Deb Arijita, Sambamoorthi Usha
a West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center , Morgantown , WV , USA.
Curr Med Res Opin. 2017 Feb;33(2):201-208. doi: 10.1080/03007995.2016.1248383. Epub 2016 Nov 11.
To estimate rates and patterns of depression treatment among adults with chronic obstructive pulmonary disease (COPD) and depression.
We used a retrospective, cross-sectional study design, pooling data from 2010 and 2012 Medical Expenditure Panel Survey (MEPS). The study sample consisted of 527 individuals aged 21 years or older, diagnosed with COPD and depression. Depression treatment was grouped into three categories based on those who received: (1) neither antidepressant nor psychotherapy; (2) antidepressants only; and (3) psychotherapy combined with antidepressants (combination therapy). We conducted chi-squared tests and multinomial logistic regressions to examine factors (demographic, socio-economic characteristics, healthcare access, health status, and personal health practices) associated with depression treatment among adults with COPD and depression.
The mean age of the study sample was 55.96 years (SD = 13.36). Overall, 18.8% of the sample adults did not report any use of antidepressants or psychotherapy, 58.3% reported antidepressants use only and 23% reported using combination therapy. Females (adjusted odds ratio [AOR] = 1.89, 95% CI = 1.02, 3.55), older adults (≥65 years: AOR = 3.69, 95% CI = 1.62, 8.41), adults with fair/poor physical health status (AOR = 3.32, 95% CI = 1.29, 8.56) and those suffering from anxiety (AOR = 1.94, 95% CI = 1.09, 3.46) were more likely to receive antidepressant treatment. Older adults (AOR =2.94, 95% CI = 1.05, 8.22), those who were never married (AOR = 3.17, 95% CI = 1.18, 8.56), suffered from anxiety (AOR =6.01, 95% CI = 3.11, 11.61) and current smokers (AOR = 2.29, 95% CI = 1.05, 4.98) were more likely to receive combination therapy. Whereas, adults who were uninsured (AOR = 0.21, 95% CI = 0.05, 0.86) and did not lacked regular physical activity (AOR = 0.33, 95% CI = 0.16, 0.67) were less likely to receive combination therapy. A key limitation of our study is that we could not control for the severity of depression or COPD which may have influenced depression treatment.
Efforts to improve depression care among adults with co-occurring COPD and depression may need to be tailored for different subgroups.
评估慢性阻塞性肺疾病（COPD）合并抑郁症的成年人中抑郁症的治疗率及治疗模式。
我们采用回顾性横断面研究设计，汇总了2010年和2012年医疗支出面板调查（MEPS）的数据。研究样本包括527名年龄在21岁及以上、被诊断为COPD合并抑郁症的个体。抑郁症治疗分为三类：（1）既未接受抗抑郁药治疗也未接受心理治疗；（2）仅接受抗抑郁药治疗；（3）心理治疗联合抗抑郁药治疗（联合治疗）。我们进行了卡方检验和多项逻辑回归分析，以研究与COPD合并抑郁症的成年人抑郁症治疗相关的因素（人口统计学、社会经济特征、医疗保健可及性、健康状况和个人健康行为）。
研究样本的平均年龄为55.96岁（标准差=13.36）。总体而言，18.8%的样本成年人未报告使用任何抗抑郁药或接受心理治疗，58.3%报告仅使用抗抑郁药，23%报告使用联合治疗。女性（调整优势比[AOR]=1.89，95%置信区间[CI]=1.02，3.55）、老年人（≥65岁：AOR=3.69，95%CI=1.62，8.41）、身体健康状况为中等/较差的成年人（AOR=3.32，95%CI=1.29，8.56）以及患有焦虑症的成年人（AOR=1.94，95%CI=1.09，3.46）更有可能接受抗抑郁药治疗。老年人（AOR=2.94，95%CI=1.05，8.22）、从未结婚的人（AOR=3.17，95%CI=1.18，8.56）、患有焦虑症的人（AOR=6.01，95%CI=3.11，11.61）以及当前吸烟者（AOR=2.29，95%CI=1.05，4.98）更有可能接受联合治疗。然而，未参保的成年人（AOR=0.21，95%CI=0.05，0.86）以及没有规律体育活动的成年人（AOR=0.33，95%CI=0.16，0.67）接受联合治疗的可能性较小。我们研究的一个关键局限性在于，我们无法控制可能影响抑郁症治疗的抑郁症或COPD的严重程度。
改善COPD合并抑郁症的成年人抑郁症护理的努力可能需要针对不同亚组进行调整。
