Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (Drs Albrecht and Abariga); OptumLabs, Cambridge, Massachusetts (Dr Albrecht); Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore (Drs dosReis, Perfetto, and Mullins); National Health Council, Washington, District of Columbia (Dr Perfetto); and Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland (Dr Rao).
J Head Trauma Rehabil. 2020 Sep/Oct;35(5):E429-E435. doi: 10.1097/HTR.0000000000000558.
Lack of evidence for efficacy and safety of treatment and limited clinical guidance have increased potential for undertreatment of depression following traumatic brain injury (TBI).
We conducted a retrospective cohort study among individuals newly diagnosed with depression from 2008 to 2014 to assess the impact of TBI on receipt of treatment for incident depression using administrative claims data. We created inverse probability of treatment-weighted populations to evaluate the impact of TBI on time to receipt of antidepressants or psychotherapy following new depression diagnosis during 24 months post-TBI or matched index date (non-TBI cohort).
Of 10 428 individuals with incident depression in the TBI cohort, 44.7% received 1 or more antidepressants and 20.0% received 1 or more psychotherapy visits. Of 10 463 in the non-TBI cohort, 41.2% received 1 or more antidepressants and 17.6% received 1 or more psychotherapy visits. TBI was associated with longer time to receipt of antidepressants compared with the non-TBI cohort (average 39.6 days longer than the average 126.2 days in the non-TBI cohort; 95% confidence interval [CI], 24.6-54.7). Longer time to psychotherapy was also observed among individuals with TBI at 6 months post-TBI (average 17.1 days longer than the average 47.9 days in the non-TBI cohort; 95% CI, 4.2-30.0), although this association was not significant at 12 and 24 months post-TBI.
This study raises concerns about the management of depression following TBI.
缺乏治疗效果和安全性的证据，以及有限的临床指导，增加了创伤性脑损伤（TBI）后治疗抑郁症不足的可能性。
我们进行了一项回顾性队列研究，纳入了 2008 年至 2014 年间新诊断为抑郁症的个体，使用行政索赔数据评估 TBI 对新发抑郁症患者接受治疗的影响。我们创建了治疗反概率加权人群，以评估 TBI 对创伤后 24 个月内（TBI 队列）或匹配的指数日期（非 TBI 队列）新诊断为抑郁症后接受抗抑郁药或心理治疗的时间的影响。
在 TBI 队列中，10428 名新发抑郁症患者中有 44.7%接受了 1 种或多种抗抑郁药治疗，20.0%接受了 1 次或多次心理治疗。在非 TBI 队列中，10463 名患者中有 41.2%接受了 1 种或多种抗抑郁药治疗，17.6%接受了 1 次或多次心理治疗。与非 TBI 队列相比，TBI 患者接受抗抑郁药的时间更长（平均比非 TBI 队列的 126.2 天多 39.6 天；95%置信区间[CI]，24.6-54.7）。在 TBI 后 6 个月时，也观察到接受心理治疗的 TBI 患者时间更长（平均比非 TBI 队列的 47.9 天多 17.1 天；95%CI，4.2-30.0），尽管在 TBI 后 12 个月和 24 个月时，这种关联并不显著。
这项研究引起了人们对 TBI 后抑郁症管理的关注。
