Journal of affective disorders · 2026
Changes in antidepressant treatment following the transition to secondary care for depression treatment in older adults and association with social determinants: A Danish register-based study.
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Ishtiak-Ahmed Kazi, Köhler-Forsberg Ole, Gasse Christiane
Аннотация
OBJECTIVE: To investigate antidepressant treatment changes following transitioning to secondary care for depression in older adults and examine their associations with social determinants.
METHODS: This Danish register-based cross-sectional study included all older adults with a first outpatient visit to psychiatric hospitals (referred by general practitioners or private psychiatrists) for depression within the first year after initiating antidepressant treatment during 2006 and 2016. Treatment changes were assessed using three outcomes based on antidepressant prescriptions redeemed before and within 90 days after the outpatient visit: (i) antidepressant switching, (ii) discontinuation, and (iii) dose changes. Social determinants included education, occupation, income, marital status, household type, urbanicity, and ethnicity. Multiple logistic regression and generalized linear regression were employed for association analyses.
RESULTS: Of 792 individuals referred to outpatient care after starting antidepressants (61% female; mean age 79), 25% discontinued treatment. Among those who continued (n = 594), 47% switched antidepressants. Of those who stayed on the same antidepressant (n = 315), only 46% had recorded dose information, and 38% of these had dose adjustments. Among social determinants, low income was associated with a higher likelihood of discontinuation compared to higher income (odds ratio: 2.10; 95% confidence interval: 1.14-3.87). Short education was associated with an average dose reduction of 15 units (beta-coefficient, 95% CI: -15, -25 to -4.4) compared to long education.
LIMITATIONS: Prescribers' information was not available and >50% of prescriptions had missing dose information.
CONCLUSIONS: Noticeable changes in antidepressant treatment occurred after secondary care contact, with some differences across social determinants, mainly related to income and education.
METHODS: This Danish register-based cross-sectional study included all older adults with a first outpatient visit to psychiatric hospitals (referred by general practitioners or private psychiatrists) for depression within the first year after initiating antidepressant treatment during 2006 and 2016. Treatment changes were assessed using three outcomes based on antidepressant prescriptions redeemed before and within 90 days after the outpatient visit: (i) antidepressant switching, (ii) discontinuation, and (iii) dose changes. Social determinants included education, occupation, income, marital status, household type, urbanicity, and ethnicity. Multiple logistic regression and generalized linear regression were employed for association analyses.
RESULTS: Of 792 individuals referred to outpatient care after starting antidepressants (61% female; mean age 79), 25% discontinued treatment. Among those who continued (n = 594), 47% switched antidepressants. Of those who stayed on the same antidepressant (n = 315), only 46% had recorded dose information, and 38% of these had dose adjustments. Among social determinants, low income was associated with a higher likelihood of discontinuation compared to higher income (odds ratio: 2.10; 95% confidence interval: 1.14-3.87). Short education was associated with an average dose reduction of 15 units (beta-coefficient, 95% CI: -15, -25 to -4.4) compared to long education.
LIMITATIONS: Prescribers' information was not available and >50% of prescriptions had missing dose information.
CONCLUSIONS: Noticeable changes in antidepressant treatment occurred after secondary care contact, with some differences across social determinants, mainly related to income and education.