Predictors Of Antidepressant Use Research Articles

High Use of Antidepressant Medication in Both Mild-to-Modelate and Possible Severe Asthma – A Nationwide Cohort Study

PurposeIn asthma, increased severity has been linked to depression assessed as assessed by patient-reported outcomes. However, little is known about predictors of antidepressant use in asthma compared to the background population.MethodsThe study consists of 60,534 asthma patients aged 18–45 and a 1:1 age- and sex-matched control group. Using national registries and prescription data, the prevalence of and risk factors for antidepressant use were investigated by logistic regression adjusted for age, sex, workforce and civil status, income- and education-level and comorbidity. Results presented as odds ratio (OR) with 95% confidence intervals (CI).ResultsA total of 16% and 22%, respectively, among patients with mild-to-moderate and possible severe asthma redeemed antidepressant drugs, compared to 10% of controls. Antidepressant use was more prevalent amongst patients with high rescue medication use (>600 annual doses) and those with a history of moderate or severe exacerbation(s). Both mild-to-moderate and possible severe asthma were independent risk factors for antidepressant use (OR 1.40 (95% CI 1.35, 1.46) and OR 1.55 (95% CI 1.41, 1.70), respectively). Female sex, age, being divorced or never married, having only primary education or currently being under education, as well as being on welfare/transfer income increased odds of antidepressant use. Completing higher education and having high income were associated with lower odds.ConclusionIn asthma, antidepressant use is significantly higher than in the background population. Even after adjusting for known risk factors, asthma remains a predictor of antidepressant use, signalling a psychologic burden related to living with asthma.

Predictors of antidepressant use in the English population: analysis of the Adult Psychiatric Morbidity Survey.

The rate of antidepressant use in the United Kingdom has outpaced diagnostic increases in the prevalence of depression. Research has suggested that personal and socioeconomic risk factors may be contributing to antidepressant use. To date, few studies have addressed these possible contributions. Thus, this study aimed to assess the relative strength of personal, socioeconomic and trauma-related risk factors in predicting antidepressant use. Data were derived from the Adult Psychiatric Morbidity Survey (n=7403), a nationally representative household sample of adults residing in England in 2007. A multivariate binary logistic regression model was developed to assess the associations between personal, socioeconomic and trauma-related risk factors and current antidepressant use. The strongest predictor of current antidepressant use was meeting the criteria for an ICD-10 depressive episode [odds ratio (OR)=9.04]. Other significant predictors of antidepressant use in this analysis included English as first language (OR=3.45), female gender (OR=1.98), unemployment (OR=1.82) and childhood sexual abuse (OR=1.53). Several personal, socioeconomic and trauma-related factors significantly contributed to antidepressant use in the multivariate model specified. These findings aid our understanding of the broader context of antidepressant use in the United Kingdom.

P093 PREDICTORS OF ANTIDEPRESSANT USE IN INFLAMMATORY BOWEL DISEASE IN A LARGE, RETROSPECTIVE HOSPITAL DATABASE

Depression occurs in up to 21% of IBD patients and is associated with increased healthcare costs. Antidepressants (AD), used by nearly 29% of IBD patients, target stress and depression, functional intestinal and somatic symptoms. IBD-related perception of disease, healthcare utilization, quality of life and outcomes are associated with racial and socio-economic disparities. Determining clinical and epidemiological predictors of antidepressant use in IBD will help identify vulnerable populations and maximize healthcare delivery. The medical database of a large, urban, teaching hospital in the Bronx, NY was searched retrospectively for all IBD patients during the time period 1/2006 to 5/2016 using ICD-9 and 10 billing codes. Along with epidemiological and admissions data, information on AD prescription was recorded. Logistic regression analysis, T-, and Chi-square tests were performed to determine predictors of AD use, rates of hospital admission of IBD patients on AD, and time trends of AD use in IBD, respectively. Of the 4549 IBD patients in the cohort, 499 (11%) were prescribed AD either within 30 days prior to or following IBD diagnosis. The odds of AD use by IBD patients were 1.38 times more likely in men (p=0.005) and 1.72 times more likely for individuals <40 years (p=0.0003). There was a significant increase in IBD-related hospital admissions in IBD patients on AD compared to those not on AD (p<0.0001) [Table]. AD use over time had been increasing from 2006 to 2014 but has a downward trend since then (p<0.05 for each time interval) [Image]. The odds of AD use in IBD patients is more likely in men and younger persons. AD use is associated with an increase in IBD-related hospital admissions. While usage increased from 2006–2014, AD use has recently declined. While it is possible that changes in management of IBD during this period may have impacted AD use, further prospective studies are needed.

Antidepressant Use After Aneurysmal Subarachnoid Hemorrhage: A Population-Based Case-Control Study.

To elucidate the predictors of antidepressant use after subarachnoid hemorrhage from saccular intracranial aneurysm (sIA-SAH) in a population-based cohort with matched controls. The Kuopio sIA database includes all unruptured and ruptured sIA cases admitted to the Kuopio University Hospital from its defined catchment population in Eastern Finland, with 3 matched controls for each patient. The use of all prescribed medicines has been fused from the Finnish national registry of prescribed medicines. In the present study, 2 or more purchases of antidepressant medication indicated antidepressant use. The risk factors of the antidepressant use were analyzed in 940 patients alive 12 months after sIA-SAH, and the classification tree analysis was used to create a predicting model for antidepressant use after sIA-SAH. The 940 12-month survivors of sIA-SAH had significantly more antidepressant use (odds ratio, 2.6; 95% confidence interval, 2.2-3.1) than their 2676 matched controls (29% versus 14%). Classification tree analysis, based on independent risk factors, was used for the best prediction model of antidepressant use after sIA-SAH. Modified Rankin Scale until 12 months was the most potent predictor, followed by condition (Hunt and Hess Scale) and age on admission for sIA-SAH. The sIA-SAH survivors use significantly more often antidepressants, indicative of depression, than their matched population controls. Even with a seemingly good recovery (modified Rankin Scale score, 0) at 12 months after sIA-SAH, there is a significant risk of depression requiring antidepressant medication.

Patterns and predictors of antidepressant use in ambulatory cancer patients with common solid tumors.

Depressive symptoms and antidepressant use are prevalent among cancer patients. We sought to identify determinants of prescribing commonly used antidepressants. This multi-institutional study enrolled 3106 ambulatory patients with cancer of the breast, prostate, colon/rectum, or lung. Five case-finding methods were used to identify patients with depressive symptoms. Logistic models were used to examine factors that impact antidepressant use. Approximately, 47% of patients were defined as having depressive symptoms. Clinicians rated being sad/depressed as one of the top three priority problems for 10.5% of patients. Antidepressants were prescribed in 19% of all patients, 25% with depressive symptoms and 14% nondepressed patients. After adjusting for other covariates, these variable categories were significantly associated with greater use of antidepressants: depressive symptoms, family history of depression, concurrent medication use, cancer treatment status, and certain other clinical and demographic variables. The strongest individual predictors were concurrent use of more than 10 medications (odds ratio [OR] = 3.3), a family history of depression (OR = 2.2), sedative use (OR = 2.1), non-Hispanic white race (OR = 2.0), and anxiolytics use (OR = 2.0). Depressive symptoms are found in nearly half of outpatients with cancer, and one-fourth of patients with depressive symptoms are taking an antidepressant. Patients receiving antidepressants are more often those taking multiple medications, those with a depression diathesis, and those with more extensive cancer treatment. Patients who were younger, white, and female were also more likely to be taking antidepressants.

Antidepressant use among survivors of childhood, adolescent and young adult cancer: A report of the childhood, adolescent and young adult cancer survivor (CAYACS) research program

Although survivors of childhood, adolescent, and young adult (AYA) cancer are at risk for late psychological sequelae, it is unclear if they are more likely to be prescription antidepressant users than their peers. All 5-year survivors of childhood or AYA cancer diagnosed before age 25 years in British Columbia from 1970 to 1995 were identified. Those with complete follow-up in the provincial health insurance registry from 2001 to 2004 were included (n = 2,389). A birth-cohort and gender-matched set of population controls 10 times the size of the survivor group was randomly selected (n = 23,890). All prescriptions filled between 2001 and 2004 were identified through linkage to the provincial prescription drug administrative database. Logistic regression analyses determined the impact of cancer survivorship on the likelihood of ever filling an antidepressant prescription. After adjusting for sociodemographic factors, survivors of childhood and AYA cancer were more likely to have filled an antidepressant prescription compared to controls (OR 1.21, 95% CI 1.09-1.35). Cancer survivors had an increased likelihood of using all categories of antidepressants, and of using drugs from two or more antidepressant categories, compared to peers (OR 1.31, 95% CI 1.11-1.55 [≥2 antidepressant categories]). Treatment was not a significant predictor of antidepressant use. Female survivors, those in young adulthood and those more than 20 years post-treatment had increased antidepressant use. Survivors of childhood and AYA cancer are more likely to fill antidepressant prescriptions compared to peer controls. This may indirectly reflect an increased underlying prevalence of mental health conditions among survivors.

The association between antidepressant use and depression eight years later: A national cohort study

Investigations of the effects of antidepressant treatment for individuals with major depression have focused on short-term outcomes in individuals that meet very specific criteria; however, there is limited knowledge about long-term outcomes associated with antidepressant use in general population samples. This study aimed to investigate the long-term outcomes associated with antidepressant use by focusing on 486 depressed adults in a prospective observational Canadian cohort in 1998/99. We used logistic regression to investigate the association between antidepressant use and depression status 8 years later. Non-random allocation to treatment was accounted for by a propensity-for-treatment model which included thirteen predictors of antidepressant use, including: severity of depressive symptoms, previous episodes of depression (from 1994 to 1997), physical health condition, social support and socio-demographic characteristics. 29% of individuals with major depression reported antidepressant use. After adjusting for propensity for treatment in 1998/99, and antidepressant use from 2000 to 2007, depressed individuals who reported antidepressant use in 1998/99 were less likely to be depressed in 2006/07 compared to those who did not report antidepressant use (OR = 0.36, 95% CI: 0.15–0.88). Amongst individuals with symptoms of major depression, those reporting use of anti-depressants at baseline exhibited improved long-term outcomes in comparison to those who did not report treatment.

Antidepressant prescribing and pregnancy: comment on ‘Prevalence and predictors of antidepressant use in a cohort of pregnant women’, by Ramos et al.

Antidepressant prescribing and pregnancy: comment on ‘Prevalence and predictors of antidepressant use in a cohort of pregnant women’, by Ramos <i>et al.</i>

Prevalence and predictors of antidepressant use in a cohort of pregnant women

Objective(1) To determine the prevalence of antidepressant utilisation before, during, and after pregnancy, (2) to determine switches, dosages, and classes of antidepressant used during pregnancy, and (3) to identify factors associated with their use at the beginning and at the end of pregnancy.DesignRetrospective longitudinal cohort.SettingThe ‘Medication and Pregnancy’ cohort was used for this study. This cohort was built by the linkage of three administrative databases (Régie de l’Assurance Maladie du Québec [RAMQ], Med-Écho, and l’Institut de la Statistique du Québec).PopulationAll pregnancies occuring in Quebec between January 1 1998 and December 31 2002.MethodsDate of entry in the cohort was the first day of gestation. To be eligible for this study, women had to be (1) 15–45 years old at cohort entry and (2) covered by the RAMQ drug plan for at least 12 months before, during, and at least 12 months after pregnancy. Antidepressant users were defined as those receiving at least one antidepressant before, during, or after pregnancy, depending on the time period analysed. Logistic regression models were used to identify factors associated with receiving an antidepressant either at the beginning or at the end of pregnancy.Main outcome measuresTo determine the prevalence and predictors associated with the use of antidepressants.ResultsA total of 97 680 women met inclusion criteria. The prevalence rates significantly declined during the first trimester compared with before pregnancy (3.7 versus 6.6%, P < 0.01). During pregnancy, antidepressants were used under the recommended daily dosage 7.7% of the time, and 4.7% of women switched to another class of antidepressant. Factors significantly associated with antidepressant utilisation on the first day of gestation (P < 0.05) were older maternal age, being on welfare, and calendar year; receiving at least six different types of medications other than antidepressants, having at least two different prescribers, having at least three visits to the physician, and having at least one diagnosis of depression in the year before pregnancy also increased the odds of having an antidepressant. Similar predictors were found at the end of pregnancy.ConclusionsOur findings indicate that antidepressant utilisation declines once pregnancy is diagnosed.Please cite this paper as: Ramos É, Oraichi D, Rey É, Blais L, Bérard A. Prevalence and predictors of antidepressant use in a cohort of pregnant women. BJOG 2007;114:1055–1064.

Predictors of Antidepressant Use Among Older Adults: Have They Changed Over Time?

Antidepressant use increased substantially among older adults with the introduction of the new-generation medications such as the selective serotonin reuptake inhibitors. The authors analyzed data from two follow-up intervals-1986-1987 to 1989-1990 (interval 1) and 1992-1993 to 1996-1997 (interval 2)-from a community-based cohort of 4,162 older adults to determine predictors of future antidepressant use. Information on antidepressant use, demographic and health characteristics, and categories of depressive symptoms-positive affect, negative affect, somatic complaints, and interpersonal problems-were obtained. Logistic regression was used to control simultaneously for multiple variables predicting antidepressant use during the two intervals. Repeated-measures logistic regression (with generalized estimating equations) was employed to model the probability of antidepressant use, with adjustment for the effect of time. Prior antidepressant use and white race were strong predictors of future use during both intervals. Negative affect was the only additional significant predictor of use during interval 1. In contrast, low positive affect scores, cognitive impairment, and poorer health were additional significant predictors during interval 2. In a repeated-measures model, race, prior antidepressant use, poor health, low positive affect scores, and somatic complaints varied as predictors over time. Negative affect and cognitive impairment were consistent predictors over time. The predictors of antidepressant use by older adults changed over time, with health-related measures of quality of life, such as positive affect, health status, and somatic complaints, becoming more prominent as predictors of use.