Impact of Psychiatric Diagnosis and Treatment on Medication Adherence in Youth With Systemic Lupus Erythematosus
Impact of Psychiatric Diagnosis and Treatment on Medication Adherence in Youth With Systemic Lupus Erythematosus
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DOI：
10.1002/acr.24450
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发表时间：
2021-01-01
影响因子：
4.7
通讯作者：
Knight, Andrea M.
中科院分区：
文献类型：
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作者：
Chang, Joyce C.;Davis, Alaina M.;Knight, Andrea M.
目的：系统性红斑狼疮（SLE）青年患者精神合并症发生率高，这可能影响药物依从性。我们进行这项研究是为了检查精神疾病和羟氯喹依从性之间的关系，并确定精神治疗是否能改变这种关系。方法：我们使用Optum Clinformatics数据集市（2000-2016年）中去识别的美国商业保险索赔，对青少年SLE（10-24岁）羟氯喹使用者事件进行了识别。在365天的时间内，使用药物占有比（MPRs）估计依从性。使用多变量线性回归模型来估计患有任何精神障碍对MPRs的影响，以及抑郁、焦虑、适应和其他精神障碍的独立影响。我们测试了精神病诊断与精神药物或心理治疗之间的相互作用。结果在873名受试者中，20%有精神病学诊断，最常见的是抑郁症。只有调整障碍与mpr降低独立相关（β -0.12, P = 0.05）。我们观察到显著的交叉相互作用，其中精神疾病对依从性有相反的影响，这取决于接受精神治疗。在有任何精神病诊断的青少年中，与不使用精神药物相比，使用精神药物与MPR增加0.15相关（相互作用P = 0.02）。在患有抑郁或焦虑的青少年中，与没有接受心理治疗相比，心理治疗也与更高的MPR相关（相互作用的P分别为0.05和P < 0.01）。结论精神障碍对药物依从性的影响因青少年是否接受过精神治疗而异。提高对精神疾病的认识和治疗可能会增加青年SLE患者的药物依从性。
Objective Youth with systemic lupus erythematosus (SLE) experience high rates of psychiatric comorbidities, which may affect medication adherence. We undertook this study to examine the association between psychiatric disorders and hydroxychloroquine adherence and to determine whether psychiatric treatment modifies this association.Methods We identified incident hydroxychloroquine users among youth with SLE (ages 10-24 years) using de-identified US commercial insurance claims in Optum Clinformatics Data Mart (2000-2016). Adherence was estimated using medication possession ratios (MPRs) over a 365-day time period. Multivariable linear regression models were used to estimate the effect of having any psychiatric disorder on MPRs, as well as the independent effects of depression, anxiety, adjustment, and other psychiatric disorders. We tested for interactions between psychiatric diagnoses and treatment with psychotropic medications or psychotherapy.Results Among 873 subjects, 20% had a psychiatric diagnosis, most commonly depression. Only adjustment disorders were independently associated with decreased MPRs (beta -0.12, P = 0.05). We observed significant crossover interactions, in which psychiatric disorders had opposite effects on adherence depending on the receipt of psychiatric treatment. Among youth with any psychiatric diagnosis, psychotropic medication use was associated with a 0.15 increase in the MPR compared with no psychotropic medication use (P = 0.02 for interaction). Among youth with depression or anxiety, psychotherapy was also associated with a higher MPR compared with no psychotherapy (P = 0.05 and P < 0.01 for interaction, respectively).Conclusion The impact of psychiatric disorders on medication adherence differed by whether youth had received psychiatric treatment. Improving recognition and treatment of psychiatric conditions may increase medication adherence in youth with SLE.