Diagnosis and Treatment of Depression in Older Community-Dwelling Adults: 1992-2005
Diagnosis and Treatment of Depression in Older Community-Dwelling Adults: 1992-2005
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DOI：
10.1111/j.1532-5415.2011.03447.x
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发表时间：
2011-06-01
影响因子：
6.3
通讯作者：
Crystal, Stephen
中科院分区：
文献类型：
--
作者：
Akincigil, Ayse;Olfson, Mark;Crystal, Stephen
目的：研究美国老年人抑郁症诊断和治疗的演变模式。S.设计：使用1992年至2005年Medicare当前受益人调查（Medicare Current Beneficiary Survey）的数据进行趋势分析，Medicare当前受益人调查是一项全国性的Medicare登记者调查，地点：社区，日常护理，参与者：老年Medicare按服务收费的受益人，测量：从Medicare索赔中确定的抑郁症诊断和心理治疗使用;结果：接受抑郁症诊断的老年人比例翻了一番，从3.2%增加到6.3%，所有人口统计学亚组的比率都大幅增加。在确诊的患者中，接受抗抑郁药物治疗的比例从53.7%上升到67.1%，而接受心理治疗的比例从26.1%下降到14.8%。调整其他特征后，诊断为抑郁症的老年人接受抗抑郁治疗的几率女性高86%，男性高53%，白人高89%，非裔美国人高13%，大都市地区居民高84%，非大都市地区居民高55%。抗抑郁治疗的几率是54%以上的诊断为重度抑郁症（MDD）和83%以上的那些与其他抑郁症的诊断，而接受心理治疗的几率是29%，降低在那些与MDD诊断和74%，降低在那些与其他抑郁症diagnosis.CONCLUSION：整体诊断和治疗率随着时间的推移而增加。抗抑郁药的作用越来越突出，而心理治疗的作用则不那么突出。这些变化在抑郁症不太严重的人群中最为明显，在这些人群中，单独使用抗抑郁药治疗的疗效证据不太清楚。J Am Geriatr Soc 59：1042-1051，2011.
OBJECTIVE: To examine evolving patterns of depression diagnosis and treatment in older U. S. adults in the era of newer-generation antidepressants.DESIGN: Trend analysis using data from the Medicare Current Beneficiary Survey, a nationally representative survey of Medicare enrollees, from 1992 to 2005.SETTING: Community, usual care.PARTICIPANTS: Older Medicare fee-for-service beneficiaries.MEASUREMENTS: Depression diagnoses and psychotherapy use identified from Medicare claims; antidepressant use identified from detailed medication inventories conducted by interviewers.RESULTS: The proportion of older adults who received a depression diagnosis doubled, from 3.2% to 6.3%, with rates increasing substantially across all demographic subgroups. Of those diagnosed, the proportion receiving antidepressants increased from 53.7% to 67.1%, whereas the proportion receiving psychotherapy declined from 26.1% to 14.8%. Adjusting for other characteristics, odds of antidepressant treatment in older adults diagnosed with depression were 86% greater for women, 53% greater for men, 89% greater for whites, 13% greater for African Americans, 84% greater for metropolitan-area residents, and 55% greater for non-metropolitan-area residents. Odds of antidepressant treatment were 54% greater for those diagnosed with major depressive disorder (MDD) and 83% greater for those with other depression diagnoses, whereas the odds of receiving psychotherapy was 29% lower in those with MDD diagnoses and 74% lower in those with other depression diagnoses.CONCLUSION: Overall diagnosis and treatment rates increased over time. Antidepressants are assuming a more-prominent and psychotherapy a less-prominent role. These shifts are most pronounced in groups with less-severe depression, in whom evidence of efficacy of treatment with antidepressants alone is less clear. J Am Geriatr Soc 59:1042-1051, 2011.