| Summary: | 碩士 === 國立陽明大學 === 醫務管理研究所 === 106 === Background: Depression is one of the most prevalent mental disease, with a relatively high risk of mortality. Depression also imposes significant burden of reduced quality of life and disability. The prevention of depression progression and its subsequent suicide and comorbidity can be under taken through early diagnosis and complete treatment. For the treatment of patients with newly diagnosed major depressive disorder (MDD), a complete course of at least 6-month medications, mainly antidepressants, is important and highly recommanded. If the disease is not properly controlled, it may have a negative impact on health and increase the risk of dealth, as mentioned.
Objectives: The purpose of this study conducted in Taiwan was to examine the association between medication fill adherence and cause of death in the newly-diagnosed patients with MDD.
Methods: This longitudinal study used data of a two-million sample drawn in 2005 from the National Health Insurance Research Database. All MDD patients (ICD-9-CM=296.2X、296.3X) newly diagnosed by a psychiatrist between 2005 and 2010 were included. Medication fill and refill adherence was measured by Proportion of Days Covered (PDC) for 3 months and 6 months after first medication. Generalized linear regression model was used to examine the association between fill adherence and 2- and 5-year total and cause specific mortality.
Results: A total of 17% patients completed six-month course of antidepressant treatment. Compared with patients with poor adherence, these with better adherence were more likely to be older, male, married, with lower level of education, having comorbidity, moderate to severe MDD, longer hospital stay, and lower visit to medical center. To better control the potential confounding from disease severity, patients were further restricted to those with moderate to severe MDD only. These with better adherence had lower risk of death from total causes and nature causes in both 2 years and 5 years of follow-up.
Conclusions: It appears to be important to follow antidepressant medications for at least three months, which has a short-term effect on reducing the risk of all-cause mortality and natural-cause mortality. Therefore, it is recommended that newly-diagnosed patients with MDD with severe symptoms depression should be administered more rigorously, and should be paid more attention to the risk groups with poor adherence. In order to provide the best care to patients suffering from severe depressive disorder, needing to raise public awareness of adherece and strive to improve the continuous antidepressant treatment and quality of care.
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