Effects of Pain, Insomnia, and Depression on Psychoactive Medication Supply in Older Adults With Osteoarthritis.
Effects of Pain, Insomnia, and Depression on Psychoactive Medication Supply in Older Adults With Osteoarthritis.
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DOI：
10.1097/mlr.0000000000000982
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发表时间：
2018-12
期刊：
影响因子：
3
通讯作者：
Vitiello MV
中科院分区：
文献类型：
--
作者：
Liu M;McCurry SM;Belza B;Buchanan DT;Dobra A;Von Korff M;Vitiello MV
尽管已知这些药物的风险和注意事项，但老年人处方精神活性药物治疗症状的决定因素仍未得到充分研究。研究疼痛、并发失眠和抑郁症状对提供给老年骨关节炎（OA）的精神活性药物的独立和联合影响。在一项随机对照试验中筛选的OA患者的疼痛、失眠和抑郁调查数据被用来确定四年期间精神活性药物供应（阿片类药物、镇静剂、三环抗抑郁药[TCAs]和非TCAs）的预测因素。分组健康合作诊断为OA的患者（N = 2976）疼痛（分级慢性疼痛量表）、失眠（失眠严重程度指数）、抑郁（患者健康问卷-8）调查资料以及通过电子医疗记录评估的药物供应。在负二项模型中，疼痛（发病率比[IRR]: 2.8-3.5, p<.001）、失眠（发病率比：2.0,p<.001）和抑郁（发病率比：1.5,p<.05）分别独立预测阿片类药物供应。失眠（IRR: 3.2, p<.001）和抑郁（IRR: 3.0, p<.001）分别独立预测镇静剂的供应。疼痛（IRR: 2.1, p< 0.05）和失眠（IRR: 2.0, p< 0.05）独立预测TCA供应，而只有抑郁（IRR: 2.2, p< 0.001）独立预测非TCA供应。疼痛和失眠/抑郁对这些药物的联合作用是加性的，使药物供应率增加了1.5至7.5倍。综合效应随着失眠或抑郁的严重程度而增加。考虑到疼痛后，并发失眠和抑郁症状预示着阿片类药物、镇静剂和抗抑郁药的供应增加，这表明睡眠和情绪障碍是增加这些药物供应的重要因素。
Determinants of prescribing psychoactive medications for symptom management in older adults remain underexamined despite known risks and cautions concerning these medications. To examine independent and combined effects of pain, concurrent insomnia and depression symptoms on psychoactive medications supplied to older adults with osteoarthritis (OA). Survey data on pain, insomnia, and depression obtained from OA patients screened for a randomized controlled trial were used to identify predictors of psychoactive medication supply (opioids, sedatives, tricyclic antidepressants [TCAs], and non-TCAs) over a four-year period. Group Health Cooperative patients with a diagnosis of OA (N = 2,976) Survey data on pain (Graded Chronic Pain Scale), insomnia (Insomnia Severity Index), and depression (Patient Health Questionnaire-8); and medications supply assessed from electronic medical records. In negative binomial models, pain (Incidence rate ratio [IRR]: 2.8–3.5, p<.001), insomnia (IRR: 2.0, p<.001), and depression (IRR: 1.5, p<.05) each independently predicted opioid supply. Insomnia (IRR: 3.2, p<.001) and depression (IRR: 3.0, p<.001) each independently predicted sedative supply. Pain (IRR: 2.1, p<.05) and insomnia (IRR: 2.0, p<.05) independently predicted TCA supply, whereas only depression (IRR: 2.2, p<.001) independently predicted non-TCA supply. Combined effects of pain and insomnia/depression on these medications were additive and increased the rate of medication supply 1.5 to 7.5 times. Combined effects increased with insomnia or depression severity. Concurrent insomnia and depressive symptoms predicted increased supply of opioids, sedatives, and antidepressants after accounting for pain, indicating the importance of sleep and mood disorders as factors increasing supply of these medications.