Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China.
Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China; Department of Psychiatry and Neuropsychology, Shanghai Deji Hospital, Qingdao University, 200331, PR China.
Prog Neuropsychopharmacol Biol Psychiatry. 2020 Jan 10;96:109755. doi: 10.1016/j.pnpbp.2019.109755. Epub 2019 Aug 24.
This research was designed to investigate patient-reported and doctor-reported reasons for the discontinuation of pharmacological treatment in Chinese patients with major depressive disorder (MDD), which was part of the National Survey on Symptomatology of Depression (NSSD) from 2014 to 2015.
This cross-sectional study included 649 patients who had discontinued antidepressant medications and 711 patients who had remained on them, selected from a group of 3516 candidates who have had at least one depressive episode. Differences in the two groups' sociodemographic factors, clinical characteristics, medication use, and self-reported reasons for drug discontinuation were compared via Student's t-test or chi-square test. Logistic regression analysis was then used to determine the association of all non-subjective dichotomous and ordinal categorical variables, including the additional 63 items of our physician-evaluated symptomatic assessment, with drug compliance.
Compared to the spontaneous drug discontinuation (SDD) group, the drug adherence (DA) group had significantly lower rates of the following: family history of mental disease (9.0% vs 13.6%), highest level of education achieved being post-graduate or above (1.6% vs 4.7%), smoking (5.8% vs 9.7%), and other health problems (33.9% vs 42.4%) (p's < 0.05). On the other hand, first-episode depression (48.5% vs 21.9%) and taking of mood stabilizer(s) (8.3% vs 5.6%) were higher in the former group than in the latter (p's < 0.05). Logistic Regression Analysis showed that five symptoms, such as depressed mood, were correlated positively with SDD, while another six symptoms, such as psychomotor retardation, were correlated negatively with it. The receiver operating characteristic (ROC) curve of this model yielded an area under the curve (AUC) of 0.701 (95% CI, 0.673-0.729). Notably, there were three main reasons given by patients in the DA group as to why they discontinued their medication(s): (1) concern about long-term side effects (36.1%), (2) no perceived need for taking said medication(s) long-term (34.2%), and (3) believing oneself to have been cured completely (30.0%).
The aforementioned factors may affect patient compliance and elicit maladaptive thinking even from patients with good educational backgrounds, increasing the risk of drug discontinuation. Compliance of pharmacological treatment might be improved by increasing clarification and elucidation of different symptom clusters to the patient and combating the main reasons for drug discontinuation.
本研究旨在探讨中国重度抑郁症（MDD）患者停止药物治疗的患者报告和医生报告的原因，这是 2014 年至 2015 年全国症状调查（NSSD）的一部分。
本横断面研究纳入了 649 例停止抗抑郁药治疗的患者和 711 例继续治疗的患者，这些患者均选自 3516 例至少有一次抑郁发作的候选者。通过 Student's t 检验或卡方检验比较两组的社会人口统计学因素、临床特征、药物使用和患者报告的停药原因差异。然后使用逻辑回归分析确定所有非主观二分法和有序分类变量（包括我们医生评估的症状评估的另外 63 项）与药物依从性的关系。
与自发停药（SDD）组相比，药物依从（DA）组的以下情况发生率显著降低：精神疾病家族史（9.0% vs. 13.6%）、最高学历为研究生及以上（1.6% vs. 4.7%）、吸烟（5.8% vs. 9.7%）和其他健康问题（33.9% vs. 42.4%）（p<0.05）。另一方面，前者的首发抑郁（48.5% vs. 21.9%）和使用情绪稳定剂（8.3% vs. 5.6%）的比例高于后者（p<0.05）。逻辑回归分析显示，抑郁情绪等五个症状与 SDD 呈正相关，而精神运动迟滞等六个症状与 SDD 呈负相关。该模型的受试者工作特征（ROC）曲线得出曲线下面积（AUC）为 0.701（95%CI，0.673-0.729）。值得注意的是，DA 组的患者给出了三个主要的停药原因：（1）担心长期副作用（36.1%），（2）认为长期不需要服用这些药物（34.2%），（3）认为自己已完全治愈（30.0%）。
上述因素可能会影响患者的依从性，并使即使来自教育背景良好的患者产生适应不良的思维，从而增加停药的风险。通过增加对患者不同症状群的澄清和阐明，并针对主要停药原因进行治疗，可能会提高药物治疗的依从性。
