Forthman Katherine L, Kuplicki Rayus, Thompson Wesley K, Nemeroff Charles B, Si Yajuan, Fan Chun Chieh, Paulus Martin P
Laureate Institute for Brain Research, Oxley College of Health and Natural Sciences, University of Tulsa, 6655 S Yale Ave, Tulsa, OK 74136-3326, United States of America.
Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, TX 78712-1873, United States of America.
J Affect Disord. 2025 Jul 9;390:119858. doi: 10.1016/j.jad.2025.119858.
This study used the All of Us (AoU) cohort to investigate treatment-resistant depression (TRD) and its demographic associations, comorbidities and antidepressant treatment patterns.
Electronic health records were used to classify major depressive disorder participants as treatment resistant. Logistic regressions determined socio-demographic and comorbidity differences between participants with TRD and treatment-responsive depression. Sankey diagrams visualized differences in treatment patterns.
13.92 % of the depression population was characterized as TRD. The TRD population was 19.10 % of the medicated depression population. Compared to treatment-responsive depression individuals, those with TRD had lower education (Odds Ratio (OR) = 1.10 [1.03, 1.16]), were unemployed (OR = 1.35 [1.27, 1.43]) or in lower income brackets (OR < 35 k = 1.10 [1.03, 1.18]), and were more likely to be between ages 35-44 (OR = 1.15 [1.07, 1.24]). TRD relative to treatment-responsive depression individuals were more likely to have comorbidity with anxiety disorders (ORs ranging from 1.85 to 2.56 for various forms), Post-Traumatic Stress Disorder (OR = 2.10) and substance use disorders (ORs from 1.36 to 3.12). A Sankey diagram revealed heterogeneity in treatment among TRD and treatment-responsive depression.
This study finds that TRD is especially prevalent among younger individuals, those with lower income, the unemployed, and individuals with comorbid anxiety or substance use disorders. This underscores the importance of integrating socio-demographic and clinical characteristics into targeted strategies aimed at identifying high-risk populations and guiding more effective treatment approaches.
本研究使用“我们所有人”（AoU）队列来调查难治性抑郁症（TRD）及其人口统计学关联、合并症和抗抑郁治疗模式。
利用电子健康记录将重度抑郁症参与者分类为难治性。逻辑回归确定了TRD参与者与治疗反应性抑郁症参与者之间的社会人口统计学和合并症差异。桑基图直观显示了治疗模式的差异。
13.92%的抑郁症患者被归类为难治性。TRD患者占接受药物治疗的抑郁症患者的19.10%。与治疗反应性抑郁症患者相比，TRD患者受教育程度较低（优势比（OR）=1.10[1.03，1.16]），失业（OR=1.35[1.27，1.43]）或收入较低（OR<35k=1.10[1.03，1.18]），且更有可能年龄在35-44岁之间（OR=1.15[1.07，1.24]）。与治疗反应性抑郁症患者相比，TRD患者更有可能合并焦虑症（各种形式的OR范围为1.85至2.56）、创伤后应激障碍（OR=2.10）和物质使用障碍（OR范围为1.36至3.12）。桑基图显示了TRD和治疗反应性抑郁症患者在治疗方面的异质性。
本研究发现，TRD在年轻人、低收入者、失业者以及合并焦虑或物质使用障碍的个体中尤为普遍。这凸显了将社会人口统计学和临床特征纳入旨在识别高危人群并指导更有效治疗方法的针对性策略的重要性。
