Cohort of one million patients initiating antidepressant treatment in France: 12-month follow-up
Cohort of one million patients initiating antidepressant treatment in France: 12-month follow-up
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DOI：
10.1111/ijcp.12850
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发表时间：
2016-09-01
影响因子：
2.6
通讯作者：
Fagot-Campagna, Anne
中科院分区：
文献类型：
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作者：
Fagot, Jean-Paul;Cuerq, Anne;Fagot-Campagna, Anne
目的：以前的研究表明，推荐的最短6个月的抗抑郁治疗期实际上只适用于少数患者。本研究的目的是对法国新处方抗抑郁药治疗的患者进行随访，并确定可能与治疗持续时间不足或发生某些事件（如病假、住院和自杀企图）相关的因素。数据提取自法国健康保险数据库（SNIIRAM）和国家住院数据库（PMSI）法国主要医疗保险计划覆盖的患者占法国人口的75%。如果患者在2011年有新处方的抗抑郁药，但在数据库中没有发现既往精神病诊断，并且没有显著的精神病药物，则将其纳入研究（如抗精神病药或情绪稳定剂）。结果：共998710例患者（占总人口的2%），平均年龄为50岁，66%的女性在2011年开始使用抗抑郁药，在89%的情况下，这是由全科医生开的。五个通用名，包括三个选择性血清素再摄取抑制剂，占首次处方的75%。40%的患者仅观察到一次报销。超过80%的患者的治疗持续时间不到6个月，低收入者更常见，并因年龄、性别和地区而异。首次访视和抗抑郁药治疗开始之间的中位时间间隔为27天。在接下来的12个月里，有3%的患者因精神疾病住院。对于2011年开始抗抑郁治疗的大多数法国患者来说，治疗和随访的持续时间都不足，这可能反映了对情绪或焦虑障碍患者的护理质量差，可能是因为过度诊断和不适当的药物治疗，或不良的依从性和副作用，或不良的随访。
Aims: Previous studies have shown that the recommended minimum 6-month period for antidepressant treatment is actually observed for only a minority of patients. The objectives of this study were to characterise patients with newly prescribed antidepressant treatment in France and identify factors possibly associated with insufficient duration of treatment or the occurrence of certain events such as sick leave, hospitalisations and suicide attempts.Methods: Data were extracted from the French health insurance database (SNIIRAM) and the national hospitalisation database (PMSI) for patients covered by the main French health insurance scheme representing 75% of the French population. Patients were included if they had a newly prescribed antidepressant in 2011, but no prior psychiatric diagnosis identified in the databases and no significant psychiatric medication (such as antipsychotic or mood stabiliser) in 2009-2010.Results: A total of 998 710 patients (2% of the overall population), with a mean age of 50 years and 66% of females, initiated an antidepressant in 2011, which was prescribed by a general practitioner in 89% of cases. Five generic names, including three selective serotonin reuptake inhibitors, accounted for 75% of first prescriptions. Only one reimbursement was observed for 40% of patients. Treatment duration was less than 6 months for more than 80% of patients, more frequently for low income earners, and varied according to age, gender and region. The median time lag between first visit and antidepressant initiation was 27 days. Hospitalisation related to a psychiatric disease over the following 12 months was observed for 3% of patients.Conclusion: Duration of treatment and follow-up were both insufficient for the majority of French patients initiating antidepressant treatment in 2011, which may reflect poor quality of care for people with mood or anxiety disorders, possibly because of overdiagnosis and inappropriate drug treatment, or poor adherence and side effects, or poor follow-up.