Department of Affective Disorders, Aarhus University Hospital Psychiatry, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Department of Public Health, Aarhus University, Aarhus 8000 Aarhus C, Denmark; Research Unit for General Practice, Aarhus University, Aarhus 8000 Aarhus C, Denmark.
J Affect Disord. 2024 Dec 15;367:244-254. doi: 10.1016/j.jad.2024.09.005. Epub 2024 Sep 2.
To investigate a wide range of sociodemographic and clinical factors associated with treatment outcomes in older adults who initiated an SSRI for depression treatment in a real-world setting.
This cohort study used Danish registry data covering all older adults (aged ≥65) who initiated SSRIs for depression from 2006 to 2017, first-time (since 1995). We followed the individuals for one year after their SSRI prescription. Six different outcomes were analyzed, including treatment discontinuation, switching, augmentation, psychiatric hospital contacts for depression, psychiatric hospital admission, and suicide attempt/self-harm. Association analyses employed Poisson regression, estimating incidence rate ratios with 95 % confidence intervals.
The study included 65,741 individuals with a mean age of 78.23 years, and 55.6 % were females. During follow-up, 40.1 % discontinued, 4.8 % switched, 20.3 % received augmentation, 3.0 % had psychiatric hospital contacts for depression, 3.2 % had psychiatric admission, and 0.1 % had suicide attempt/self-harm records. Differential treatment outcomes were observed based on sociodemographic and clinical factors. For example, being female, residing predominantly in rural areas, having psychiatric or somatic diagnoses, and using medications acting on blood/blood-forming organs, the cardiovascular system, or musculo-skeletal systems were linked to fewer unfavorable clinical outcomes. Conversely, marital status as being single or separated and the use of nervous system drugs were associated with a higher risk of unfavorable outcomes.
Confounding by indication might remain a problem, and depression severity data was not unavailable.
Our findings emphasize considering patient characteristics in clinical decisions, as they can influence the clinical course of those undergoing depression treatment.
在真实环境中，调查与老年人群中接受 SSRI 治疗的抑郁患者治疗结果相关的广泛社会人口学和临床因素。
本队列研究使用丹麦登记数据，涵盖了所有自 1995 年以来首次（首次）因抑郁而开始服用 SSRI 的≥65 岁老年患者。我们对这些患者在开具 SSRI 处方后的一年进行了随访。分析了 6 种不同的结局，包括治疗中断、换药、增效、因抑郁而就诊于精神科医院、入院以及自杀未遂/自残。关联分析采用泊松回归，用 95%置信区间估计发病率比。
该研究纳入了 65741 名平均年龄为 78.23 岁的患者，其中 55.6%为女性。在随访期间，40.1%的患者中断治疗，4.8%的患者换药，20.3%的患者接受增效治疗，3.0%的患者因抑郁就诊于精神科医院，3.2%的患者入院，0.1%的患者有自杀未遂/自残记录。根据社会人口学和临床因素，观察到不同的治疗结果。例如，女性、主要居住在农村地区、有精神或躯体诊断以及使用作用于血液/造血器官、心血管系统或肌肉骨骼系统的药物与较少的不良临床结局相关。相反，单身或离异的婚姻状况以及使用神经系统药物与不良结局的风险增加相关。
可能仍然存在混杂因素的问题，且未获得抑郁严重程度的数据。
我们的研究结果强调在临床决策中考虑患者特征的重要性，因为这些特征可能会影响接受抑郁治疗患者的临床过程。
