adverse reactions due to self-medication were due to psycholeptics. Likewise, Huaman and Tamayo’s22 study on self-medication of anxiolytics and antidepressants in adult women during the COVID-19 pandemic found that 40.3% consumed anxiolytics/benzodiazepines, 20.8% non-benzodiazepines and 16.7% sertraline, fluoxetine and citalopram. In addition, Rodríguez, et al.28 found in a study on self-medication of anxiolytics in users who go to drugstores and pharmacies that the drugs that stand out are: bentazepam 24.1%, bromazepam 16.7% and alprazolam 19.8%.
In conclusion, it was determined that there was a moderate relationship between self-medication and anxiety symptoms in the context of COVID-19, in users who went to a pharmacy in Los Olivos.
Zenodo: Self-medication for anxiety symptoms in the context of COVID-19, in users who go to a drugstore in Los Olivos, Lima-2021, https://doi.org/10.5281/zenodo.6678270.29
This project contains the following underlying data:
Zenodo: Self-medication for anxiety symptoms in the context of COVID-19, in users who go to a drugstore in Los Olivos, Lima-2021, https://doi.org/10.5281/zenodo.6678270.29
This project contains the following extended data:
Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).
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Is the work clearly and accurately presented and does it cite the current literature?
Partly
Is the study design appropriate and is the work technically sound?
Partly
Are sufficient details of methods and analysis provided to allow replication by others?
Partly
If applicable, is the statistical analysis and its interpretation appropriate?
Yes
Are all the source data underlying the results available to ensure full reproducibility?
Partly
Are the conclusions drawn adequately supported by the results?
Partly
Competing Interests: No competing interests were disclosed.
Reviewer Expertise: Clinical Research, Genetics, Neurology,Internal Medicine,Epidemiology,Public Health,
Is the work clearly and accurately presented and does it cite the current literature?
Partly
Is the study design appropriate and is the work technically sound?
Partly
Are sufficient details of methods and analysis provided to allow replication by others?
Yes
If applicable, is the statistical analysis and its interpretation appropriate?
Partly
Are all the source data underlying the results available to ensure full reproducibility?
Yes
Are the conclusions drawn adequately supported by the results?
Yes
References
1. Ayosanmi OS, Alli BY, Akingbule OA, Alaga AH, et al.: Prevalence and Correlates of Self-Medication Practices for Prevention and Treatment of COVID-19: A Systematic Review.Antibiotics (Basel). 2022; 11 (6). PubMed Abstract | Publisher Full TextCompeting Interests: No competing interests were disclosed.
Reviewer Expertise: Pharmaceutical Analysis
Alongside their report, reviewers assign a status to the article:
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