Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.
Sci Rep. 2020 Sep 24;10(1):15712. doi: 10.1038/s41598-020-72677-1.
This study investigated the association between the duration of pharmacotherapy treatment for depression, or discontinuation from treatment, and work functioning impairment. This was a retrospective cohort study examining 30,409 workers. Work functioning impairment was assessed using a questionnaire, and treatment status was assessed using medical claims data. Odds ratios (ORs) of workers with severe work functioning impairment compared with healthy workers (control group) were calculated using logistic regression analysis. Continuous medical treatment was associated with severely impaired work functioning regardless of treatment period [continuous medical treatment; 4 months <: OR = 3.2, 4 months ≥, 10 months <: OR = 2.6, 10 months ≥, 14 months <: OR = 2.3, 14 months ≥, 16 months <: OR = 2.3, which are all statistically significant (p < 0.05)]. Workers who initially received pharmacotherapy treatment but discontinued in < 11 months had a significantly higher OR (treatment discontinuation period; 3 months <: OR = 2.3, 3 months ≥, 8 months <; OR = 2.0, 8 months ≥, 11 months <; OR = 3.0), while those who discontinued at ≥ 11 months did not (OR = 1.4, 95% CI 0.6-3.5). The sensitivity analysis excluding participants with at least one psychiatric comorbidity other than depression did not change the final result. It is important for the occupational health practitioners and attending psychiatrists to follow up in cooperation with each other, paying attention to the decrease in work functioning in addition to the symptoms.
这项研究调查了抗抑郁药物治疗持续时间或停药与工作功能障碍之间的关系。这是一项回顾性队列研究，共纳入了 30409 名工人。使用问卷评估工作功能障碍，使用医疗索赔数据评估治疗状况。使用逻辑回归分析计算与健康工人（对照组）相比严重工作功能障碍的工人的比值比 (OR)。无论治疗期如何，连续药物治疗均与严重工作功能障碍相关[连续药物治疗；4 个月<：OR=3.2，4 个月≥，10 个月<：OR=2.6，10 个月≥，14 个月<：OR=2.3，14 个月≥，16 个月<：OR=2.3，均具有统计学意义（p<0.05）]。最初接受药物治疗但在<11 个月内停药的工人具有更高的 OR（停药时间；3 个月<：OR=2.3，3 个月≥，8 个月<：OR=2.0，8 个月≥，11 个月<：OR=3.0），而停药时间≥11 个月的工人则没有（OR=1.4，95%CI 0.6-3.5）。排除至少有一种除抑郁症以外的精神共病的参与者的敏感性分析并未改变最终结果。对于职业健康从业者和主治精神科医生来说，重要的是要相互合作进行随访，除了关注症状外，还要注意工作功能的下降。
