Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
Veterans Affairs Health Services Research & Development, Center for Clinical Management and Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.
Oncologist. 2022 Apr 5;27(4):314-322. doi: 10.1093/oncolo/oyab033.
Androgen deprivation therapy (ADT) use is associated with an increased risk of developing depression and anxiety. Little is known about how the mental health of these men is treated.
We identified men with prostate cancer who received ADT between 2001 and 2015 using Optum's de-identified Clinformatics Data Mart Database. We determined the incidence of depression or anxiety diagnoses, mental health treatments, and the specialty of providers initiating psychotropic medications, after the start of ADT. Outcomes were compared with those of men with prostate cancer not receiving ADT and men without prostate cancer.
Of 37 388 men with prostate cancer treated with ADT, 3964 (10.6%) received a new diagnosis of depression or anxiety. Of those 3964 men, 1892 (47.7%) did not receive a documented treatment, 10 (0.3%) received psychotherapy, 1321 (33.3%) a selective serotonin reuptake inhibitor, and 744 (18.8%) a benzodiazepine. The median time from initiation of ADT to a depression or anxiety diagnosis was 9.3 months. Primary care physicians were the most common prescribers of psychotropic medications (72.2%). The proportion of men not receiving mental health treatments of interest (47.7%) was similar compared to men without prostate cancer (49.1%), but statistically significantly lower compared to men with prostate cancer not receiving ADT (52.7%).
In men with prostate cancer receiving ADT with a new diagnosis of depression or anxiety, nearly half are not receiving mental health care while one in five is introduced to a benzodiazepine. Further investigation toward improving the mental health care for men on ADT is needed.
雄激素剥夺疗法（ADT）的使用与抑郁和焦虑风险的增加相关。目前对于这些男性的心理健康治疗方法知之甚少。
我们使用 Optum 的去识别 Clinformatics Data Mart 数据库，确定了 2001 年至 2015 年间接受 ADT 的前列腺癌男性。我们确定了 ADT 开始后抑郁或焦虑诊断、心理健康治疗以及开始使用精神药物的提供者的专业，以及与未接受 ADT 的前列腺癌男性和无前列腺癌男性进行比较。
在接受 ADT 治疗的 37388 名前列腺癌男性中，有 3964 名（10.6%）新诊断为抑郁或焦虑。在这 3964 名男性中，有 1892 名（47.7%）未接受记录的治疗，10 名（0.3%）接受了心理治疗，1321 名（33.3%）接受了选择性 5-羟色胺再摄取抑制剂，744 名（18.8%）接受了苯二氮䓬类药物。从 ADT 开始到抑郁或焦虑诊断的中位时间为 9.3 个月。初级保健医生是开精神药物最常见的医生（72.2%）。与无前列腺癌男性（49.1%）相比，未接受感兴趣的心理健康治疗的男性比例（47.7%）相似，但与未接受 ADT 的前列腺癌男性（52.7%）相比，这一比例明显较低。
在接受 ADT 治疗并新诊断为抑郁或焦虑的前列腺癌男性中，近一半未接受心理健康护理，而五分之一的男性被开了苯二氮䓬类药物。需要进一步研究以改善接受 ADT 的男性的心理健康护理。
