Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland.
BMC Psychiatry. 2020 May 13;20(1):232. doi: 10.1186/s12888-020-02642-9.
Treatment resistant depression (TRD) is common among patients with depression, and is associated with clinical and functional disability. However, the risk and risk factors for being granted disability pension (DP) among patients with TRD have not been investigated.
All antidepressant initiators in Sweden with a diagnosis of depression in specialized care were identified in nationwide registers 2006-2013 and followed regarding treatment trials. TRD was defined as the start of a third sequential trial. Patients with TRD who were not on DP (N = 3204) were matched by age, sex, history of depression, calendar year, and time for treatment start with 3204 comparators with depression and ongoing antidepressant treatment. A proportional Cox Regression was performed with DP as outcome, adjusted for various sociodemographic and clinical covariates.
Compared to the comparison cohort, TRD was associated with a doubled risk for all-cause DP (aHR 2.07; 95%CI 1.83-2.35), DP due to depression (2.28; 1.82-2.85) and to any mental disorder (2.24; 1.95-2.57) but not due to somatic diagnoses (1.25; 0.84-1.86). Among significant risk factors for DP in TRD were female sex, being > 29 years of age, unemployment and a diagnosis of comorbid personality disorder (ICD-10 codes F60.0-9).
TRD is associated with an elevated risk for DP compared to other patients with depression, with large potential costs for the affected patients and for society. Clinical and therapeutic implications for patients with TRD who are granted DP should be further investigated.
No clinical data, e.g. type of depression or reason for treatment switch, was available for this study.
治疗抵抗性抑郁症（TRD）在抑郁症患者中较为常见，与临床和功能残疾有关。然而，TRD 患者获得残疾抚恤金（DP）的风险和风险因素尚未得到调查。
在全国登记处 2006-2013 年，确定了瑞典所有接受抗抑郁药治疗的抑郁症患者，并对其进行了治疗试验随访。TRD 被定义为开始第三次连续试验。未领取 DP 的 TRD 患者（N=3204）根据年龄、性别、抑郁症病史、日历年度和治疗开始时间与 3204 名接受抑郁症和持续抗抑郁治疗的对照患者进行匹配。使用 DP 作为结局，采用比例 Cox 回归进行调整，调整了各种社会人口学和临床协变量。
与对照队列相比，TRD 患者全因 DP（aHR 2.07；95%CI 1.83-2.35）、因抑郁症（2.28；1.82-2.85）和任何精神障碍（2.24；1.95-2.57）而领取 DP 的风险增加了一倍，但因躯体诊断（1.25；0.84-1.86）而领取 DP 的风险无显著增加。在 TRD 患者中，DP 的显著风险因素包括女性、年龄>29 岁、失业和共病人格障碍诊断（ICD-10 编码 F60.0-9）。
与其他抑郁症患者相比，TRD 患者领取 DP 的风险增加，这对患者和社会都有潜在的巨大成本。应进一步研究领取 DP 的 TRD 患者的临床和治疗意义。
本研究没有获得有关患者的临床数据，例如抑郁症的类型或治疗转换的原因。
