Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Twin Cities, MN, USA.
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Twin Cities, MN, USA.
Prev Med. 2017 Jul;100:101-111. doi: 10.1016/j.ypmed.2017.04.015. Epub 2017 Apr 14.
Existing literature shows mixed findings regarding the efficacy and effectiveness of depression screening, and relatively little is known about the effectiveness of depression screening among older adults in primary care visits in the U.S. This study examines the effects of depression screening on the three following outcomes: mood disorder diagnoses, overall antidepressant prescriptions, and potentially inappropriate antidepressant prescriptions among older adults ages 65 or older in office-based outpatient primary care settings. We used data from 2010-2012 National Ambulatory Medical Care Survey (NAMCS), a nationally representative sample of office-based primary care outpatient visits among older adults (n=9,313 unweighted). We employed an instrumental variable approach to control for selection bias in our repeated cross-sectional population-based study. Injury prevention and stress management were selected as instrumental variables, as they were considered completely exogenous to outcomes of interests using conceptual and statistical criteria. We conducted multivariate bivariate probit (biprobit) regression analyses to investigate the effect of depression screening on each outcome, when controlled for other covariates. We found that depression screening was negatively associated with potentially inappropriate antidepressant prescriptions (β=-2.17; 95% CI -2.80 to -1.53; p<0.001). However, no significant effect of depression screening on diagnosis of mood disorders and overall antidepressant prescriptions was found. Overall, depression screening had a negative effect on potentially inappropriate antidepressant prescriptions. Primary care physicians and other healthcare providers should actively utilize depression screening to minimize potentially inappropriate antidepressant prescriptions in older adult patients.
现有文献表明，抑郁症筛查的效果和有效性存在混合结果，并且对于美国初级保健就诊中老年人群的抑郁症筛查效果相对知之甚少。本研究考察了抑郁症筛查对以下三个结果的影响：情绪障碍诊断、总体抗抑郁药物处方和 65 岁及以上老年人群在门诊初级保健环境下潜在不适当的抗抑郁药物处方。我们使用了 2010-2012 年全国门诊医疗调查（NAMCS）的数据，该调查是针对老年人群门诊初级保健就诊的全国代表性样本（未加权 n=9,313）。我们采用了工具变量方法来控制我们的重复横断面基于人群研究中的选择偏差。伤害预防和压力管理被选为工具变量，因为根据概念和统计标准，它们被认为与感兴趣的结果完全外生。我们进行了多元双变量二项式（biprobit）回归分析，以调查在控制其他协变量的情况下，抑郁症筛查对每个结果的影响。我们发现，抑郁症筛查与潜在不适当的抗抑郁药物处方呈负相关（β=-2.17；95%CI -2.80 至-1.53；p<0.001）。然而，抑郁症筛查对情绪障碍诊断和总体抗抑郁药物处方的影响没有显著差异。总体而言，抑郁症筛查对潜在不适当的抗抑郁药物处方有负面影响。初级保健医生和其他医疗保健提供者应积极利用抑郁症筛查，以尽量减少老年患者中潜在不适当的抗抑郁药物处方。
