Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
OptumLabs, Cambridge, Massachusetts, USA.
J Neurotrauma. 2020 Dec 1;37(23):2542-2548. doi: 10.1089/neu.2019.6957. Epub 2020 Jul 8.
The objectives of this study were to identify characteristics associated with receipt of antidepressants for treatment of incident depression diagnosed following traumatic brain injury (TBI) and to assess the impact of receipt of treatment for depression on risk of other neuropsychiatric outcomes associated with TBI. We conducted a retrospective cohort study of individuals with TBI who were subsequently diagnosed with incident depression between 2008 and 2014 using data from the OptumLabs Data Warehouse. We identified factors associated with receipt of antidepressants and compared risk of new diagnosis of alcohol dependence disorder, anxiety, insomnia, and substance dependence disorder between those who received antidepressants and those who did not over a maximum 2-year follow-up, controlling for duration of use and clinical and demographic characteristics. Of 9581 individuals newly diagnosed with depression following TBI, 4103 (43%) received at least one antidepressant. Moderate-severe TBI (odds ratio [OR] 1.44; 95% confidence interval [CI]: 1.39, 1.50), female sex (OR 1.21; 95% CI: 1.19, 1.24), diagnosis of Alzheimer's disease (OR 1.39; 95% CI: 1.35, 1.44), and anxiety (OR 1.35; 95% CI: 1.31, 1.38) were associated with receipt of antidepressants. Longer duration of antidepressant use was associated with decreased risk of newly diagnosed anxiety (hazard ratio [HR] 0.92; 95% CI: 0.89, 0.96), insomnia (HR 0.94; 95% CI: 0.91, 0.98), and substance dependence disorder (HR 0.92; 95% CI: 0.88, 0.97). These results provide evidence of a beneficial effect of antidepressant use on incidence of outcomes associated with poorer recovery from TBI.
本研究旨在确定与创伤性脑损伤（TBI）后诊断为抑郁发作的患者接受抗抑郁药治疗相关的特征，并评估治疗抑郁对与 TBI 相关的其他神经精神结局风险的影响。我们对 2008 年至 2014 年间在 OptumLabs 数据仓库中随后诊断为抑郁发作的 TBI 患者进行了回顾性队列研究。我们确定了与接受抗抑郁药治疗相关的因素，并在最长 2 年的随访期间，比较了接受和未接受抗抑郁药治疗的患者新诊断为酒精依赖障碍、焦虑症、失眠症和物质依赖障碍的风险，同时控制了药物使用持续时间以及临床和人口统计学特征。在 9581 例 TBI 后新诊断为抑郁症的患者中，有 4103 例（43%）至少接受了一种抗抑郁药治疗。中重度 TBI（比值比 [OR] 1.44；95%置信区间 [CI]：1.39，1.50）、女性（OR 1.21；95% CI：1.19，1.24）、阿尔茨海默病诊断（OR 1.39；95% CI：1.35，1.44）和焦虑症（OR 1.35；95% CI：1.31，1.38）与抗抑郁药的使用有关。抗抑郁药使用时间较长与新诊断的焦虑症（风险比 [HR] 0.92；95% CI：0.89，0.96）、失眠症（HR 0.94；95% CI：0.91，0.98）和物质依赖障碍（HR 0.92；95% CI：0.88，0.97）的风险降低相关。这些结果提供了抗抑郁药治疗对改善 TBI 后康复较差相关结局发生率有益效果的证据。
