Department of Veterans Affairs, Health Services Research and Development (HSR&D) Center of Excellence, Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI, USA.
Adm Policy Ment Health. 2009 Nov;36(6):406-15. doi: 10.1007/s10488-009-0230-2. Epub 2009 Jul 16.
Depressed patients discharged from psychiatric hospitalizations face increased risks for adverse outcomes including suicide, yet antidepressant adherence rates during this high-risk period are unknown. Using Veterans Affairs (VA) data, we assessed antidepressant adherence and predictors of poor adherence among depressed veterans following psychiatric hospitalization. We identified VA patients nationwide with depressive disorders who had a psychiatric hospitalization between April 1, 1999 and September 30, 2003, received antidepressant medication, and had an outpatient appointment following discharge. We calculated medication possession ratios (MPRs), a measure of medication adherence, within 3 and 6 months following discharge. We assessed patient factors associated with having lower levels of adherence (MPRs < 0.8) after discharge. The criteria for 3- and 6-month MPRs were met by 20,931 and 23,182 patients respectively. The mean 3 month MPR was 0.79 (SD = 0.37). The mean 6 month MPR was 0.66 (SD = 0.40). Patients with poorer adherence were male, younger, non-white, and had a substance abuse disorder, but were less likely to have PTSD or other anxiety disorders. Poor antidepressant adherence is common among depressed patients after psychiatric hospitalization. Efforts to improve adherence at this time may be critical in improving the outcomes of these high-risk patients.
从精神科住院部出院的抑郁症患者面临着更高的不良后果风险，包括自杀，但在这一高风险时期，抗抑郁药的依从率尚不清楚。我们利用退伍军人事务部（VA）的数据，评估了精神科住院后抑郁退伍军人的抗抑郁药依从性和不良依从的预测因素。我们确定了全国范围内患有抑郁障碍的退伍军人，他们在 1999 年 4 月 1 日至 2003 年 9 月 30 日期间有过一次精神科住院，接受了抗抑郁药物治疗，并在出院后进行了门诊预约。我们计算了出院后 3 个月和 6 个月内的药物维持率（MPR），这是衡量药物依从性的一个指标。我们评估了患者在出院后药物依从性较低（MPR < 0.8）的相关因素。符合 3 个月和 6 个月 MPR 标准的患者分别为 20931 名和 23182 名。3 个月的平均 MPR 为 0.79（标准差 = 0.37）。6 个月的平均 MPR 为 0.66（标准差 = 0.40）。依从性较差的患者为男性、年龄较小、非裔或西班牙裔、有药物滥用障碍，但患有创伤后应激障碍或其他焦虑障碍的可能性较小。精神科住院后，抑郁患者的抗抑郁药依从性普遍较差。此时努力提高依从性可能对改善这些高风险患者的预后至关重要。
