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Association of Hospitalization With First-Line Antidepressant Polypharmacy Among Veterans of Iraq and Afghanistan With Post-Traumatic Stress Disorder: Examining the Influence of Methodological Approaches.

Abstract：

OBJECTIVE:To compare the influence of various statistical analysis approaches while assessing the marginal effect of polypharmacy (prescription of multiple psychotropics including a first-line antidepressant) on all-cause hospital admission among veterans diagnosed with post-traumatic stress disorder. METHODS:Data were obtained on 398 Iraq/Afghanistan veterans being followed in a southwestern U.S. health care system from October 2005 through September 2009, diagnosed with post-traumatic stress disorder and receiving first-line antidepressants (serotonin selective or serotonin norepinephrine reuptake inhibitors). High-dimensional propensity score (hd-PS) approaches were considered, examining both covariate adjustment per PS deciles and propensity weighting, with results compared to those of standard multivariable logistic regression. RESULTS:Veterans prescribed polypharmacy did not appear to have increased odds of admission in either the decile-adjusted hd-PS model (odds ratio [OR] = 2.1; 95% confidence interval [CI]: 0.9-4.9, not significant [ns]) or traditional covariate-adjusted logistic model (OR = 2.1; 0.9-5.0, ns). Inverse probability of treatment (OR = 2.1; 1.3-3.3) and standardized-morbidity-ratio-weighted (OR = 2.2; 1.3-3.6) hd-PS models estimated similar odds of admission with narrower CIs. CONCLUSIONS:Future research should incorporate alternate analytical methods for observational data and investigate their respective biases relative to clinician treatment decision-making. For several analytical approaches, greater risk of admission among patients prescribed antidepressant-related polypharmacy was observed despite recommended guidelines, suggesting the need to investigate why clinicians may deviate from guidelines.

journal_name

Mil Med

journal_title

Military medicine

authors

Stock EM,Copeland LA,Tsan JY,Zeber JE,Veronin MA,Thompson AW

doi

10.7205/MILMED-D-15-00327

subject

Has Abstract

pub_date

2016-10-01 00:00:00

pages

1248-1257

issue

eissn

0026-4075

issn

1930-613X

journal_volume

181

pub_type

杂志文章

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Association of Hospitalization With First-Line Antidepressant Polypharmacy Among Veterans of Iraq and Afghanistan With Post-Traumatic Stress Disorder: Examining the Influence of Methodological Approaches.