Howren Alyssa, Sayre Eric C, Avina-Zubieta J Antonio, Puyat Joseph H, Da Costa Deborah, Xie Hui, Davidson Eileen, Gupta Amit, De Vera Mary A
Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada.
Arthritis Res Ther. 2025 Jan 21;27(1):13. doi: 10.1186/s13075-024-03466-8.
Describe patterns of pharmacotherapy and psychological treatment and evaluate receipt of minimally adequate treatment for incident depression and anxiety in individuals with inflammatory arthritis (IA).
We used population-based linked administrative health databases from British Columbia, Canada to evaluate pharmacotherapy and psychological treatments for incident depression and/or anxiety among individuals with IA and without IA ('IA-free controls'). We defined minimally adequate pharmacotherapy as antidepressant prescriptions filled with ≥ 84 days' supply and adequate psychological treatment as ≥ 4 counselling/psychotherapy services. Multivariable logistic regression models were used to evaluate the odds of individuals with IA receiving minimally adequate pharmacotherapy and/or psychological treatment compared to IA-free controls.
6,951 (mean age 54.8 ± 18.3 years; 65.5% female) individuals with IA had incident depression and 3,701 (mean age 52.9 ± 16.8 years; 74.3% female) had incident anxiety. Minimally adequate pharmacotherapy and psychological treatment for depression was respectively observed in 50.5% and 19.6% of those with IA, proportions similar to IA-free controls (pharmacotherapy: aOR 1.10, 95% CI 1.00 to 1.21; psychological: aOR 1.07, 95% CI 0.94 to 1.21). Results were similar regarding anxiety treatment. Individuals with IA had a significantly greater likelihood of dispensing ≥ 1 benzodiazepine (anxiety: IA 45.0%, IA-free controls 39.0%, p-value < 0.001) and ≥ 1 tricyclic antidepressant prescription (anxiety: IA 12.8%, IA-free controls 7.8%, p-value < 0.001). Significantly higher average days' supply of benzodiazepines was observed for IA (anxiety: IA 123.7 days, controls 112.4 days, p-value = 0.003).
A substantial proportion of individuals with IA were not receiving adequate mental health treatment for depression and anxiety, a finding similar for IA-free controls. The undertreatment of mental disorders for people with IA has well-known negative implications for the provision of effective rheumatology care. It remains fundamental to expand publicly funded health care to include mental health services in an effort to address unmet counselling needs.
描述药物治疗和心理治疗模式，并评估炎症性关节炎（IA）患者新发抑郁和焦虑的最低充分治疗的接受情况。
我们使用了加拿大不列颠哥伦比亚省基于人群的关联行政卫生数据库，以评估IA患者和非IA患者（“无IA对照”）中针对新发抑郁和/或焦虑的药物治疗和心理治疗。我们将最低充分药物治疗定义为开具供应天数≥84天的抗抑郁药处方，将充分心理治疗定义为≥4次咨询/心理治疗服务。多变量逻辑回归模型用于评估与无IA对照相比，IA患者接受最低充分药物治疗和/或心理治疗的几率。
6951名（平均年龄54.8±18.3岁；65.5%为女性）IA患者出现新发抑郁，3701名（平均年龄52.9±16.8岁；74.3%为女性）出现新发焦虑。IA患者中分别有50.5%和19.6%接受了针对抑郁的最低充分药物治疗和心理治疗，这一比例与无IA对照相似（药物治疗：调整后比值比[aOR]为1.10，95%置信区间[CI]为1.00至1.21；心理治疗：aOR为1.07，95%CI为0.94至1.21）。焦虑治疗的结果相似。IA患者开具≥1种苯二氮䓬类药物（焦虑：IA患者为45.0%，无IA对照为39.0%，p值<0.001）和≥1种三环类抗抑郁药处方（焦虑：IA患者为12.8%，无IA对照为r7.8%，p值<0.001）的可能性显著更高。IA患者苯二氮䓬类药物的平均供应天数明显更高（焦虑：IA患者为123.7天，对照为112.4天，p值=0.003）。
相当一部分IA患者未接受针对抑郁和焦虑的充分心理健康治疗，这一发现与无IA对照相似。IA患者精神障碍治疗不足对提供有效的风湿病护理具有众所周知的负面影响。扩大公共资助的医疗保健范围以纳入心理健康服务，以满足未满足的咨询需求仍然至关重要。
