难治性抑郁症患者的全因死亡率：一项美国人群队列研究。
All-cause mortality in patients with treatment-resistant depression: a cohort study in the US population.
作者信息
Li Gang, Fife Daniel, Wang Grace, Sheehan John J, Bodén Robert, Brandt Lena, Brenner Philip, Reutfors Johan, DiBernardo Allitia
机构信息
1Real World Evidence, Statistics & Decision Sciences, Janssen Research & Development, 920 US Highway 202 S, Raritan, NJ 08869 USA.
2Department of Epidemiology, Janssen Research & Development, 920 US Highway 202 S, Raritan, NJ 08869 USA.
出版信息
Ann Gen Psychiatry. 2019 Sep 30;18:23. doi: 10.1186/s12991-019-0248-0. eCollection 2019.
BACKGROUND
Treatment-resistant depression (TRD) may represent a substantial proportion of major depressive disorder (MDD); however, the risk of mortality in TRD is still incompletely assessed.
METHODS
Data were obtained from Optum Clinformatics™ Extended, a US claims database. Date of the first antidepressant (AD) dispensing was designated as the index date for study entry and 6 months prior to that was considered the baseline period. Patients with MDD aged ≥ 18 years, index date between January 1, 2008 and September 30, 2015, no AD claims during baseline, and continuous enrollment in the database during baseline were included. Patients who started a third AD regimen after two regimens of appropriate duration were included in the TRD cohort. All-cause mortality was compared between patients with TRD and non-TRD MDD using a proportional hazards model and Kaplan-Meier estimate with TRD status being treated as a time-varying covariate. The model was adjusted for study year, age, gender, depression diagnosis, substance use disorder, psychiatric comorbidities, and Charlson comorbidity index.
RESULTS
Out of 355,942 patients with MDD, 34,176 (9.6%) met the criterion for TRD. TRD was associated with a significantly higher mortality compared with non-TRD MDD (adjusted HR: 1.29; 95% CI 1.22-1.38; < 0.0001). Survival time was significantly shorter in the TRD cohort compared with the non-TRD MDD cohort ( < 0.0001).
CONCLUSIONS
Patients with TRD had a higher all-cause mortality compared with non-TRD MDD patients.
背景
难治性抑郁症（TRD）可能占重度抑郁症（MDD）的很大比例；然而，TRD的死亡率风险仍未得到充分评估。
方法
数据来自美国索赔数据库Optum Clinformatics™ Extended。首次开具抗抑郁药（AD）的日期被指定为研究入组的索引日期，在此之前的6个月被视为基线期。纳入年龄≥18岁、索引日期在2008年1月1日至2015年9月30日之间、基线期无AD索赔且在基线期持续纳入数据库的MDD患者。在两种适当疗程的治疗方案后开始第三种AD治疗方案的患者被纳入TRD队列。使用比例风险模型和Kaplan-Meier估计比较TRD患者和非TRD MDD患者的全因死亡率，将TRD状态视为随时间变化的协变量。该模型针对研究年份、年龄、性别、抑郁症诊断、物质使用障碍、精神科合并症和Charlson合并症指数进行了调整。
结果
在355,942例MDD患者中，34,176例（9.6%）符合TRD标准。与非TRD MDD相比，TRD与显著更高的死亡率相关（调整后的HR：1.29；95%CI 1.22 - 1.38；P<0.0001）。与非TRD MDD队列相比，TRD队列的生存时间显著更短（P<0.0001）。
结论
与非TRD MDD患者相比，TRD患者的全因死亡率更高。
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