TABLE 1.
Patient characteristics by any ADM exposure during first 90 days after depression diagnosis in FY2006 (unadjusted) and adjusted Cox regression estimates comparing mortality risks associated with three groups of ADMs relative to no ADMs (N=720,821)
| Characteristics | Unadjusted | Adjusted | |||
|---|---|---|---|---|---|
| Non-exposed | Exposed | Total | HR | 95% CI | |
| N (%) | N (%) | N (%) | |||
| 186,985 (25.94) | 33,836 (74.06) | 720,821 | |||
| ADM classes† | |||||
| Older agents | NA | 60,567 (11.35) | 60,567 (8.40) | 0.96 | 0.92–1.01 |
| Newer agents | NA | 182,704 (34.22) | 182,704 (25.35) | 0.98 | 0.94–1.02 |
| SSRIs | NA | 392,259 (73.48) | 392,259 (54.42) | 0.96 | 0.94–0.99 |
| Prior treatment* | |||||
| Any ADM treatment in the prior 90 days | 17,414 (9.31) | 382,342 (71.62) | 399,756 (55.46) | 0.90 | 0.87–0.93 |
| Psychotherapy treatment in the prior 90 days | 45,313 (24.23) | 196,541 (36.82) | 241,854 (33.55) | 0.75 | 0.72–0.78 |
| Depression severity (most to least severe)** | |||||
| Group A | 9,963 (5.33) | 68,234 (12.78) | 78,197 (10.85) | 0.83 | 0.76–0.89 |
| Group B | 125,868 (67.31) | 354,013 (66.31) | 479,881 (66.57) | 1.00 | 0.93–1.08 |
| Group C | 4,136 (2.21) | 18,550 (3.47) | 22,686 (3.15) | 0.79 | 0.72–0.88 |
| Group D | 5,619 (3.01) | 18,046 (3.38) | 23,665 (3.28) | 0.81 | 0.74–0.89 |
| Group E | 4,261 (2.28) | 10,823 (2.03) | 15,084 (2.09) | 0.78 | 0.70–0.86 |
| Group F (“newly” diagnosed) | 37,138 (19.86) | 64,170 (12.02) | 101,308 (14.05) | ref | ref |
| Demographic factors | |||||
| Age (years) – mean ± SD | 58.42 ± 14.98 | 58.60 ± 13.82 | 58.55 ± 14.13 | NA | NA |
| 18 to <30 | 8,310 (4.44) | 15,930 (2.98) | 24,240 (3.36) | ref | ref |
| 30–39 | 12,159 (6.50) | 32,452 (6.08) | 44,611 (6.19) | 1.08 | 0.83–1.39 |
| 40–49 | 28,364 (15.17) | 77,315 (14.48) | 105,679 (14.66) | 1.80 | 1.44–2.25 |
| 50–59 | 61,790 (33.05) | 196,071 (36.73) | 257,861 (35.77) | 2.71 | 2.16–3.39 |
| 60–69 | 32,855 (17.57) | 97,769 (18.31) | 130,624 (18.12) | 3.88 | 3.10–4.86 |
| 70–79 | 24,936 (13.34) | 69,932 (13.10) | 94,868 (13.16) | 7.17 | 5.72–9.00 |
| >=80 | 18,571 (9.93) | 44,367 (8.31) | 62,938 (8.73) | 13.18 | 10.54–16.48 |
| Male | 169,481 (90.64) | 479,118 (89.75) | 648,599 (89.98) | 1.66 | 1.54–1.78 |
| Race | |||||
| African American | 31,167 (16.67) | 69,086 (12.94) | 100,253 (13.91) | 0.81 | 0.76–0.86 |
| Other | 27,492 (14.70) | 65,625 (12.29) | 93,117 (12.92) | 1.39 | 1.31–1.47 |
| White | 128,326 (68.63) | 399,125 (74.77) | 527,451 (73.17) | ref | ref |
| Health services utilization* | |||||
| Non-psychotherapy outpatient visits | |||||
| 0 | 8,983 (4.80) | 27,384 (5.13) | 36,367 (5.05) | ref | ref |
| 1 | 55,070 (29.45) | 124,598 (23.34) | 179,668 (24.93) | 0.84 | 0.78–0.91 |
| ≥2 | 122,932 (65.74) | 381,854 (71.53) | 504,786 (70.03) | 0.74 | 0.68–0.80 |
| Any psychiatric hospitalization | 4,789 (2.56) | 13,197 (2.47) | 17,986 (2.50) | 0.99 | 0.91–1.07 |
| Any non-psychiatric hospitalization | 17,304 (9.25) | 38,673 (7.24) | 55,977 (7.76) | 2.55 | 2.45–2.64 |
| Comorbidities** | |||||
| Charlson score, mean ± SD | 1.10 ± 1.70 | 1.15 ± 1.64 | 1.14 ± 1.66 | NA | NA |
| 0 | 95,230 (50.93) | 252,481 (47.30) | 347,711 (48.24) | ref | ref |
| 1 | 43,636 (23.34) | 134,831 (25.26) | 178,467 (24.76) | 1.61 | 1.54–1.68 |
| 2 | 20,850 (11.15) | 63,952 (11.98) | 84,802 (11.76) | 2.51 | 2.40–2.62 |
| 3 | 12,079 (6.46) | 38,593 (7.23) | 50,672 (7.03) | 3.09 | 2.95–3.25 |
| ≥4 | 15,190 (8.12) | 43,979 (8.24) | 59,169 (8.21) | 5.25 | 5.01–5.49 |
| Anxiety and/or PTSD | 50,499 (27.01) | 203,025 (38.03) | 253,524 (35.17) | 0.80 | 0.78–0.83 |
| Serious mental illness*** | 18,914 (10.12) | 50,406 (9.44) | 69,320 (9.62) | 1.15 | 1.09–1.20 |
| Nicotine use | 39,038 (20.88) | 118,220 (22.15) | 157,258 (21.82) | 1.20 | 1.17–1.24 |
| Alcohol use disorder | 28,304 (15.14) | 78,121 (14.63) | 106,425 (14.76) | 1.33 | 1.28–1.38 |
| Substance use disorder | 21,138 (11.30) | 55,080 (10.32) | 76,218 (10.57) | 1.12 | 1.06–1.18 |
| Opioid medication use | 33,604 (17.97) | 139,027 (26.04) | 172,631 (23.95) | 1.33 | 1.29–1.37 |
| Psychotropic use** | |||||
| Anticholinesterase | 2,802 (1.50) | 14,440 (2.70) | 17,242 (2.39) | 1.17 | 1.10–1.25 |
| Mood stabilizers | 20,205 (10.81) | 101,327 (18.98) | 121,532 (16.86) | 0.89 | 0.86–0.93 |
| Atypical antipsychotics | 11,867 (6.35) | 66,373 (12.43) | 78,240 (10.85) | 1.22 | 1.16–1.29 |
| Conventional antipsychotics | 1,342 (0.72) | 3,649 (0.68) | 4,991 (0.69) | 1.28 | 1.12–1.47 |
| Antianxiety medications**** | 23,485 (12.56) | 127,319 (23.85) | 150,804 (20.92) | 1.25 | 1.20–1.30 |
†
patients can be taking more than one ADM class
*
90 days prior to first depression diagnosis in FY2006
**
one year prior to first depression diagnosis in FY2006
***
Serious mental illness includes bipolar, schizophrenia, other psychoses
****
antianxiety medications include benzodiazepines and hypnotics