Association of Early Treatment With Chronicity and Hazard of Hospitalization After New Adjustment Disorder.
Association of Early Treatment With Chronicity and Hazard of Hospitalization After New Adjustment Disorder.
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DOI：
10.1176/appi.psychotherapy.20190019
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发表时间：
2020-06-01
影响因子：
2.5
通讯作者：
Marcangelo M
中科院分区：
文献类型：
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作者：
Gao YN;Marcangelo M
探讨了早期心理治疗和精神活性药物对新诊断为适应障碍的患者后来住院的影响。使用了Truven Health MarketScan的商业索赔数据。进行患者水平倾向评分匹配，然后拟合治疗逆概率加权Cox比例风险模型。接受精神活性药物治疗与后期精神住院（HR=2.61 95% CI=2.07-3.28）和总体住院（HR=1.12 CI=1.04-1.21）的风险增加相关。具体来说，苯二氮卓类药物与后期精神病住院的风险增加相关（HR=1.59 CI=1.02-2.51）。相比之下，接受心理治疗与后来精神病住院风险的小幅降低相关（HR= 0.85）CI= 0.73 - 0.99)，对总体住院率没有影响。与对照组相比，适应障碍治疗的早期药物使用持续与总体和精神住院水平较高相关。这项研究表明，观察到的提供者倾向于用药物治疗更多的疾病患者可能会产生有害的长期影响。
The effect of early psychotherapy and psychoactive medications on later hospitalizations for patients with a new diagnosis of adjustment disorder was examined. Commercial claims data from Truven Health MarketScan were used. Patient-level propensity score matching was performed, followed by fitting to an inverse probability of treatment weighted Cox proportional hazard model. Receipt of psychoactive medication is associated with an increased hazard of both later psychiatric hospitalization (HR=2.61 95% CI=2.07-3.28) and overall hospitalization (HR=1.12 CI=1.04-1.21). Specifically, benzodiazepines were associated with an increased hazard of later psychiatric hospitalization (HR=1.59 CI=1.02-2.51). By contrast, receipt of psychotherapy was associated with a small decrease in the hazard of later psychiatric hospitalization (HR=.85 CI=.73-.99) with no effect on hospitalizations overall. Early medication use for adjustment disorder treatment was persistently associated with higher levels of overall and psychiatric hospitalization compared to controls. This study suggests that an observed provider preference to treat more medically ill patients with medications may have deleterious long-run effects.