Holvast Floor, van Hattem Bernard A, Sinnige Judith, Schellevis François, Taxis Katja, Burger Huibert, Verhaak Peter F M
Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.
Fam Pract. 2017 Sep 1;34(5):539-545. doi: 10.1093/fampra/cmx018.
Late-life depression often coincides with chronic somatic diseases and, consequently, with polypharmacy, which may complicate medical treatment.
To determine the associations between patients diagnosed with late-life depression in primary care and multimorbidity and polypharmacy.
This cross-sectional observational study was performed using 2012 primary care data. Depressed patients aged ≥60 years were compared to age and gender matched patients diagnosed with other psychological diagnoses and mentally healthy controls. Morbidity and prescription data were combined, and regression analyses were performed for the associations between depression and chronic disease and chronic drug use.
We included 4477 patients; 1512 had a record of depression, 1457 of other mental health or psychological diagnoses and 1508 were controls. Depressed patients had a 16% [Prevalence Ratio (PR) 1.16; 95% confidence interval (95% CI) 10%-24%] higher rate of chronic somatic disease and higher odds for multimorbidity (OR 1.55; 95% CI 1.33-1.81) compared with controls. No differences existed between depressed patients and patients with other psychological diagnoses. Compared with controls, depressed patients had a 46% (95% CI 39-53%) higher rate of chronic drug use and higher odds for polypharmacy (OR 2.89; 95% CI 2.41-3.47). Depressed patients also had higher rates of chronic drug use and higher odds for polypharmacy compared with patients with other psychological diagnoses (PR 1.26; OR 1.75; both P < 0.001).
Late-life depression in primary care patients is associated with more chronic drug use, even beyond the increased rates of comorbid somatic diseases. General practitioners should consider medication reviews to prevent unnecessary drug-related problems in these patients.
老年期抑郁症常与慢性躯体疾病同时存在，因此也常与多种药物联合使用相关，这可能会使医疗治疗变得复杂。
确定在初级保健中被诊断为老年期抑郁症的患者与多病共存及多种药物联合使用之间的关联。
本横断面观察性研究使用了2012年的初级保健数据。将年龄≥60岁的抑郁症患者与年龄和性别匹配的被诊断为其他心理疾病的患者及心理健康对照组进行比较。合并发病率和处方数据，并对抑郁症与慢性病及慢性药物使用之间的关联进行回归分析。
我们纳入了4477名患者；1512名有抑郁症记录，1457名有其他心理健康或心理疾病诊断记录，1508名是对照组。与对照组相比，抑郁症患者的慢性躯体疾病发生率高16%[患病率比（PR）1.16；95%置信区间（95%CI）10%-24%]，多病共存的几率更高（OR 1.55；95%CI 1.33-1.81）。抑郁症患者与其他心理疾病诊断患者之间无差异。与对照组相比，抑郁症患者的慢性药物使用率高46%（95%CI 39-53%），多种药物联合使用的几率更高（OR 2.89；95%CI 2.41-3.47）。与其他心理疾病诊断患者相比，抑郁症患者的慢性药物使用率也更高，多种药物联合使用的几率也更高（PR 1.26；OR 1.75；均P<0.001）。
初级保健患者中的老年期抑郁症与更多的慢性药物使用相关，甚至超出了共病躯体疾病增加的比例。全科医生应考虑进行药物审查，以预防这些患者中不必要的药物相关问题。
