Large posttraumatic stress disorder improvement and antidepressant medication adherence
Large posttraumatic stress disorder improvement and antidepressant medication adherence
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DOI：
10.1016/j.jad.2019.08.095
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发表时间：
2020-01-01
影响因子：
6.6
通讯作者：
Lustman, Patrick
中科院分区：
文献类型：
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作者：
Salas, Joanne;Scherrer, Jeffrey F.;Lustman, Patrick
背景：患有创伤后应激障碍 (PTSD) 的患者与未患创伤后应激障碍 (PTSD) 的患者更有可能抗抑郁药物 (ADM) 依从性较差，但尚不清楚 PTSD 的改善是否与 ADM 依从性相关。我们确定临床上有意义的 PTSD 症状减轻是否与 ADM 依从性相关。方法：从使用 PTSD 专科诊所的 742 名退伍军人健康事务部 (VHA) 患者获得电子健康记录数据 (2008-2015)，这些患者有 PTSD 诊断且 PTSD 检查表 (PCL) 评分 >= 50。第一次 PCL >= 50 后暴露年份中的最后一个 PCL 用于识别具有临床意义的 PCL 降低 >= 的患者20分）与没有的（<20分）。患者在暴露年之前的 12 个月内被诊断为抑郁症，并在暴露年接受了 ADM。所覆盖的天数比例在暴露年度定义的遵守情况中达到 80%。使用倾向评分和治疗权重的逆概率来控制混杂因素。结果：患者年龄为 42.2 +/- 13.1 岁，其中 63.9% 为白人，18.9% 的 PCL 出现有临床意义的下降。控制混杂变量后，与没有临床意义的 PCL 降低的患者相比，患者明显更有可能坚持治疗（OR = 1.78；95% CI：1.16-2.73）。然而，PCL 明显下降和 PCL 不明显下降的患者的依从性仍然较低（53.5% 对比 39.3%）。 局限性：样本仅限于 VHA 患者。患者可能没有按照处方服药。结论：PTSD 症状的大幅减轻与 ADM 依从性相关。先前的文献表明，坚持 ADM 可以改善抑郁症状。因此，创伤后应激障碍（PTSD）症状的减轻可能会带来更好的抑郁结果。
Background: Patients with vs. without posttraumatic stress disorder (PTSD) are more likely to have poor antidepressant medication (ADM) adherence but it is unclear if improved PTSD is associated with ADM adherence. We determined if clinically meaningful PTSD symptom reduction was associated with ADM adherence.Methods: Electronic health record data (2008-2015) was obtained from 742 Veterans Health Affairs (VHA) patients using PTSD specialty clinics with a PTSD diagnosis and PTSD checklist (PCL) score >= 50. The last PCL in the exposure year after the first PCL >= 50 was used to identify patients with a clinically meaningful PCL decrease >= 20 point) versus those without ( < 20 point). Patients had a depression diagnosis in the 12-months before the exposure year and received an ADM in the exposure year. Proportion of days covered 80% in exposure year defined adherence. Confounding was controlled using propensity scores and inverse probability of treatment weighting.Results: Patients were 42.2 +/- 13.1 years of age, 63.9% white and 18.9% had a clinically meaningful PCL decrease. After controlling for confounding variables, patients with vs. without a clinically meaningful PCL decrease were significantly more likely to be adherent (OR = 1.78; 95% CI:1.16-2.73). However, adherence remained low in both patients with and without meaningful PCL decrease (53.5% vs. 39.3%).Limitations: The sample was limited to VHA patients. Patients may not have taken medication as prescribed.Conclusions: Large reductions in PTSD symptoms are associated with ADM adherence. Prior literature suggests ADM adherence improves depression symptoms. Thus, PTSD symptom reduction may lead to better depression outcomes.