Gronemann Frederikke Hørdam, Jørgensen Martin Balslev, Nordentoft Merete, Andersen Per Kragh, Osler Merete
Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Frederiksberg, Denmark.
Psychiatric Centre Copenhagen, Copenhagen, Denmark; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
J Psychiatr Res. 2021 Mar;135:197-202. doi: 10.1016/j.jpsychires.2021.01.014. Epub 2021 Jan 19.
Treatment-resistant depression (TRD) has been associated with higher mortality and risk of suicide, but this has mainly been showed in few studies which did not include self-harm. The aim was to investigate the association of TRD with all-cause mortality, suicide and self-harm in a nationwide cohort of patients with major depression and explore any differences in relation to patient characteristics.
First-time hospital contacts for major depression between January 1, 1996 and December 31, 2014 were identified in Danish patient registers (ICD-10: F32 and F33). TRD was defined as two shifts in antidepressant treatment, assessed from one year prior depression diagnosis until one year after. Information on mortality, suicide and self-harm was obtained from Danish registers and associations between TRD and the three prognostic outcomes were analyzed using Cox Proportional Hazard Regression.
TRD was not associated with all-cause mortality the first year of follow-up (adjusted HR (aHR) 1.04, 95% confidence interval (CI) [0.98-1.11]), and the HR for mortality was lower the following 1-5 years. However, TRD was associated with higher rates of suicide (0-1 year: aHR 2.20, 95% CI [1.77-2.74]; 1-5 years: aHR 1.70, 95% CI [1.42-2.03]) and self-harming behavior (0-1 year: aHR 1.51, 95% CI [1.36-1.66]; 1-5 years: aHR 1.59, 95% CI [1.48-1.70]). The above risk estimates varied only slightly across sociodemographic and clinical patient characteristics.
Patients with TRD have higher rates of suicide and self-harm compared with non-TRD patients, whereas there seems to be no increase overall in all-cause mortality - in fact, there was a lower rate at follow-up after 1 year. We found only a few differences in HRs for mortality or suicidality across patient characteristics.
难治性抑郁症（TRD）与更高的死亡率和自杀风险相关，但这主要在少数未纳入自我伤害情况的研究中得到体现。本研究旨在调查在一个全国性的重度抑郁症患者队列中，TRD与全因死亡率、自杀及自我伤害之间的关联，并探讨与患者特征相关的任何差异。
在丹麦患者登记系统（国际疾病分类第十版：F32和F33）中识别出1996年1月1日至2014年12月31日期间首次因重度抑郁症住院的患者。TRD定义为从抑郁症诊断前一年至诊断后一年期间抗抑郁治疗发生两次变化。从丹麦登记系统获取死亡率、自杀及自我伤害信息，并使用Cox比例风险回归分析TRD与这三种预后结果之间的关联。
在随访的第一年，TRD与全因死亡率无关（校正风险比（aHR）为1.04，95%置信区间（CI）[0.98 - 1.11]），且在接下来的1 - 5年中死亡率的风险比更低。然而，TRD与更高的自杀率（0 - 1年：aHR 2.20，95% CI [1.77 - 2.74]；1 - 5年：aHR 1.70，95% CI [1.42 - 2.03]）和自我伤害行为（0 - 1年：aHR 1.51，95% CI [1.36 - 1.66]；1 - 5年：aHR 1.59，95% CI [1.48 - 1.70]）相关。上述风险估计在社会人口统计学和临床患者特征方面仅有轻微差异。
与非TRD患者相比，TRD患者的自杀率和自我伤害率更高，而全因死亡率总体上似乎没有增加——事实上，随访1年后的死亡率更低。我们发现不同患者特征在死亡率或自杀风险比方面仅有少数差异。
