Trajectories of antidepressant medication use in individuals before and after being granted disability pension due to common mental disorders- a nationwide register-based study.
Trajectories of antidepressant medication use in individuals before and after being granted disability pension due to common mental disorders- a nationwide register-based study.
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DOI：
10.1186/s12888-018-1628-8
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发表时间：
2018-02-13
期刊：
影响因子：
4.4
通讯作者：
Mittendorfer-Rutz E
中科院分区：
文献类型：
--
作者：
Rahman S;Wiberg M;Alexanderson K;Jokinen J;Tanskanen A;Mittendorfer-Rutz E
在欧洲国家，由于常见精神障碍（CMD）而导致的残疾养老金（DP）导致的提前退休是常见的。治疗不当，例如，DP前的次优抗抑郁药（AD）治疗在此类DP中可能至关重要。这项探索性研究旨在根据DP批准前后的限定日剂量（DDD）理清AD的轨迹，并通过社会人口统计学和医学因素表征轨迹。纳入了2009 - 2010年瑞典所有4642名年龄在19 - 64岁之间因CMD发生DP的个体。采用分组轨迹法分析了6年间AD的年DDDs轨迹。通过卡方检验和多项逻辑回归估计社会人口统计学或医学因素与不同轨迹之间的关联。确定了AD的五个轨迹。三组，包括34%，34%和21%的队列，有恒定的AD水平之前和之后DP与平均年DDDs分别为29，234和580。两组，每组包括6%的队列，DDDs水平增加，DP后稳定在约1150和785 DDDs。特别是年龄、精神病诊断和DP诊断导致的门诊治疗与不同的轨迹显著相关（p <0.05）。所有组的老年人比例都较大（> 50%，45 - 64岁），但"低增长"组除外，其中年轻人占多数（> 60%，18 - 44岁），他们因"焦虑症"更频繁地退出劳动力市场，与其他组相比，DP之前的教育程度较低，医疗保健更专业。五个轨迹组之间的异质性部分解释了年龄，精神障碍的严重程度和DP诊断。大多数药品在给予DP前后的DDDs差异不大，但水平不同。此外，三分之一的人的AD水平非常低。早期识别和关注"逐渐降低"组可能很重要，以便识别即使在获得DP后AD年DDDs进一步增加的风险个体，并且也可能有助于预防DP。需要对不同群体进行进一步的详细研究。
Early retirement caused by disability pension (DP) due to common mental disorders (CMDs) is frequent in European countries. Inadequate treatment, e.g., suboptimal antidepressant (AD) medication before DP can be crucial in such DP. This explorative study aimed to disentangle trajectories of AD based on defined daily dose (DDD) before and after granted DP, and to characterize the trajectories by socio-demographics and medical factors. All 4642 individuals in Sweden aged 19–64 with incident DP due to CMD in 2009–2010 were included. Trajectories of annual DDDs of AD were analysed over a 6-year period by a group-based trajectory method. Associations between socio-demographic or medical factors and different trajectories were estimated by chi2-test and multinomial logistic regression. Five trajectories of ADs were identified. Three groups, comprising 34%, 34%, and 21% of the cohort, had constant AD levels before and after DP with mean annual DDDs of 29, 234, and 580, respectively. Two groups, each including 6% of the cohort, had increasing levels of DDDs, levelling off at around 1150 and 785 DDDs after DP. Particularly age, outpatient care due to mental diagnoses and DP diagnoses were significantly associated with different trajectories (p < 0.05). All the groups had a larger proportion of older individuals (> 50%, 45–64 years), except for the ‘increasing low’ group, where younger individuals were in majority (> 60%, 18–44 years), who more frequently exited labour market due to ‘anxiety disorders’, with lower education and more specialised healthcare before DP than the other groups. The heterogeneity among the five trajectory groups was partly explained by age, the severity of the mental disorder and the DP diagnoses. DDDs of ADs, though on different levels, varied marginally before and after granted DP in the majority. Moreover, AD levels were very low in one third of the individuals. Early identification and focus on the ‘increasing low’ group might be important in order to identify individuals at risk for further increase in annual DDDs of ADs even after granted DP, and might also contribute in prevention of DP. Further detailed research regarding different groups is warranted.
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DOI：
10.1016/j.jaac.2013.09.017
发表时间：
2014-01
影响因子：
13.3
作者：
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影响因子：
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发表时间：
2011-02-01
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