Hengartner Michael P, Passalacqua Silvia, Andreae Andreas, Heinsius Thomas, Hepp Urs, Rössler Wulf, von Wyl Agnes
Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland.
Integrated Psychiatric Clinic of Winterthur and Zurich Unterland (ipw), Winterthur, Switzerland.
Front Psychiatry. 2019 Feb 22;10:79. doi: 10.3389/fpsyt.2019.00079. eCollection 2019.
Some evidence suggests that antidepressants may relate to poor outcomes in depression. The aim of this study was, therefore, to examine, whether antidepressant use may worsen the long-term outcome in real-world psychiatric patients with both primarily affective and non-affective mental disorders. Based on a total of = 151 inpatients with a mixed range of diagnoses enrolled at two psychiatric hospitals in Zurich, Switzerland, matched pairs of = 45 antidepressant users and = 45 non-users were selected via nearest neighbor propensity score matching. Pairs were matched according to 14 clinically relevant covariates assessing psychosocial impairments, functioning deficits and illness severity. The two outcomes of interest were the number and total duration of all rehospitalisations over a 12-month follow-up after discharge from the hospital based on the official clinical registry. Altogether 35.6% of antidepressant users were rehospitalised at least once, as compared to 22.2% in matched non-users. Two or more rehospitalisations occurred in 22.2% of antidepressant users but only in 2.2% of non-users. In antidepressant users, the mean total duration of rehospitalisations was 22.22 days, as compared to 8.51 in matched non-users. According to Poisson regression analyses, antidepressant use during acute inpatient care prospectively relates to both a higher risk (incidence rate ratio [IRR] = 3.64, 95% confidence interval [95%-CI] = 1.71-7.75, = 0.001) and a longer duration (IRR = 2.61, 95%-CI = 1.01-6.79, = 0.049) of subsequent rehospitalisations. These findings were consistently replicated when traditional multivariable regression analysis was applied to the full sample. Findings also replicated when patients with affective and non-affective disorders were analyzed separately. Our findings raise the possibility that, in the long-term, antidepressants may impair recovery and increase the risk of rehospitalisation in patients with both primarily affective and non-affective disorders. More work is required to explore possible aetiopathological pathways leading to psychiatric rehospitalisation.
一些证据表明，抗抑郁药可能与抑郁症的不良预后有关。因此，本研究的目的是检验在现实世界中患有原发性情感性和非情感性精神障碍的精神病患者中，使用抗抑郁药是否会使长期预后恶化。基于瑞士苏黎世两家精神病医院收治的151名诊断范围各异的住院患者，通过最近邻倾向评分匹配法，选取了45名抗抑郁药使用者和45名非使用者组成匹配对。根据14个评估心理社会损害、功能缺陷和疾病严重程度的临床相关协变量进行配对。两个感兴趣的结局是根据官方临床登记数据，出院后12个月随访期间所有再住院的次数和总时长。共有35.6%的抗抑郁药使用者至少再住院一次，而匹配的非使用者中这一比例为22.2%。22.2%的抗抑郁药使用者发生了两次或更多次再住院，而非使用者中这一比例仅为2.2%。在抗抑郁药使用者中，再住院的平均总时长为22.22天，而匹配的非使用者为8.51天。根据泊松回归分析，急性住院治疗期间使用抗抑郁药与后续再住院的更高风险（发病率比[IRR]=3.64，95%置信区间[95%-CI]=1.71-7.75，P=0.001）和更长时长（IRR=2.61，95%-CI=1.01-6.79，P=0.049）均存在前瞻性关联。当对全样本应用传统多变量回归分析时，这些发现得到了一致重复。当分别分析情感性和非情感性障碍患者时，发现也得到了重复。我们的研究结果提示，从长期来看，抗抑郁药可能会损害原发性情感性和非情感性障碍患者的康复，并增加再住院风险。需要开展更多工作来探索导致精神病患者再住院的可能病因病理途径。
