Clinical Research and Epidemiology Workgroup, Research Service (151-JC), Department of Veterans Affairs (VA) Medical Center St. Louis, St. Louis, MO 63106, USA.
Psychiatr Serv. 2011 Apr;62(4):381-8. doi: 10.1176/ps.62.4.pss6204_0381.
Adequate treatment of depression improves the prognosis of depressed individuals. This study identified sociodemographic, medical, psychiatric, and health care utilization factors associated with receipt of adequate antidepressant pharmacotherapy by Veterans Health Administration (VHA) patients with recurrent depression.
National VHA electronic medical records were used to construct a cohort of depressed patients who were experiencing a recurrent episode of depression between 1999 and 2006. Multinomial logistic regression determined factors that were associated with no receipt of treatment and with three levels of treatment: some antidepressant pharmacotherapy, adequate acute-phase pharmacotherapy, and adequate continuation-phase pharmacotherapy.
A total of 26,770 patients aged 25 to 80 years, most of whom were male (84.5%), who were experiencing a recurrent episode of depression were identified. Female patients and those with substance abuse or dependence, nicotine dependence, or panic disorder were more likely to receive adequate acute-phase or continuation-phase treatment (or both) than to receive no treatment. Nonwhite race, being unmarried, having only VA benefits, having generalized anxiety disorder, and receiving treatment outside the mental health specialty sector were associated with a lower likelihood of receiving guideline-concordant care.
Factors associated with receipt of adequate treatment for recurrent depression were similar to those found in previous studies for patients with new episodes of depression. This study was one of the first to focus specifically on patients experiencing recurrent depression, rather than combining patients with new and recurrent episodes in one sample. Continued research is warranted on how to modify factors to increase receipt of adequate care.
充分治疗抑郁症可改善抑郁患者的预后。本研究旨在确定退伍军人事务部（VA）复发性抑郁症患者接受充分抗抑郁药治疗的相关社会人口学、医学、精神科和医疗保健利用因素。
利用 VA 电子病历构建了一个队列，其中包括 1999 年至 2006 年期间经历复发性抑郁发作的抑郁患者。采用多项逻辑回归分析确定了与未接受治疗和三种治疗水平（部分抗抑郁药治疗、充分急性期药物治疗和充分延续期药物治疗）相关的因素。
共确定了 26770 名年龄在 25 至 80 岁之间的患者，其中大多数为男性（84.5%），正在经历复发性抑郁发作。与未接受治疗相比，女性患者以及有物质滥用或依赖、尼古丁依赖或惊恐障碍的患者更有可能接受充分的急性期或延续期治疗（或两者兼有）。非白种人、未婚、仅享受 VA 福利、患有广泛性焦虑症以及在精神卫生专业部门以外接受治疗与接受符合指南的护理的可能性降低相关。
与新发抑郁患者的研究结果相似，复发性抑郁症患者接受充分治疗的相关因素与研究结果相似。本研究首次专门针对经历复发性抑郁的患者，而不是将新发病例和复发病例的患者合并在一个样本中。有必要进一步研究如何改变相关因素以增加接受充分治疗的机会。
