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首页> 外文期刊>Preventive Medicine: An International Journal Devoted to Practice and Theory >Effects of depression screening on diagnosing and treating mood disorders among older adults in office-based primary care outpatient settings: An instrumental variable analysis
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Effects of depression screening on diagnosing and treating mood disorders among older adults in office-based primary care outpatient settings: An instrumental variable analysis

机译：抑郁症筛查对基于办公室初级保健门诊环境中老年人诊断和治疗情绪障碍的影响：仪器变量分析

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Existing literature shows mixed findings regarding the efficacy and effectiveness of depression screening, and relatively little is known about the effectiveness of depression screening among older adults in primary care visits in the U.S. This study examines the effects of depression screening on the three following outcomes: mood disorder diagnoses, overall antidepressant prescriptions, and potentially inappropriate antidepressant prescriptions among older adults ages 65 or older in office-based outpatient primary care settings. We used data from 2010-2012 National Ambulatory Medical Care Survey (NAMCS), a nationally representative sample of office-based primary care outpatient visits among older adults (n = 9,313 unweighted). We employed an instrumental variable approach to control for selection bias in our repeated cross-sectional population-based study. Injury prevention and stress management were selected as instrumental variables, as they were considered completely exogenous to outcomes of interests using conceptual and statistical criteria. We conducted multivariate bivariate probit (biprobit) regression analyses to investigate the effect of depression screening on each outcome, when controlled for other covariates. We found that depression screening was negatively associated with potentially inappropriate antidepressant prescriptions (beta = -2.17; 95% CI - 2.80 to - 1.53; p b 0.001). However, no significant effect of depression screening on diagnosis of mood disorders and overall antidepressant prescriptions was found. Overall, depression screening had a negative effect on potentially inappropriate antidepressant prescriptions. Primary care physicians and other healthcare providers should actively utilize depression screening to minimize potentially inappropriate antidepressant prescriptions in older adult patients. (C) 2017 Elsevier Inc. All rights reserved.
机译：现有文献显示有关抑郁症筛查的疗效和有效性的混合结果，据称对美国初级保健访问中老年人的抑郁症筛选的有效性所知的相对较少的是，本研究审查了抑郁症筛选对三个以下结果的影响：心情疾病诊断，整个抗抑郁药处，以及在基于办公室的门诊初级保养环境中65岁或以上的老年人年龄段的潜在不恰当的抗抑郁症处。我们使用2010-2012国家外国医疗护理调查（NAMCS）的数据，该调查（NAMCS）是一个全国基于办事处的初级护理门诊观察的国家代表性，老年人（N = 9,313号未加权）。我们采用了一种乐器可变方法来控制我们反复横断面群体的研究中的选择偏见。选择伤害预防和应力管理作为工具变量，因为使用概念和统计标准，它们被认为是完全外部的利益结果。我们进行了多元生物衰强率（BiProbit）回归分析，以研究抑郁筛查对每个结果的影响，当时控制其他协变量。我们发现抑制筛查与潜在不恰当的抗抑郁症处方（β= -2.17; 95％CI-2.80至-1.53​​; p b 0.001）负相关。然而，发现抑郁症对情绪障碍诊断和整体抗抑郁症处方的诊断没有显着影响。总体而言，抑郁症筛查对潜在的不恰当的抗抑郁病毒处方具有负面影响。初级保健医生和其他医疗保健提供者应积极利用抑郁症筛查，以尽量减少老年成年患者的潜在不恰当的抗抑郁处方。 （c）2017年Elsevier Inc.保留所有权利。

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