Depression Treatment and Substance Abuse

描述(由申请人提供)：在患有物质使用障碍(SUD)的人中，精神疾病的发生率比其他人群高得多。国家共病调查的一项为期10年的纵向跟踪调查证实，与没有严重抑郁症的人相比，基线上有严重抑郁症的人患尼古丁依赖的几率高40%，在接下来的十年里开始使用非法药物的几率高90%。抑郁症和肥皂症之间的联系开启了一种可能性，即儿童抑郁症的成功治疗可以减轻肥皂症的不良后果，因为在儿科人群中有一系列循证治疗，而且70%的肥皂液首先出现在20岁之前。然而，关于抑郁症治疗是否可以减轻肥皂症和/或其后果的严格证据很少，因为很难确定抑郁症是否导致药物使用，反之亦然，或者第三个因素是否会导致抑郁症和肥皂症之间的虚假关联。为了研究抑郁症治疗如何预防或改变肥胖症的发病和后果，我们建议利用一个强大的自然实验：2004年食品和药物管理局(FDA)关于儿童抗抑郁药使用相关自杀风险的警告导致处方模式和抗抑郁药使用的突然变化。这些警告被大众媒体广泛报道，导致有记录的抑郁症确诊率下降，并在患有抑郁症的儿童患者中减少了20%至30%的抗抑郁药使用，使这成为一项罕见而有力的自然实验。此外，在FDA发出警告后，处方模式和抗抑郁药物的使用发生了突然变化，与此同时，美国青少年自杀率在经历了15年的相对稳定下降后上升了14%，这意味着这些警告深刻地影响了抑郁症状。这项拟议的研究使用了三个数据源，它们共同提供了有关药物使用、滥用和依赖、医疗保健利用(包括处方药数据)以及学术和犯罪相关结果的信息，旨在：1)检查FDA关于儿童抗抑郁药使用的警告以及伴随的儿童抗抑郁药使用的下降是否增加了药物使用、滥用和依赖的开始或强度(对于烟草、酒精、非法药物和非法使用处方药)；2)检查FDA关于儿童抗抑郁药使用的警告和伴随的儿童抗抑郁药使用的下降是否增加了医疗保健的使用和成本；以及3)检查FDA关于儿童抗抑郁药使用的警告以及随之而来的儿童抗抑郁药使用的下降是否增加了药物使用、滥用和依赖(医疗保健使用、学习成绩差、犯罪、犯罪)的社会成本。我们的分析将使用回归不连续设计来比较在2004年FDA对儿童抗抑郁药使用发出警告之前和之后新发抑郁症的年轻人的处方模式和SUD结果。

DESCRIPTION (provided by applicant): Rates of mental illness are much higher among people suffering from a substance use disorder (SUD) than in the rest of the population. A 10-year longitudinal follow-up of the National Comorbidity Survey confirmed that individuals with major depression at baseline had 40% higher odds of developing nicotine dependence and 90% higher odds of initiating the use of illicit drugs in the subsequent decade compared to individuals without major depression. Associations between depression and SUDs open the possibility that the successful treatment of pediatric depression could mitigate adverse consequences of SUDs, given an array of evidence-based treatments in pediatric populations and the fact that 70% of SUDs first emerge by the age of 20. However, rigorous evidence on whether depression treatment could mitigate SUDs and/or their consequences is scant, because it is difficult to ascertain if depression causes substance use, the reverse, or whether a third factor generates a spurious correlation between depression and SUDs. To examine how depression treatment may prevent or alter the onset and consequences of SUDs, we propose to take advantage of a powerful natural experiment: the sudden change in the prescribing patterns and use of antidepressants induced by the Food and Drug Administration's (FDA's) 2004 warnings on the risks of suicidality associated with pediatric antidepressant use. The warnings were extensively covered by the popular press, led to documented decreases in rates of identified depression, and reduced antidepressant use by 20 to 30% among pediatric patients with depression, making this a rare and powerful natural experiment. Furthermore, this abrupt change in prescribing patterns and use of antidepressants after the FDA warnings coincided with a 14% rise in youth suicide in the U.S. after 15 years of relatively steady decline in suicide rates, implying that the warnings profoundly affected depressive symptoms. Using three data sources that together provide information on substance use, abuse, and dependence, medical care utilization (including data on prescription drugs), and academic and crime related outcomes, the proposed research aims to: 1) Examine whether FDA warnings regarding pediatric antidepressant use and the concomitant drop in pediatric antidepressant use increased the onset or intensity of substance use, abuse, and dependence (for tobacco, alcohol, illicit drugs, and illicit use of prescription drugs); 2) Examine whether FDA warnings regarding pediatric antidepressant use and the concomitant drop in pediatric antidepressant use increased health care use and costs; and 3) Examine whether FDA warnings regarding pediatric antidepressant use and the concomitant drop in pediatric antidepressant use increased the social costs of substance use, abuse, and dependence (health care use, poor school performance, delinquency, criminal activity). Our analysis will use a regression discontinuity design to compare the prescribing patterns and SUD outcomes of youths with new onset of depression just before and immediately after the 2004 FDA warnings on pediatric antidepressant use.