Jerrell Jeanette M, Tripathi Avnish, McIntyre Roger S
Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia (Dr Jerrell); Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia (Dr Tripathi); and Departments of Psychiatry and Pharmacology, University of Toronto, Ontario, Canada (Dr McIntyre).
Prim Care Companion CNS Disord. 2011;13(2). doi: 10.4088/PCC.10m01063.
To describe the prevalence and treatment of comorbid depressive disorders in children and adolescents diagnosed with sickle cell disease.
A retrospective cohort design evaluating South Carolina Medicaid medical and pharmacy claims between January 1, 1996, and December 31, 2006, was employed to identify 2,194 children and adolescents aged 17 years and younger diagnosed with sickle cell disease. Cohorts diagnosed with and without comorbid unipolar depressive disorders (using DSM-IV-TR criteria) were then compared.
Forty-six percent of the sickle cell disease cohort was diagnosed with a depressive disorder (n = 1,017), either dysthymia (90%) or major depressive disorder (10%). Dysthymia was diagnosed at approximately 9 years of age, whereas major depressive disorder was diagnosed at approximately 14 years of age. Compared with the controls, the sickle cell disease cohort with depression had more acute vaso-occlusive pain and acute chest syndrome visits per year, developed more complications with related organ damage, and incurred significantly higher outpatient, acute (emergency + inpatient), and total sickle cell disease care costs. The depression cohort was primarily treated with selective serotonin reuptake inhibitors (SSRIs; 12%) or serotonin-norepinephrine reuptake inhibitors (SNRIs; 10%) for approximately 9 months. Although alleviating the comorbid depression might positively affect their sickle cell disease pain, over 80% of the patients received no antidepressant medications, and many of the prescribed SSRIs and SNRIs have previously shown no impact on relieving chronic pain.
Comorbid depression in sickle cell disease is associated with adverse course and outcomes. These findings underscore the need for earlier and more aggressive treatment of comorbid depression by primary care or psychiatric providers in order to reduce the chronic, severe pain-depression burden on these patients.
描述诊断为镰状细胞病的儿童和青少年中合并抑郁障碍的患病率及治疗情况。
采用回顾性队列设计，评估1996年1月1日至2006年12月31日期间南卡罗来纳州医疗补助计划的医疗和药房理赔记录，以识别2194名17岁及以下诊断为镰状细胞病的儿童和青少年。然后对诊断为合并单相抑郁障碍（采用《精神疾病诊断与统计手册》第四版修订版标准）和未合并该障碍的队列进行比较。
46%的镰状细胞病队列被诊断为抑郁障碍（n = 1017），其中90%为恶劣心境，10%为重度抑郁障碍。恶劣心境约在9岁时被诊断，而重度抑郁障碍约在14岁时被诊断。与对照组相比，患有抑郁症的镰状细胞病队列每年有更多的急性血管阻塞性疼痛发作和急性胸部综合征就诊次数，出现更多与相关器官损害有关的并发症，并且门诊、急性（急诊+住院）和镰状细胞病总护理费用显著更高。抑郁障碍队列主要接受选择性5-羟色胺再摄取抑制剂（SSRI；12%）或5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRI；10%）治疗，持续约9个月。虽然缓解合并的抑郁可能对他们的镰状细胞病疼痛产生积极影响，但超过80%的患者未接受抗抑郁药物治疗，而且许多开具的SSRI和SNRI此前已显示对缓解慢性疼痛无作用。
镰状细胞病合并抑郁与不良病程及结局相关。这些发现强调了初级保健或精神科医生需要更早且更积极地治疗合并的抑郁，以减轻这些患者慢性、严重的疼痛-抑郁负担。
