Humanistic outcomes in treatment resistant depression: a secondary analysis of the STAR*D study

DiBernardo, Allitia; Lin, Xiwu; Zhang, Qiaoyi; Xiang, Jim; Lu, Ling; Jamieson, Carol; Benson, Carmela; Lee, Kwan; Bodén, Robert; Brandt, Lena; Brenner, Philip; Reutfors, Johan; Li, Gang

doi:10.1186/s12888-018-1920-7

Cited by 43 publications

(41 citation statements)

References 32 publications

(39 reference statements)

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“…The levels of absenteeism, presenteeism, overall work productivity loss and activity impairment associated with ED in the current study (7.1%, 22.5%, 24.8% and 28.6%, respectively) were comparable to those reported in prior research on treatment resistant depression, obesity and type 2 diabetes mellitus . The levels of HRQoL observed in the current study among men with ED (46.7, 48.3 and 0.693 for the Mental Component Summary, Physical Component Summary and SF‐6D, respectively) were likewise in line with the aforementioned conditions.…”

Section: Discussionsupporting

confidence: 89%

The association of erectile dysfunction with productivity and absenteeism in eight countries globally

Goldstein

Goren

et al. 2019

Int J Clin Pract

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Aim:To evaluate the association of erectile dysfunction (ED) with work productivity loss, activity impairment and health-related quality of life (HRQoL) across Brazil, China, France, Germany, Italy, Spain, the UK and the US. Methods:This cross-sectional observational study used data from adult men (40-70 years old; N = 52 697) from the 2015 and 2016 National Health and Wellness Surveys. ED assessment was based on self-reported difficulty in achieving or maintaining an erection in the past 6 months. Impairment to work and non-work activities and HRQoL were assessed for each country and compared against the US. Multivariable models tested interactions between ED status and country for each outcome. Results:Overall ED prevalence was reported as 49.7%, with Italy reporting the highest rate (54.7%). Men with ED reported significantly higher absenteeism (7.1% vs 3.2%), presenteeism (22.5% vs 10.1%), overall work productivity impairment (24.8% vs 11.2%), activity impairment (28.6% vs 14.5%) and significantly lower Mental Component Summary scores (MCS; 46.7 vs 51.2), Physical Component Summary scores (PCS; 48.3 vs 53.0), and health state utilities (SF-6D: 0.693 vs 0.778; all, P < 0.001) than men with no ED. After adjusting for covariates, compared with the US, the association of ED status with overall work productivity impairment was greatest in the UK (26% higher; P < 0.05), and with MCS, PCS and SF-6D scores was greatest in China (−2.67, −1.58, and −0.043 points, respectively; all, P < 0.001). Greater ED severity was significantly associated with higher impairment to work and non-work activities and lower HRQoL, with China reporting the highest burden, compared with the US (most P < 0.05).Conclusion: ED poses a significant burden with respect to work productivity and HRQoL, with greater severity associated with worse outcomes. Better management and earlier detection may help reduce this burden, especially in countries reporting a strong association between ED and poor economic and health outcomes. | INTRODUC TI ONErectile dysfunction (ED) is defined as the persistent inability to achieve and/or maintain penile erection sufficient for performing sexual intercourse. 1 ED can be caused by endocrine (reduced serum testosterone levels), non-endocrine (arterial inflow disorders and abnormalities of venous outflow), neurogenic (affecting innervation and nervous function) and iatrogenic (relating to a medical or surgical treatment) factors. 2 An extrapolation of the Massachusetts Male Aging Study, whichreported an ED prevalence of 52% in men aged 40-70 years, suggested that global ED prevalence will increase from 152 million

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Section: Discussionsupporting

confidence: 89%

The association of erectile dysfunction with productivity and absenteeism in eight countries globally

Goldstein

Goren

et al. 2019

Int J Clin Pract

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“…In the STAR*D study, participants reported high unemployment rates, ranging from 36% for patients who responded to step 1 treatment to 47% for patients who progressed to step 4 [ 5 ]. In another STAR*D analysis, patients with treatment-resistant depression demonstrated lower vocational productivity than patients with non–treatment-resistant major depressive disorder [ 31 ]. A claims-based study found that employees with treatment-resistant depression had an average of 35.8 work loss days per year, which was 1.7 times the rate of work loss days in employees with non–treatment-resistant major depressive disorder and 6.2 times that of those without major depressive disorder [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

A retrospective analysis to estimate the healthcare resource utilization and cost associated with treatment-resistant depression in commercially insured US patients

Zhang

DiBernardo

et al. 2020

PLoS ONE

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The economic burden of commercially insured patients in the United States with treatmentresistant depression and patients with non-treatment-resistant major depressive disorder was compared using data from the Optum Clinformatics™ claims database. Methods Patients 18-63 years on antidepressant treatment between 1/1/13 and 9/30/13, who had no treatment claims for depression 6 months before the index date (first antidepressant dispensing), and who had a major depressive disorder or depression diagnosis within 30 days of the index date, were included. Treatment-resistant depression was defined as receiving 3 antidepressant regimens during 1 major depressive disorder episode. Patients with treatment-resistant depression were matched with patients with non-treatment-resistant major depressive disorder at a 1:4 ratio using propensity score matching. The study consisted of 1-year baseline (pre-index) and 2-year follow-up (post index) periods. Cost outcomes were compared using a generalized linear model. Results 2,370 treatment-resistant depression and 9,289 non-treatment-resistant major depressive disorder patients were included. In year 1 of the follow-up period, compared with non-treatment-resistant major depressive disorder, patients with treatment-resistant depression had: more emergency department visits (odds ratio = 1.39, 95% confidence interval = 1.24-1.56); more inpatient hospitalizations (odds ratio = 1.73, 95% confidence interval = 1.46-2.05); longer hospital stays (mean difference vs non-treatment-resistant major depressive

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“…In one clinical study, TRD out-patients incurred higher costs than other depressed patients related to the number of working days lost, and these costs did not correlate with depression severity [24]. Also, a recent re-analysis of data from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial showed greater functional and work impairment as well as lower work productivity among the patients classified with TRD compared to other depressed patients [25].…”

Section: Introductionmentioning

confidence: 99%

Risk and risk factors for disability pension among patients with treatment resistant depression– a matched cohort study

et al. 2020

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Background: Treatment resistant depression (TRD) is common among patients with depression, and is associated with clinical and functional disability. However, the risk and risk factors for being granted disability pension (DP) among patients with TRD have not been investigated. Methods: All antidepressant initiators in Sweden with a diagnosis of depression in specialized care were identified in nationwide registers 2006-2013 and followed regarding treatment trials. TRD was defined as the start of a third sequential trial. Patients with TRD who were not on DP (N = 3204) were matched by age, sex, history of depression, calendar year, and time for treatment start with 3204 comparators with depression and ongoing antidepressant treatment. A proportional Cox Regression was performed with DP as outcome, adjusted for various sociodemographic and clinical covariates. Results: Compared to the comparison cohort, TRD was associated with a doubled risk for all-cause DP (aHR 2.07; 95%CI 1.83-2.35), DP due to depression (2.28; 1.82-2.85) and to any mental disorder (2.24; 1.95-2.57) but not due to somatic diagnoses (1.25; 0.84-1.86). Among significant risk factors for DP in TRD were female sex, being > 29 years of age, unemployment and a diagnosis of comorbid personality disorder (ICD-10 codes F60.0-9). Conclusion: TRD is associated with an elevated risk for DP compared to other patients with depression, with large potential costs for the affected patients and for society. Clinical and therapeutic implications for patients with TRD who are granted DP should be further investigated. Limitation: No clinical data, e.g. type of depression or reason for treatment switch, was available for this study.

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Humanistic outcomes in treatment resistant depression: a secondary analysis of the STAR*D study

Cited by 43 publications

References 32 publications

The association of erectile dysfunction with productivity and absenteeism in eight countries globally

The association of erectile dysfunction with productivity and absenteeism in eight countries globally

A retrospective analysis to estimate the healthcare resource utilization and cost associated with treatment-resistant depression in commercially insured US patients

Risk and risk factors for disability pension among patients with treatment resistant depression– a matched cohort study

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