TY - JOUR
T1 - Socio-demographic and clinical risk factors of treatment-resistant depression: A Danish population-based cohort study
AU - Gronemann, Frederikke Hordam
AU - Jorgensen, Martin Balslev
AU - Nordentoft, Merete
AU - Andersen, Per Kragh
AU - Osler, Merete
PY - 2020/1/15
Y1 - 2020/1/15
N2 - Background: Knowledge of risk factors of treatment-resistant depression (TRD) contributes to understand the underlying mechanisms and to identify patients at risk. However, there is still a lack of studies on how different risk factors associate with TRD. The objective of this study was to determine the independent association of several socio-demographic and clinical risk factors with TRD. Methods: 194.074 patients with a first-time hospital contact for depression identified in the Danish National Patient Registry (DNPR) from 1996 through 2014 were followed for TRD for 12 months after diagnosis. Socio-demographic and clinical risk factors were identified in nation-wide registries. Data were analyzed using Cox Proportional Hazard Regression and Fine-Gray model for competing mortality risk. Results: Indicators of disease severity (recurrent depression (adjusted HR (aHR) 1.17 (1.14–1.20)), severity of depression (aHR 2.01 (1.95–2.08)), admission to a psychiatric ward (aHR 2.03 (1.96, 2.10)) were strong risk factors. Aged 65–84 (aHR 1.96 (1.83–2.10)), lost labor market affiliation ((aHR 1.12 (1.08, 1.16)), cohabiting (aHR 1.27 (1.23, 1.30)), comorbid anxiety (aHR 1.18 (1.10–1.27)), insomnia (aHR 1.27 (1.06–1.51)), migraine (aHR 1.42 (1.16–1.73)) and use of psychotropic drugs was also associated with higher rates of TRD. Limitations: Information on drug use during hospitalization was not available. Information on rating scales could have provided a more precise assessment of symptom severity and treatment response. Conclusions: Besides indicators of disease severity, other important risk factors associated with TRD are age, lost labor market affiliation, cohabiting with a partner as well as anxiety, insomnia, migraine and the use of psychotropic medications.
AB - Background: Knowledge of risk factors of treatment-resistant depression (TRD) contributes to understand the underlying mechanisms and to identify patients at risk. However, there is still a lack of studies on how different risk factors associate with TRD. The objective of this study was to determine the independent association of several socio-demographic and clinical risk factors with TRD. Methods: 194.074 patients with a first-time hospital contact for depression identified in the Danish National Patient Registry (DNPR) from 1996 through 2014 were followed for TRD for 12 months after diagnosis. Socio-demographic and clinical risk factors were identified in nation-wide registries. Data were analyzed using Cox Proportional Hazard Regression and Fine-Gray model for competing mortality risk. Results: Indicators of disease severity (recurrent depression (adjusted HR (aHR) 1.17 (1.14–1.20)), severity of depression (aHR 2.01 (1.95–2.08)), admission to a psychiatric ward (aHR 2.03 (1.96, 2.10)) were strong risk factors. Aged 65–84 (aHR 1.96 (1.83–2.10)), lost labor market affiliation ((aHR 1.12 (1.08, 1.16)), cohabiting (aHR 1.27 (1.23, 1.30)), comorbid anxiety (aHR 1.18 (1.10–1.27)), insomnia (aHR 1.27 (1.06–1.51)), migraine (aHR 1.42 (1.16–1.73)) and use of psychotropic drugs was also associated with higher rates of TRD. Limitations: Information on drug use during hospitalization was not available. Information on rating scales could have provided a more precise assessment of symptom severity and treatment response. Conclusions: Besides indicators of disease severity, other important risk factors associated with TRD are age, lost labor market affiliation, cohabiting with a partner as well as anxiety, insomnia, migraine and the use of psychotropic medications.
KW - Treatment-resistant
KW - Depression
KW - Major depressive disorder
KW - Antidepressants
KW - Population-based study
KW - Epidemiology
U2 - 10.1016/j.jad.2019.10.005
DO - 10.1016/j.jad.2019.10.005
M3 - Journal article
C2 - 31655377
SN - 0165-0327
VL - 261
SP - 221
EP - 229
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
ER -