Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Niuvanniemi Hospital, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Unit Suicide Research & Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria.
J Affect Disord. 2021 Nov 1;294:831-837. doi: 10.1016/j.jad.2021.07.096. Epub 2021 Jul 30.
The objective of this study was to investigate whether persistence of antidepressant use differs between refugee youth and Swedish-born youth after a diagnosis of a common mental disorder (CMD), and if clinical and sociodemographic factors are associated with antidepressant discontinuation.
Youth aged 16-25 years, with an incident diagnosis of CMD (depression, post-traumatic stress disorder (PTSD), anxiety disorders) accessing specialized healthcare in Sweden 2006-2016 were included. New users were identified with a one-year washout period. Refugees (N=1575) were compared with Swedish-born youth (N=2319). Cox regression models [reported as adjusted Hazard Ratios (HRs) with 95% confidence intervals (CIs)] were used to investigate factors associated with discontinuation of antidepressant use.
Among youth (mean age 20.9 years, SD 2.7, 50% females), the median duration of antidepressant use differed considerably between refugee (101 days, IQR 31-243) and Swedish-born youth (252 days, IQR 101-558). Refugees were more likely to discontinue treatment (HR 1.61, 95% CI 1.47-1.77). Factors associated with an increased risk for discontinuation in refugees included ≤5 years duration of formal residency (HR 1.28, 95% CI 1.12-1.45), antidepressant type, and dispensing lag (time from prescription to dispensing) of >7 days (1.43, 1.25-1.64), whereas PTSD (0.78, 0.64-0.97) and anxiolytic use (0.79, 0.64-0.96) were associated with a lower discontinuation risk.
Only persons treated in specialized healthcare could be included.
The relatively short treatment durations among refugee youth suggest that antidepressant treatment may not be optimal in CMD, and better monitoring of treatment as well as transcultural education of healthcare personnel are warranted.
本研究旨在探讨在确诊常见精神障碍（CMD）后，难民青年和瑞典出生青年的抗抑郁药持续使用情况是否存在差异，以及临床和社会人口学因素是否与抗抑郁药停药相关。
本研究纳入了 2006 年至 2016 年在瑞典接受专门医疗保健服务、年龄在 16-25 岁之间、患有 CMD（抑郁症、创伤后应激障碍（PTSD）、焦虑症）的青年。新使用者需经过一年的洗脱期。本研究将难民（n=1575）与瑞典出生青年（n=2319）进行了比较。采用 Cox 回归模型[以调整后的危害比（HR）及其 95%置信区间（CI）报告]，分析了与抗抑郁药停药相关的因素。
在青年（平均年龄 20.9 岁，标准差 2.7，50%为女性）中，难民和瑞典出生青年的抗抑郁药使用持续时间中位数差异较大，分别为 101 天（IQR 31-243）和 252 天（IQR 101-558）。难民更有可能停止治疗（HR 1.61，95%CI 1.47-1.77）。与难民停药风险增加相关的因素包括在瑞典居住时间≤5 年（HR 1.28，95%CI 1.12-1.45）、抗抑郁药类型和配药延迟（从处方到配药的时间）>7 天（1.43，1.25-1.64），而 PTSD（0.78，0.64-0.97）和使用抗焦虑药（0.79，0.64-0.96）与较低的停药风险相关。
本研究仅纳入了在专门医疗保健机构接受治疗的人群。
难民青年的治疗持续时间相对较短，表明在 CMD 中抗抑郁药治疗可能并不理想，因此需要更好地监测治疗情况，并对医疗保健人员进行跨文化教育。
