Anmella Gerard, Sanabra Miriam, Primé-Tous Mireia, Segú Xavier, Solanes Aleix, Ruíz Victoria, Morilla Ivette, Also Fontanet Antonieta, Sant Elisenda, Murgui Sandra, Sans-Corrales Mireia, Martínez-Aran Anabel, Fico Giovanna, De Prisco Michele, Oliva Vincenzo, Murru Andrea, Zahn Roland, Young Allan H, Vicens Victor, Viñas-Bardolet Clara, Aparicio-Nogué Vicenç, Martínez-Cerdá Juan Francisco, Mas Ariadna, Carreras Bernat, Blanch Jordi, Radua Joaquim, Fullana Miquel A, Cavero Myriam, Vieta Eduard, Hidalgo-Mazzei Diego
Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain.
Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Rev Psiquiatr Salud Ment. 2022 Dec 14. doi: 10.1016/j.rpsm.2022.12.001.
There has been an increase in the prescription of antidepressants (AD) in primary care (PC). However, it is unclear whether this was explained by a rise in diagnoses with an indication for AD. We investigated the changes in frequency and the variables associated with AD prescription in Catalonia, Spain.
We retrieved AD prescription, sociodemographic, and health-related data using individual electronic health records from a population-representative sample (N=947.698) attending PC between 2010 and 2019. Prescription of AD was calculated using DHD (Defined Daily Doses per 1000 inhabitants/day). We compared cumulative changes in DHD with cumulative changes in diagnoses with an indication for AD during the study period. We used Poisson regression to examine sociodemographic and health-related variables associated with AD prescription.
Both AD prescription and mental health diagnoses with an indication for AD gradually increased. At the end of the study period, DHD of AD prescriptions and mental health diagnoses with an indication for AD reached cumulative increases of 404% and 49% respectively. Female sex (incidence rate ratio (IRR)=2.83), older age (IRR=25.43), and lower socio-economic status (IRR=1.35) were significantly associated with increased risk of being prescribed an AD.
Our results from a large and representative cohort of patients confirm a steady increase of AD prescriptions that is not explained by a parallel increase in mental health diagnoses with an indication for AD. A trend on AD off-label and over-prescriptions in the PC system in Catalonia can be inferred from this dissociation.
基层医疗中抗抑郁药（AD）的处方量有所增加。然而，目前尚不清楚这是否是由有AD适应症的诊断增加所导致的。我们调查了西班牙加泰罗尼亚地区AD处方的频率变化以及与之相关的变量。
我们使用个体电子健康记录，从2010年至2019年期间就诊于基层医疗的具有人群代表性的样本（N = 947,698）中检索AD处方、社会人口统计学和健康相关数据。AD处方量采用限定日剂量（每1000居民每日的限定日剂量，即DHD）来计算。我们比较了研究期间DHD的累积变化与有AD适应症的诊断的累积变化。我们使用泊松回归来研究与AD处方相关的社会人口统计学和健康相关变量。
AD处方量和有AD适应症的心理健康诊断均逐渐增加。在研究期末，AD处方的DHD和有AD适应症的心理健康诊断的累积增幅分别达到404%和49%。女性（发病率比（IRR）= 2.83）、老年（IRR = 25.43）以及较低的社会经济地位（IRR = 1.35）与开具AD处方的风险增加显著相关。
我们来自一个大型且具有代表性的患者队列的结果证实，AD处方量稳步增加，这并非由有AD适应症的心理健康诊断的平行增加所解释。从这种脱节现象可以推断出加泰罗尼亚基层医疗系统中存在AD超适应症用药和过度处方的趋势。
