생물정신의학 (Korean Journal of Biological Psychiatry)

  • 제26권2호
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  • Pages.39-46
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  • 2019
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  • 1225-8709(pISSN)
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  • 2005-7571(eISSN)
대한생물정신의학회 (The Korean Society of Biological Psychiatry)
권호 표지

정신과 의사와 비정신과 의사의 항우울제 처방에 대한 연구 : 건강보험심사평가원 청구 데이터 중심으로

The Epidemiology of Antidepressant Prescriptions in South Korea from the Viewpoint of Medical Providers : A Nationwide Register-Based Study

  • 김민지 (서울대병원 정신건강의학과) ;
  • 김남우 (서울대병원 정신건강의학과) ;
  • 신다운 (서울대병원 정신건강의학과) ;
  • 이상진 (서울대병원 정신건강의학과) ;
  • 박형근 (서울대병원 정신건강의학과) ;
  • 김혜영 (인하대병원 정신건강의학과) ;
  • 양보람 (서울대병원 의학연구협력센터) ;
  • 안용민 (서울대병원 정신건강의학과)
  • Kim, Min Ji (Department of Psychiatry, Seoul National University Hospital) ;
  • Kim, Namwoo (Department of Psychiatry, Seoul National University Hospital) ;
  • Shin, Daun (Department of Psychiatry, Seoul National University Hospital) ;
  • Rhee, Sang Jin (Department of Psychiatry, Seoul National University Hospital) ;
  • Park, C. Hyung Keun (Department of Psychiatry, Seoul National University Hospital) ;
  • Kim, Hyeyoung (Department of Psychiatry, Inha University Hospital) ;
  • Yang, Boram (Medical Research Collaborating Center, Seoul National University Hospital) ;
  • Ahn, Yong Min (Department of Psychiatry, Seoul National University Hospital)
  • 투고 : 2019.08.09
  • 심사 : 2019.08.23
  • 발행 : 2019.10.31
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초록

Antidepressants are widely used to treat depression in Korea, however, only a few studies have focused on the provider of the treatment. The aim of the study is to compare the differences between patients who were prescribed antidepressants by psychiatrists and those who were prescribed antidepressants by non-psychiatrists in South Korea. Patients with a diagnosis of depressive disorder who had been newly prescribed antidepressants in 2012 were selected from the Health Insurance Review and Assessment Service database. They were classified into two groups depending on whether they received the antidepressant prescription from a psychiatrist or non-psychiatrist. Sociodemographic, clinical, and depression related cost has been investigated. Treatment resistant depression, which is defined as a failure of two antidepressant regimens to alleviate symptoms, was also investigated. Prescription adequacy was assessed based on whether a regimen was maintained for at least 4 weeks. Among the 834694 patients with pharmaceutically treated depression (PTD) examined in this study, 326122 (39.1%) were treated by psychiatrists. Patients who were treated by psychiatrists were younger and had more psychiatric comorbidities than those treated by non-psychiatrists. They had longer PTD duration (229.3 days vs. 103.0 days, p < 0.05) and a larger proportion of treatment resistant depression (9.3% of PTD) when compared to those patients treated by non-psychiatrists. The patients treated by psychiatrists had a smaller proportion of inadequate antidepressant use compared to those patients in the non-psychiatrist group (44.5% vs. 65.1%, p < 0.05). The costs related to depression corrected with PTD duration were higher in the non-psychiatrist group (32214 won vs. 56001 won, p < 0.05). Patients who receive antidepressants from psychiatrists are patients with more severe, treatment-resistant depression. Psychiatrists prescribe antidepressants more adequately and cost- effectively than non-psychiatrists.

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참고문헌

  1. Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet 1997;349:1436-1442. https://doi.org/10.1016/S0140-6736(96)07495-8
  2. Berto P, D'Ilario D, Ruffo P, Di Virgilio R, Rizzo F. Depression: cost-of-illness studies in the international literature, a review. J Ment Health Policy Econ 2000;3:3-10. https://doi.org/10.1002/1099-176X(200003)3:1<3::AID-MHP68>3.0.CO;2-H
  3. Greenberg PE, Fournier AA, Sisitsky T, Pike CT, Kessler RC. The economic burden of adults with major depressive disorder in the United States (2005 and 2010). J Clin Psychiatry 2015;76:155-162. https://doi.org/10.4088/JCP.14m09298
  4. Paulose-Ram R, Safran MA, Jonas BS, Gu Q, Orwig D. Trends in psychotropic medication use among U.S. adults. Pharmacoepidemiol Drug Saf 2007;16:560-570. https://doi.org/10.1002/pds.1367
  5. Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, et al. Psychotropic drug utilization in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl 2004;109:55-64.
  6. Wang PS, Lane M, Olfson M, Pincus HA, Wells KB, Kessler RC. Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005;62:629-640. https://doi.org/10.1001/archpsyc.62.6.629
  7. Henriksson S, Asplund R, Boethius G, Hallstrom T, Isacsson G. Infrequent use of antidepressants in depressed individuals (an interview and prescription database study in a defined Swedish population 2001-2002). Eur Psychiatry 2006;21:355-360. https://doi.org/10.1016/j.eurpsy.2006.04.003
  8. Goldberg DP, Huxley P. Common Mental Disorders: A Bio-Social Model. London: Routledge;1992.
  9. Sireling LI, Freeling P, Paykel ES, Rao BM. Depression in general practice: clinical features and comparison with out-patients. Br J Psychiatry 1985;147:119-126. https://doi.org/10.1192/bjp.147.2.119
  10. Sireling LI, Paykel ES, Freeling P, Rao BM, Patel SP. Depression in general practice: case thresholds and diagnosis. Br J Psychiatry 1985;147:113-119. https://doi.org/10.1192/bjp.147.2.113
  11. Simon GE, Von Korff M, Rutter CM, Peterson DA. Treatment process and outcomes for managed care patients receiving new antidepressant prescriptions from psychiatrists and primary care physicians. Arch Gen Psychiatry 2001;58:395-401. https://doi.org/10.1001/archpsyc.58.4.395
  12. Vuorilehto MS, Melartin TK, Rytsala HJ, Isometsa ET. Do characteristics of patients with major depressive disorder differ between primary and psychiatric care? Psychol Med 2007;37:893-904. https://doi.org/10.1017/s0033291707000098
  13. McManus P, Mant A, Mitchell P, Britt H, Dudley J. Use of antidepressants by general practitioners and psychiatrists in Australia. Aust N Z J Psychiatry 2003;37:184-189. https://doi.org/10.1046/j.1440-1614.2003.01132.x
  14. Kerr MP. Antidepressant prescribing: a comparison between general practitioners and psychiatrists. Br J Gen Pract 1994;44:275-276.
  15. Sihvo S, Isometsa E, Kiviruusu O, Hamalainen J, Suvisaari J, Perala J, et al. Antidepressant utilisation patterns and determinants of shortterm and non-psychiatric use in the Finnish general adult population. J Affect Disord 2008;110:94-105. https://doi.org/10.1016/j.jad.2008.01.012
  16. Lawrence RE, Rasinski KA, Yoon JD, Meador KG, Koenig HG, Curlin FA. Primary care physicians' and psychiatrists' approaches to treating mild depression. Acta Psychiatr Scand 2012;126:385-392. https://doi.org/10.1111/j.1600-0447.2012.01887.x
  17. Kniesner TJ, Powers RH, Croghan TW. Provider type and depression treatment adequacy. Health Policy 2005;72:321-332. https://doi.org/10.1016/j.healthpol.2004.09.008
  18. Sturm R, Wells KB. How can care for depression become more costeffective? JAMA 1995;273:51-58. https://doi.org/10.1001/jama.1995.03520250067036
  19. Croghan TW, Melfi CA, Dobrez DG, Kniesner TJ. Effect of mental health specialty care on antidepressant length of therapy. Med Care 1999;37:AS20-AS23. https://doi.org/10.1097/00005650-199904001-00004
  20. Park K. Direction of health care and health insurance system reform to strengthen primary care: comparative analysis of Korea, Japan and Taiwan. J Korean Acad Fam Med 2003;24:328-345.
  21. American Psychiatric Association. Practice Guidelines for the Treatment of Patients with Major Depressive Disorder. [serial online] 2010 Nov [cited 2019 Aug]. Available from URL: https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf
  22. Desseilles M, Witte J, Chang TE, Iovieno N, Dording CM, Ashih H, et al. Assessing the adequacy of past antidepressant trials: a clinician's guide to the antidepressant treatment response questionnaire. J Clin Psychiatry 2011;72:1152-1154. https://doi.org/10.4088/JCP.11ac07225
  23. Fife D, Feng Y, Wang MY, Chang CJ, Liu CY, Juang HT, et al. Epidemiology of pharmaceutically treated depression and treatment resistant depression in Taiwan. Psychiatry Res 2017;252:277-283. https://doi.org/10.1016/j.psychres.2017.03.006
  24. Davidson JR, Miller RD, Turnbull CD, Sullivan JL. Atypical depression. Arch Gen Psychiatry 1982;39:527-534. https://doi.org/10.1001/archpsyc.1982.04290050015005
  25. Birmaher B, Ryan ND, Williamson DE, Brent DA, Kaufman J, Dahl RE, et al. Childhood and adolescent depression: a review of the past 10 years. Part I. J Am Acad Child Adolesc Psychiatry 1996;35:1427-1439. https://doi.org/10.1097/00004583-199611000-00011
  26. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005;62:617-627. https://doi.org/10.1001/archpsyc.62.6.617
  27. Melartin TK, Rytsala HJ, Leskela US, Lestela-Mielonen PS, Sokero TP, Isometsa ET. Severity and comorbidity predict episode duration and recurrence of DSM-IV major depressive disorder. J Clin Psychiatry 2004;65:810-819. https://doi.org/10.4088/JCP.v65n0612
  28. Hirschfeld RM, Keller MB, Panico S, Arons BS, Barlow D, Davidoff F, et al. The National Depressive and Manic-Depressive Association consensus statement on the undertreatment of depression. JAMA 1997;277:333-340. https://doi.org/10.1001/jama.1997.03540280071036
  29. Davidson JR, Meltzer-Brody SE. The underrecognition and undertreatment of depression: what is the breadth and depth of the problem? J Clin Psychiatry 1999;60:4-9.
  30. Weilburg JB, O'Leary KM, Meigs JB, Hennen J, Stafford RS. Evaluation of the adequacy of outpatient antidepressant treatment. Psychiatr Serv 2003;54:1233-1239. https://doi.org/10.1176/appi.ps.54.9.1233
  31. Tarricone R. Metodologia di indagine e primi risultati sul costo sociale della depressione maggiore in Italia. Mecosan 1997;6:57-68.
  32. Demyttenaere K. Risk factors and predictors of compliance in depression. Eur Neuropsychopharmacol 2003;13:69-75. https://doi.org/10.1016/S0924-977X(03)00095-6
  33. Demyttenaere K. Compliance during treatment with antidepressants. J Affect Disord 1997;43:27-39. https://doi.org/10.1016/S0165-0327(96)00095-X
  34. Maddox JC, Levi M, Thompson C. The compliance with antidepressants in general practice. J Psychopharmacol 1994;8:48-52. https://doi.org/10.1177/026988119400800108
  35. Tai-Seale M, Croghan TW, Obenchain R. Determinants of antidepressant treatment compliance: implications for policy. Med Care Res Rev 2000;57:491-512. https://doi.org/10.1177/107755870005700405