Antidepressant Use and Cognitive Deficits in Older Men: Addressing Confounding by Indications with Different Methods
Antidepressant Use and Cognitive Deficits in Older Men: Addressing Confounding by Indications with Different Methods
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DOI：
10.1016/j.annepidem.2011.10.004
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发表时间：
2012-01-01
影响因子：
5.6
通讯作者：
Allore, Heather G.
中科院分区：
文献类型：
--
作者：
Han, Ling;Kim, Nancy;Allore, Heather G.
目的：抗抑郁药的使用与老年人的认知障碍有关。我们试图研究这种关联是否反映了适应症偏倚。方法：共有544名年龄≥ 65岁的社区高血压男性在基线和1年时完成了霍普金斯言语学习测试。通过使用医疗记录确定抗抑郁药物。使用多元线性回归、倾向评分和结构方程模型（SEM），通过调整抑郁症相关诊断和抑郁症症状的严重程度，检查适应症的潜在混杂因素。在调整适应症之前，一个单位的抗抑郁药累积暴露与-1.00（95%置信区间[CI]，-1.94，-0.06）点降低HVLT评分。使用多元线性回归或倾向评分调整适应症后，相关性分别降至-0.48（95%CI，-0.62，1.58）和-0.58（95%CI，-0.60，1.58）。最具临床可解释性的经验SEM（具有足够的tit）涉及两种适应症的直接和间接路径。抑郁症相关诊断和抑郁症状显著预测抗抑郁药的使用（p <0.05）。霍普金斯言语学习测验得分的总标准化通径系数（0.073）是抗抑郁药使用（0.035）的2倍（0.034）。SEM提供了一种启发式经验方法，用于检查适应症的混杂，但与传统方法相比，在定量上没有上级偏倚减少。Ann Epidemiol 2012;22：9-16. (C)2012 Elsevier Inc. All rights reserved.
PURPOSE: Antidepressant use has been associated with cognitive impairment in older persons. We sought to examine whether this association might reflect an indication bias.METHODS: A total of 544 community-dwelling hypertensive men aged >= 65 years completed the Hopkins Verbal Learning Test at baseline and 1 year. Antidepressant medications were ascertained by the use of medical records. Potential confounding by indications was examined by adjusting for depression-related diagnoses and severity of depression symptoms using multiple linear regression, a propensity score, and a structural equation model (SEM).RESULTS: Before adjusting for the indications, a one unit cumulative exposure to antidepressants was associated with -1.00 (95% confidence interval [CI], -1.94, -0.06) point lower HVLT score. After adjusting for the indications using multiple linear regression or a propensity score, the association diminished to -0.48 (95% Cl, -0.62, 1.58) and -0.58 (95% Cl, -0.60, 1.58), respectively. The most clinical interpretable empirical SEM with adequate tit involves both direct and indirect paths of the two indications. Depression-related diagnoses and depression symptoms significantly predict antidepressant use (p < .05). Their total standardized path coefficients on Hopkins Verbal Learning Test score were twice (0.073) or as large (0.034) as the antidepressant use (0.035).CONCLUSION: The apparent association between antidepressant use and memory deficit in older persons may be confounded by indications. SEM offers a heuristic empirical method for examining confounding by indications but not quantitatively superior bias reduction compared with conventional methods. Ann Epidemiol 2012;22:9-16. (C) 2012 Elsevier Inc. All rights reserved.