From the Department of Health Policy and Behavioral Sciences (Owen-Smith), Georgia State University School of Public Health; Kaiser Permanente Georgia, Center for Research and Evaluation (Owen-Smith, McDonald, Sesay, McCracken), Atlanta, Georgia; and Kaiser Permanente Washington, Health Research Institute (Simon), Washington, DC.
Psychosom Med. 2023 Apr 1;85(3):260-265. doi: 10.1097/PSY.0000000000001184. Epub 2023 Feb 26.
The purpose of this study was to examine the extent to which the presence of chronic noncancer pain (CNCP) impacts the likelihood that patients with diagnoses of depression will initiate depression treatment compared with those without CNCP.
We performed a retrospective cohort study of Kaiser Permanente of Georgia members older than 18 years who received a diagnosis of depression. Demographics and medical history were extracted from the electronic health record database. Members were further classified by the presence or absence of a CNCP diagnosis. Outcomes of interest were treated as time dependent and included ( 1 ) time to fulfillment of a new antidepressant medication and ( 2 ) time to a follow-up mental health encounter. Outcomes were compared between members with and without a CNCP diagnosis using Kaplan-Meier survival curves and Cox proportional hazard regression models.
During the study period, 22,996 members met the inclusion criteria and 27.4% had a diagnosis of CNCP. In the matched sample, there was no difference in the time to a new antidepressant fill among members with and without CNCP (hazard ratio = 0.96; 95% confidence interval = 0.90-1.02; p = .18). In contrast, members with CNCP were significantly less likely to have a new mental health encounter after diagnosis (hazard ratio = 0.87; 95% confidence interval = 0.81-0.94; p < .001).
Patients with CNCP were significantly less likely to have a new mental health encounter after a depression diagnosis compared with patients without CNCP. Additional outreach and consideration may be needed to improve initiation of depression treatment for newly diagnosed patients with comorbid depression and CNCP.
本研究旨在探讨慢性非癌性疼痛（CNCP）的存在对伴有抑郁诊断的患者与不伴有 CNCP 的患者相比，启动抑郁治疗的可能性的影响程度。
我们对佐治亚州 Kaiser Permanente 的年龄在 18 岁以上的、接受抑郁诊断的成员进行了回顾性队列研究。从电子健康记录数据库中提取人口统计学和病史信息。成员进一步根据是否存在 CNCP 诊断进行分类。感兴趣的结果被视为时间依赖性，包括（1）新抗抑郁药物治疗的实现时间和（2）后续心理健康就诊的时间。使用 Kaplan-Meier 生存曲线和 Cox 比例风险回归模型比较有和无 CNCP 诊断的成员之间的结果。
在研究期间，有 22996 名成员符合纳入标准，其中 27.4%有 CNCP 诊断。在匹配样本中，有和无 CNCP 的成员在新抗抑郁药物填充时间上没有差异（风险比=0.96；95%置信区间=0.90-1.02；p=0.18）。相比之下，患有 CNCP 的成员在诊断后进行新的心理健康就诊的可能性显著降低（风险比=0.87；95%置信区间=0.81-0.94；p<0.001）。
与不伴有 CNCP 的患者相比，患有 CNCP 的患者在抑郁诊断后进行新的心理健康就诊的可能性显著降低。对于新诊断为伴有抑郁和 CNCP 的患者，可能需要额外的外联和考虑，以改善抑郁治疗的启动。
