Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia.
University of California, San Diego, California.
Prim Care Companion CNS Disord. 2022 Sep 6;24(5):21m03162. doi: 10.4088/PCC.21m03162.
To evaluate the temporal trend in young adult depression, prescription patterns of first- and second-line antidepressants, and factors influencing therapy intensification for depression stratified by sex. A retrospective cohort of people aged ≥ 18 years with incident depression between 2006 and 2017 was extracted from the Centricity Electronic Medical Records. Among 2,201,086 people with depression (82% on antidepressants), the mean age was 47 years, 29% were male, 40% had cardiometabolic multimorbidity, and 32% were diagnosed at age < 40 years (young adult depression). Prevalence of young adult depression increased significantly from 26% to 36% with a higher proportion in females compared to males (34% vs 26%) between 2006 and 2017. Selective serotonin reuptake inhibitors (SSRIs) were the most prescribed first-line antidepressant (56%), with a prescribing rate increase from 47 per 1,000 person-years to 81 per 1,000 person-years. Among first-line antidepressant recipients, 23% had treatment intensification after a median of 17 months. Compared to those aged 60-70 years, younger males and females had a similar significantly higher treatment intensification risk (range of hazard ratio [HR], 1.09-1.46). Cardiometabolic multimorbidity was associated with a 2% (HR CI, 1.01-1.05) and 7% (HR CI, 1.05-1.09) higher treatment intensification risk in males and females, respectively, while anxiety increased the treatment intensification risk by 63% (HR CI, 1.57-1.68) in males and 57% (HR CI, 1.52-1.62) in females. Non-Whites and SSRI initiators had lower risks of treatment intensification (all HR CI < 1). More than one-third of US adults with depression are aged < 40 years with an increasing trend among females. The temporal antidepressant prescribing rates were similar between sex, while significant ethnic disparity in therapy intensification was observed between sex.
评估青年成年人抑郁症的时间趋势、一线和二线抗抑郁药的处方模式，以及按性别分层的抑郁症治疗强化的影响因素。从 Centricity 电子病历中提取了 2006 年至 2017 年期间患有抑郁症的年龄≥18 岁的患者的回顾性队列。在患有抑郁症的 2201086 人中（82%服用抗抑郁药），平均年龄为 47 岁，29%为男性，40%患有心血管代谢性多种合并症，32%在 40 岁之前（青年成年人抑郁症）被诊断出患有该疾病。青年成年人抑郁症的患病率从 2006 年的 26%显著上升至 2017 年的 36%，女性中的比例高于男性（34%比 26%）。选择性 5-羟色胺再摄取抑制剂（SSRIs）是最常用的一线抗抑郁药（56%），其处方率从每千人每年 47 例上升至每千人每年 81 例。在一线抗抑郁药接受者中，中位数为 17 个月后有 23%的人接受了治疗强化。与 60-70 岁年龄组相比，年轻的男性和女性有类似的治疗强化风险显著升高（危险比 [HR]范围，1.09-1.46）。心血管代谢性多种合并症与男性和女性的治疗强化风险分别增加 2%（HR CI，1.01-1.05）和 7%（HR CI，1.05-1.09），而焦虑使男性和女性的治疗强化风险分别增加 63%（HR CI，1.57-1.68）和 57%（HR CI，1.52-1.62）。非白人及 SSRI 使用者的治疗强化风险较低（所有 HR CI<1）。超过三分之一的美国成年人患有抑郁症，且女性的发病率呈上升趋势。两性之间的抗抑郁药处方率随时间推移相似，而两性之间的治疗强化存在显著的种族差异。
