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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，关于抑郁症筛查的有效性和有效性的研究结果喜忧参半，而对美国初级保健就诊中老年人抑郁症筛查的有效性知之甚少。本研究考察了抑郁症筛查对以下三种结果的影响：心境障碍诊断、整体抗抑郁药物处方、，以及65岁或以上的老年人在办公室门诊初级保健机构中可能不合适的抗抑郁药处方。我们使用了2010-2012年全国非卧床医疗调查（NAMCS）的数据，这是一个全国代表性的老年人办公室初级保健门诊就诊样本（n=9313，未加权）。在我们的重复横断面人群研究中，我们采用工具变量方法来控制选择偏差。伤害预防和压力管理被选为工具变量，因为使用概念和统计标准，它们被认为完全是利益结果的外生变量。我们进行了多元双变量probit（biprobit）回归分析，以研究抑郁症筛查在控制其他协变量的情况下对每个结果的影响。我们发现抑郁症筛查与潜在不适当的抗抑郁药处方呈负相关（β=2.17；95%可信区间-2.80至-1.53；P0.001）。然而，抑郁症筛查对心境障碍的诊断和整体抗抑郁药物处方没有显著影响。总的来说，抑郁症筛查对可能不合适的抗抑郁药处方有负面影响。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，尽量减少老年患者可能不适当的抗抑郁药物处方。（C） 2017爱思唯尔公司版权所有。

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