Background

: The objective of this study was to investigate whether persistence of antidepressant use differs between refugee youth and Swedish-born youth after a diagnosis of a common mental disorder (CMD), and if clinical and sociodemographic factors are associated with antidepressant discontinuation.

Methods

: Youth aged 16-25 years, with an incident diagnosis of CMD (depression, post-traumatic stress disorder (PTSD), anxiety disorders) accessing specialized healthcare in Sweden 2006-2016 were included. New users were identified with a one-year washout period. Refugees (N=1575) were compared with Swedish-born youth (N=2319). Cox regression models [reported as adjusted Hazard Ratios (HRs) with 95% confidence intervals (CIs)] were used to investigate factors associated with discontinuation of antidepressant use.

Results

: Among youth (mean age 20.9 years, SD 2.7, 50% females), the median duration of antidepressant use differed considerably between refugee (101 days, IQR 31-243) and Swedish-born youth (252 days, IQR 101-558). Refugees were more likely to discontinue treatment (HR 1.61, 95% CI 1.47-1.77). Factors associated with an increased risk for discontinuation in refugees included ≤5 years duration of formal residency (HR 1.28, 95% CI 1.12-1.45), antidepressant type, and dispensing lag (time from prescription to dispensing) of >7 days (1.43, 1.25-1.64), whereas PTSD (0.78, 0.64-0.97) and anxiolytic use (0.79, 0.64-0.96) were associated with a lower discontinuation risk.

Limitations

: Only persons treated in specialized healthcare could be included.

Conclusion

: The relatively short treatment durations among refugee youth suggest that antidepressant treatment may not be optimal in CMD, and better monitoring of treatment as well as transcultural education of healthcare personnel are warranted.

中文翻译：

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患有常见精神障碍的难民青年中抗抑郁药的持续使用

背景

：本研究的目的是调查在诊断出常见精神障碍 (CMD) 后，难民青年和瑞典出生的青年使用抗抑郁药的持续性是否不同，以及临床和社会人口学因素是否与停用抗抑郁药有关。

方法

：包括 2006 年至 2016 年在瑞典获得专业医疗保健的 16-25 岁的青少年，包括 CMD（抑郁症、创伤后应激障碍 (PTSD)、焦虑症）的事件诊断。新用户被确定为一年的清除期。难民 (N=1575) 与瑞典出生的青年 (N=2319) 进行了比较。Cox 回归模型[报告为具有 95% 置信区间 (CI) 的调整后的危险比 (HR)] 用于研究与停止使用抗抑郁药相关的因素。

结果

：在青年（平均年龄 20.9 岁，SD 2.7，50% 女性）中，难民（101 天，IQR 31-243）和瑞典出生的青年（252 天，IQR 101-558）抗抑郁药使用时间的中位数差异很大. 难民更有可能停止治疗（HR 1.61，95% CI 1.47-1.77）。与难民停药风险增加相关的因素包括 ≤ 5 年的正式居住时间（HR 1.28，95% CI 1.12-1.45）、抗抑郁药类型和配药延迟（从开药到配药的时间）> 7 天（1.43， 1.25-1.64)，而 PTSD (0.78, 0.64-0.97) 和抗焦虑药的使用 (0.79, 0.64-0.96) 与较低的停药风险相关。

限制

：只能包括接受专业医疗保健的人员。

结论

：难民青年中相对较短的治疗持续时间表明抗抑郁药治疗在 CMD 中可能不是最佳的，需要更好地监测治疗以及对医护人员进行跨文化教育。