Table 1. Characteristics of Simultaneous Antidepressant and Benzodiazepine New Users and Non–Simultaneous Antidepressant New Users With Depression and Factors Associated With Simultaneous New Usea.
| Variable | Non–Simultaneous New Usersb (n = 684 110) |
Simultaneous New Usersb (n = 81 020) |
Simultaneous New Use | ||
|---|---|---|---|---|---|
| Simultaneous New Users, % (95% CI) | Crude RR | Multivariable RRc (95% CI) | |||
| Sex | |||||
| Male | 231 600 (33.9) | 26 079 (32.2) | 10.1 (10.0-10.2) | 1 [Reference] | 1 [Reference] |
| Female | 452 510 (66.1) | 54 941 (67.8) | 10.8 (10.7-10.9) | 1.07 | 1.09 (1.08-1.11) |
| Age, median (IQR), y | 39 (29-49) | 39 (30-49) | NA | NA | NA |
| Age group, y | |||||
| 18-24 | 120 403 (17.6) | 10 140 (12.5) | 7.8 (7.6-7.9) | 1 [Reference] | 1 [Reference] |
| 25-34 | 144 620 (21.1) | 19 358 (23.9) | 11.8 (11.6-12.0) | 1.52 | 1.59 (1.56-1.63) |
| 35-49 | 249 217 (36.4) | 32 715 (40.4) | 11.6 (11.5-11.7) | 1.49 | 1.68 (1.64-1.71) |
| 50-64 | 169 870 (24.8) | 18 807 (23.2) | 10.0 (9.8-10.1) | 1.28 | 1.55 (1.51-1.59) |
| Initial antidepressant class | |||||
| SSRI | 474 001 (69.3) | 64 460 (79.6) | 12.0 (11.9-12.1) | 1 [Reference] | 1 [Reference] |
| SNRI | 65 935 (9.6) | 5554 (6.9) | 7.8 (7.6-8.0) | 0.65 | 0.69 (0.67-0.70) |
| Bupropion | 86 725 (12.7) | 5667 (7.0) | 6.1 (6.0-6.3) | 0.51 | 0.57 (0.56-0.59) |
| Other | 57 449 (8.4) | 5339 (6.6) | 8.5 (8.3-8.7) | 0.71 | 0.65 (0.63-0.67) |
| Depression diagnosis (index diagnosis)d | |||||
| Not otherwise specified | 339 912 (49.7) | 32 443 (40.0) | 8.7 (8.6-8.8) | 1 [Reference] | 1 [Reference] |
| Major depressive disorder | 178 503 (26.1) | 23 466 (29.0) | 11.6 (11.5-11.8) | 1.33 | 1.40 (1.38-1.43) |
| Other | 165 695 (24.2) | 25 111 (31.0) | 13.2 (13.0-13.3) | 1.51 | 1.75 (1.72-1.78) |
| Inpatient index depression diagnosis | 13 144 (1.9) | 2398 (3.0) | 15.4 (14.9-16.0) | 1.47 | 1.34 (1.29-1.40) |
| Nonrecent depression diagnosis | 161 261 (23.6) | 13 328 (16.5) | 7.6 (7.5-7.8) | 0.67 | 0.71 (0.69-0.72) |
| Specialty of physician who provided index depression diagnosis | |||||
| Family practice | 229 862 (33.6) | 27 350 (33.8) | 10.6 (10.5-10.8) | 1 [Reference] | 1 [Reference] |
| Psychiatry | 86 879 (12.7) | 13 398 (16.5) | 13.4 (13.2-13.6) | 1.26 | 1.32 (1.29-1.35) |
| Psychologist or therapist | 70 953 (10.4) | 6673 (8.2) | 8.6 (8.4-8.8) | 0.81 | 0.85 (0.83-0.88) |
| Other specialty | 234 533 (34.3) | 26 513 (32.7) | 10.2 (10.0-10.3) | 0.96 | 0.98 (0.96-0.99) |
| Unknown or multiple physicians | 61 883 (9.0) | 7086 (8.7) | 10.3 (10.0-10.5) | 0.97 | 0.93 (0.91-0.96) |
| Anxiety disorder diagnosis, recent | |||||
| Unspecified anxiety | 52 389 (7.7) | 16 651 (20.6) | 24.1 (23.8-24.4) | 2.61 | 2.58 (2.54-2.62) |
| Generalized anxiety disorder | 21 350 (3.1) | 5705 (7.0) | 21.1 (20.6-21.6) | 2.07 | 1.90 (1.85-1.95) |
| Panic disorder | 4471 (0.7) | 2870 (3.5) | 39.1 (38.0-40.2) | 3.79 | 2.67 (2.58-2.76) |
| PTSD | 4819 (0.7) | 783 (1.0) | 14.0 (13.1-14.9) | 1.32 | 1.14 (1.05-1.22) |
| OCD, phobic disorder, or other anxiety | 5910 (0.9) | 1465 (1.8) | 19.9 (19.0-20.8) | 1.89 | 1.47 (1.40-1.55) |
| Insomnia or sleep disturbance diagnosis, recent | 39 006 (5.7) | 6618 (8.2) | 14.5 (14.2-14.8) | 1.40 | 1.31 (1.28-1.34) |
| ADHD | 20 452 (3.0) | 1329 (1.6) | 6.1 (5.8-6.4) | 0.57 | 0.63 (0.59-0.66) |
| Acute reaction to stress | 9030 (1.3) | 1936 (2.4) | 17.7 (17.0-18.4) | 1.68 | 1.43 (1.37-1.49) |
| Treated self-harm | 861 (0.1) | 83 (0.1) | 8.8 (7.1-10.8) | 0.83 | 0.74 (0.59-0.92) |
| Psychotherapy, recent | |||||
| None recorded | 529 351 (77.4) | 64 845 (80.0) | 10.9 (10.8-11.0) | 1 [Reference] | 1 [Reference] |
| ≥1 Session | 154 759 (22.6) | 16 175 (20.0) | 9.5 (9.3-9.6) | 0.87 | 0.83 (0.81-0.85) |
| Epilepsy or recurrent seizures | 3458 (0.5) | 321 (0.4) | 8.5 (7.6-9.4) | 0.80 | 0.80 (0.72-0.89) |
Abbreviations: ADHD, attention-deficit/hyperactivity disorder; IQR, interquartile range; NA, not applicable; OCD, obsessive-compulsive disorder; PTSD, posttraumatic stress disorder; RR, risk ratio; SNRI, serotonin-norepinephrine reuptake inhibitors; SSRI, selective serotonin reuptake inhibitor.
Characteristics were defined using inpatient and outpatient International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes; Current Procedural Terminology, fourth edition, procedure codes; and outpatient dispensed prescriptions. A full list of characteristics is given in eTable 1 in the Supplement. Recent refers to measures within the 30 days before antidepressant treatment initiation (nonrecent: 31-365 days before treatment initiation).
Data are presented as number (percentage) of patients unless otherwise indicated.
Multivariable RRs are adjusted for all the variables in eTable 1 in the Supplement and include the following: additional psychiatric comorbidities (adjustment disorder, nonrecent anxiety diagnosis, or other episodic mood disorder), fall or fracture risk factures (fracture, bone mineral density scan, osteoporosis, cataracts or glaucoma, or visual loss or disturbance), poisoning, nonpsychiatric comorbidities (cardiac disorders, chronic kidney disease, osteoarthritis and allied disorders, Crohn disease or gastroenteritis, diabetes, fatigue, hearing problem, hypertension, hypothyroidism, overweight or obese, or urinary incontinence), health care use measures (outpatient visits, inpatient admission, or medication use), region, and year of treatment initiation. The full model resulted in a C statistic of 0.697.
For index depression diagnosis, other includes adults diagnosed with dysthymic disorder, adjustment disorder with depressed mood, or prolonged depressive reaction; not otherwise specified includes adults without a specific diagnosis.