Variation in the 12-Month Treatment Trajectories of Children and Adolescents After a Diagnosis of Depression.
Variation in the 12-Month Treatment Trajectories of Children and Adolescents After a Diagnosis of Depression.
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DOI：
10.1001/jamapediatrics.2017.3808
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发表时间：
2018-01-01
期刊：
影响因子：
26.1
通讯作者：
Hatfield LA
中科院分区：
文献类型：
--
作者：
Joyce NR;Schuler MS;Hadland SE;Hatfield LA
儿童和青少年时期的抑郁症是多种多样的。治疗模式往往是在总体上进行检查，但有很大的差异，在个别治疗轨迹。了解这种变异性有助于确定青少年抑郁症患者的治疗差距。描述青少年抑郁症患者心理治疗和抗抑郁药治疗12个月轨迹的异质性。这是一项对18岁或18岁以下的年轻人进行的队列研究，这些年轻人新诊断为抑郁症，并在诊断后至少随访12个月，根据2007年至2014年提交的商业保险索赔确定。潜在类别模型适合于索引诊断后12个月内心理治疗和抗抑郁药使用的汇总指标。我们检查了基线健康，卫生保健利用和健康结果的变化，具有相似的心理治疗和抗抑郁药使用模式的班级。数据分析在2016年6月至2017年3月期间进行。心理治疗和抗抑郁药的使用。该队列包括84909名患者，索引诊断时的平均（SD）年龄为15.0（2.6）岁，其中49995名（59%）为女性。注意力缺陷/多动障碍（n = 14625; 17%）和焦虑（n = 12358; 15%）是最常见的共病诊断。在评估期间，59023人（70%）在任何时候接受了心理治疗，33997人（40%）在任何时候分发了抗抑郁药。八类不同的治疗轨迹被确定，我们分为4大类：3类，接受双重治疗（n = 18 710; 22%），2类接受抗抑郁药单药治疗（n = 15 287; 18%），2类接受心理治疗单药治疗（n = 40313; 48%）和1类未接受治疗（n = 10599; 13%）。最常见的类别接受心理治疗单药治疗（n = 35243; 42%），在评估期间和评估后期间自杀未遂（0.8/100人-年[PY]）和住院治疗（3.5/100 PY）的发生率最低（分别为0.5/100 PY和1.3/100 PY）。接受双重治疗组在评估期间（4.7-7.1/100 PY，取决于类别）和评估后期间（1.5-1.7/100 PY）的自杀未遂发生率最高。在我们的样本中，13%的青少年没有接受任何治疗，18%的青少年在没有伴随心理治疗的情况下接受抗抑郁药。治疗的概括性措施可以掩盖心理治疗和抗抑郁药使用的信息模式。潜在类别分析可用于识别具有相似治疗轨迹的个体亚组，并帮助识别当前实践模式下的治疗差距。
Depression during childhood and adolescence is heterogeneous. Treatment patterns are often examined in aggregate, yet there is substantial variability across individual treatment trajectories. Understanding this variability can help identify treatment gaps among youths with depression. To characterize heterogeneity in 12-month trajectories of psychotherapy and antidepressant treatment in youths with depression. This is a longitudinal-cohort study of youths 18 years or younger with a new diagnosis of depression and at least 12 months of follow-up following diagnosis, as determined from commercial insurance claims filed from 2007 to 2014. Latent class models were fit to summary measures of psychotherapy and antidepressant use in the 12 months following the index diagnosis. We examined variation in baseline health, health care utilization, and health outcomes across classes with similar patterns of psychotherapy and antidepressant use. Data analysis took place between June 2016 and March 2017. Psychotherapy and antidepressant use. The cohort included 84 909 individuals with a mean (SD) age at index diagnosis of 15.0 (2.6) years, of whom 49 995 (59%) were female. Attention-deficit/hyperactivity disorder (n = 14625; 17%) and anxiety (n = 12358; 15%) were the most common comorbid diagnoses. During the assessment period, 59 023 individuals (70%) received psychotherapy at any point, and 33 997 individuals (40%) were dispensed antidepressants at any point. Eight classes with distinct treatment trajectories were identified, which we classified into 4 broad groups: 3 classes that received dual therapy (n = 18 710; 22%), 2 classes that received antidepressant monotherapy (n = 15 287; 18%), 2 classes that received psychotherapy monotherapy (n = 40313; 48%) and 1 class that received no treatment (n = 10599; 13%). The most common class received psychotherapy monotherapy (n = 35243; 42%) and had the lowest incidence of attempted suicide (0.8 per 100 person-years [PY]) and inpatient hospitalization (3.5 per 100 PY) during the assessment period and postassessment period (0.5 per 100 PY and 1.3 per 100 PY, respectively). The group receiving dual therapy had the highest incidence of attempted suicide during the assessment period (4.7-7.1 per 100 PY, depending on the class) and postassessment period (1.5-1.7 per 100 PY). In our sample, 13% of youths received no treatment, and 18% received antidepressants without concomitant psychotherapy. Summary measures of treatment can mask informative patterns of psychotherapy and antidepressant use. Latent class analysis can be used to identify subgroups of individuals with similar treatment trajectories and help identify treatment gaps under current practice patterns.
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DOI：
10.1136/bmj.i65
发表时间：
2016-01-27
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Sharma T;Guski LS;Freund N;Gøtzsche PC
通讯作者：
Gøtzsche PC
儿童和青少年的抗抑郁药治疗和自杀企图和自杀性伤害。
影响因子：
2.6
作者：
Gibbons, Robert D.;Perraillon, Marcelo Coca;Hur, Kwan;Conti, Rena M.;Valuck, Robert J.;Brent, David A.
通讯作者：
Brent, David A.
影响因子：
25.8
作者：
Olfson, Mark;Blanco, Carlos;Correll, Christoph U.
通讯作者：
Correll, Christoph U.
影响因子：
17.7
作者：
Simon, Gregory E.;Savarino, James
通讯作者：
Savarino, James
影响因子：
25.8
作者：
Paksarian, Diana;Cui, Lihong;Merikangas, Kathleen R.
通讯作者：
Merikangas, Kathleen R.