Fagot Jean-Paul, Cuerq Anne, Samson Solène, Fagot-Campagna Anne
Strategy and Research Department, Caisse nationale de l'assurance maladie, Paris, France.
Int J Clin Pract. 2016 Sep;70(9):744-51. doi: 10.1111/ijcp.12850. Epub 2016 Aug 3.
Previous studies have shown that the recommended minimum 6-month period for antidepressant treatment is actually observed for only a minority of patients. The objectives of this study were to characterise patients with newly prescribed antidepressant treatment in France and identify factors possibly associated with insufficient duration of treatment or the occurrence of certain events such as sick leave, hospitalisations and suicide attempts.
Data were extracted from the French health insurance database (SNIIRAM) and the national hospitalisation database (PMSI) for patients covered by the main French health insurance scheme representing 75% of the French population. Patients were included if they had a newly prescribed antidepressant in 2011, but no prior psychiatric diagnosis identified in the databases and no significant psychiatric medication (such as antipsychotic or mood stabiliser) in 2009-2010.
A total of 998 710 patients (2% of the overall population), with a mean age of 50 years and 66% of females, initiated an antidepressant in 2011, which was prescribed by a general practitioner in 89% of cases. Five generic names, including three selective serotonin reuptake inhibitors, accounted for 75% of first prescriptions. Only one reimbursement was observed for 40% of patients. Treatment duration was less than 6 months for more than 80% of patients, more frequently for low income earners, and varied according to age, gender and region. The median time lag between first visit and antidepressant initiation was 27 days. Hospitalisation related to a psychiatric disease over the following 12 months was observed for 3% of patients.
Duration of treatment and follow-up were both insufficient for the majority of French patients initiating antidepressant treatment in 2011, which may reflect poor quality of care for people with mood or anxiety disorders, possibly because of overdiagnosis and inappropriate drug treatment, or poor adherence and side effects, or poor follow-up.
既往研究表明，只有少数患者实际遵循了推荐的至少6个月的抗抑郁药治疗疗程。本研究的目的是描述法国新开具抗抑郁药治疗的患者特征，并确定可能与治疗疗程不足或病假、住院和自杀未遂等特定事件发生相关的因素。
从法国医疗保险数据库（SNIIRAM）和国家住院数据库（PMSI）中提取数据，这些数据来自法国主要医疗保险计划覆盖的患者，占法国人口的75%。纳入标准为2011年新开具抗抑郁药，但数据库中无既往精神科诊断且2009 - 2010年无显著精神科用药（如抗精神病药或心境稳定剂）的患者。
2011年共有998710名患者（占总人口的2%）开始使用抗抑郁药，平均年龄50岁，女性占66%，其中89%的病例由全科医生开具处方。五种通用名药物，包括三种选择性5-羟色胺再摄取抑制剂，占首次处方的75%。40%的患者仅报销了一次。超过80%患者的治疗疗程少于6个月，低收入者更常见，且因年龄、性别和地区而异。首次就诊与开始使用抗抑郁药之间的中位时间间隔为27天。在接下来的12个月中，3%的患者因精神疾病住院。
2011年开始使用抗抑郁药治疗的大多数法国患者的治疗疗程和随访均不足，这可能反映出对情绪或焦虑障碍患者的护理质量较差，可能是由于过度诊断和不适当的药物治疗、依从性差和副作用、或随访不佳所致。
