Mallinger Julie B, Lamberti Steven J
MPH, University of Rochester, Department of Community & Preventive Medicine, Rochester, NY, USA.
J Ment Health Policy Econ. 2007 Mar;10(1):15-22.
Antidepressants, mood stabilizers and anxiolytics are frequently used in addition to antipsychotic medications in order to control ancillary symptom complexes among patients with schizophrenia. Although extensive data has demonstrated racial disparities in diagnostic and treatment patterns for schizophrenia, little is known about racial differences in the use of adjunctive medications. Since these adjunctive medications may significantly improve clinical outcomes, further investigation is warranted.
The purpose of this study was to determine the rates at which adjunctive antidepressants, mood stabilizers and anxiolytics were prescribed to black patients and white patients with schizophrenia. The authors hypothesized that black patients would be less likely to receive any adjunctive medication as compared to white patients.
This cross-sectional study utilized data from an academic medical center in Rochester, New York. Three multivariate logistic regression were performed to model the likelihood of receiving each of the three types of adjunctive medication. The primary independent variable was race, and the models also controlled for clinical and sociodemographic factors such as diagnosis, age, gender, living situation, and insurance status.
Of the 456 patients included in the study, 37% received an antidepressant, 33% received a mood stabilizer and 23% received an anxiolytic. All patients received an antipsychotic medication. In each multivariate model, race was significantly associated with likelihood of receiving the adjunctive medication (p<.01 for all). None of the covariates was consistently associated with receipt of an adjunctive medication.
Even after controlling for potentially confounding clinical and sociodemographic factors, race was strongly associated with receipt of adjunctive medications. This finding is consistent with previous work demonstrating racial disparities in the treatment and management of schizophrenia. The cross-sectional study design, however, limits the conclusions that can be drawn from this study, as length-time bias may have led to a misrepresentation of how many patients receive adjunctive medications. Caution should be observed in interpreting our results and replication is necessary.
Differences in the use of adjunctive medications may be due to true differences in the frequency of ancillary symptom complexes. Previous work, however, suggests that differences are more likely to be due to underdiagnosis of affective or anxiety symptoms among black patients. Among patients with recognized ancillary symptoms complexes, black patients may also be less likely than white patients to receive treatment. This may be due to racial differences in accessibility of mental health care, physician perceptions of patients, and patient beliefs and preferences. In future work, use of standardized diagnostic tools may help to determine actual rates of ancillary symptom complexes and to identify racial variations. Additionally, further research is needed to clarify the underlying biases and behaviors that affect use of adjunctive medications among patients with schizophrenia in whom ancillary symptom complexes have been identified.
在精神分裂症患者中，除抗精神病药物外，还经常使用抗抑郁药、心境稳定剂和抗焦虑药来控制伴随症状群。尽管大量数据表明精神分裂症的诊断和治疗模式存在种族差异，但对于辅助药物使用方面的种族差异却知之甚少。由于这些辅助药物可能会显著改善临床结局，因此有必要进一步研究。
本研究的目的是确定给患有精神分裂症的黑人患者和白人患者开具辅助抗抑郁药、心境稳定剂和抗焦虑药的比例。作者假设与白人患者相比，黑人患者接受任何辅助药物治疗的可能性较小。
这项横断面研究使用了纽约罗切斯特一家学术医疗中心的数据。进行了三项多变量逻辑回归分析，以模拟接受三种辅助药物中每种药物治疗的可能性。主要自变量是种族，模型还控制了临床和社会人口统计学因素，如诊断、年龄、性别、生活状况和保险状况。
在纳入研究的456名患者中，37%的患者接受了抗抑郁药治疗，33%的患者接受了心境稳定剂治疗，23%的患者接受了抗焦虑药治疗。所有患者均接受了抗精神病药物治疗。在每个多变量模型中，种族与接受辅助药物治疗的可能性显著相关（所有p值均<0.01）。没有一个协变量与接受辅助药物治疗始终相关。
即使在控制了潜在的混杂临床和社会人口统计学因素之后，种族与接受辅助药物治疗仍密切相关。这一发现与先前关于精神分裂症治疗和管理中存在种族差异的研究结果一致。然而，横断面研究设计限制了从本研究中得出的结论，因为时间长度偏差可能导致对接受辅助药物治疗的患者数量的错误表述。在解释我们的结果时应谨慎，有必要进行重复研究。
辅助药物使用方面的差异可能是由于伴随症状群出现频率的真正差异。然而，先前的研究表明，差异更可能是由于黑人患者情感或焦虑症状的诊断不足。在已识别出伴随症状群的患者中，黑人患者接受治疗的可能性也可能低于白人患者。这可能是由于心理健康护理可及性、医生对患者的看法以及患者的信念和偏好方面的种族差异。在未来的研究中，使用标准化诊断工具可能有助于确定伴随症状群的实际发生率，并识别种族差异。此外，还需要进一步研究以阐明影响已识别出伴随症状群的精神分裂症患者辅助药物使用的潜在偏差和行为。
