目的:调查在现实世界中发起SSRI治疗抑郁症的老年人中与治疗结果相关的广泛的社会人口统计学和临床因素。
方法:这项队列研究使用了丹麦登记数据,涵盖了2006年至2017年首次(自1995年以来)发起SSRIs治疗抑郁症的所有老年人(年龄≥65岁)。在他们的SSRI处方后,我们跟踪了他们一年。分析了六种不同的结果,包括停止治疗,切换,增强,精神病医院接触抑郁症,精神病院入院,和自杀企图/自我伤害。关联分析采用泊松回归,用95%置信区间估计发病率比率。
结果:该研究包括65,741名平均年龄为78.23岁的个体,女性占55.6%。随访期间,40.1%停产,4.8%切换,20.3%接受了增强,3.0%曾有精神病医院接触过抑郁症,3.2%有精神病患者入院,0.1%有自杀企图/自我伤害记录.根据社会人口统计学和临床因素观察差异治疗结果。例如,作为女性,主要居住在农村地区,有精神病或躯体诊断,使用作用于血液/造血器官的药物,心血管系统,或肌肉-骨骼系统与较少的不利临床结局相关.相反,单身或分居的婚姻状况以及使用神经系统药物与较高的不良结局风险相关。
结论:适应症的混淆可能仍然是一个问题,和抑郁严重程度数据不可用.
结论:我们的研究结果强调在临床决策中考虑患者特征,因为它们可以影响那些接受抑郁症治疗的患者的临床过程。
OBJECTIVE: To investigate a wide range of sociodemographic and clinical factors associated with treatment outcomes in older adults who initiated an SSRI for depression treatment in a real-world setting.
METHODS: This cohort study used Danish registry data covering all older adults (aged ≥65) who initiated SSRIs for depression from 2006 to 2017, first-time (since 1995). We followed the individuals for one year after their SSRI prescription. Six different outcomes were analyzed, including treatment discontinuation, switching, augmentation, psychiatric hospital contacts for depression, psychiatric hospital admission, and suicide attempt/self-harm. Association analyses employed Poisson regression, estimating incidence rate ratios with 95 % confidence intervals.
RESULTS: The study included 65,741 individuals with a mean age of 78.23 years, and 55.6 % were females. During follow-up, 40.1 % discontinued, 4.8 % switched, 20.3 % received augmentation, 3.0 % had psychiatric hospital contacts for depression, 3.2 % had psychiatric admission, and 0.1 % had suicide attempt/self-harm records. Differential treatment outcomes were observed based on sociodemographic and clinical factors. For example, being female, residing predominantly in rural areas, having psychiatric or somatic diagnoses, and using medications acting on blood/blood-forming organs, the cardiovascular system, or musculo-skeletal systems were linked to fewer unfavorable clinical outcomes. Conversely, marital status as being single or separated and the use of nervous system drugs were associated with a higher risk of unfavorable outcomes.
CONCLUSIONS: Confounding by indication might remain a problem, and depression severity data was not unavailable.
CONCLUSIONS: Our findings emphasize considering patient characteristics in clinical decisions, as they can influence the clinical course of those undergoing depression treatment.