Comorbidity, Treatment, and Service Utilization Patterns in Difficult-to-Treat Depression Patients: A Retrospective Study in a Portuguese Community Mental Health Team
<i>Background and Objectives</i>: Observational studies with data from real-world clinical practice with patients with difficult-to-treat depression (DTD) are rare. This study aims to collect observational data from the real-world clinical practice of a Portuguese community mental health...
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2024-10-01
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| author | João Gouveia Marta Moura Neves Nuno Madeira Vítor Santos António Macedo |
| author_facet | João Gouveia Marta Moura Neves Nuno Madeira Vítor Santos António Macedo |
| author_sort | João Gouveia |
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| description | <i>Background and Objectives</i>: Observational studies with data from real-world clinical practice with patients with difficult-to-treat depression (DTD) are rare. This study aims to collect observational data from the real-world clinical practice of a Portuguese community mental health team (CMHT) on the prevalence of DTD and to explore differences between DTD and non-DTD groups. <i>Materials and Methods</i>: We conducted a retrospective chart review study using data from Electronic Health Records (EHRs) of adult patients with psychiatric disorders followed by a CMHT from the Department of Psychiatry of the Coimbra Local Health Unit (between 1 December 2020–31 December 2022). The Dutch Measure for quantification of Treatment Resistance in Depression (DM-TRD) was used to assess the degree of treatment resistance and the Charlson Comorbidity Index (CCI) to measure medical comorbidity. <i>Results</i>: A quantity of 473 patients were referred to Cantanhede CMHT for a first assessment. Of these, 219 patients met the criteria for a primary diagnosis of any depressive disorder. Assistant psychiatrists identified 57 patients with DTD during follow-up (approximately 26%). The DTD group had higher rates of depressive episodes, greater depression severity, increased service use, higher DM-TRD scores, and a higher prevalence of comorbid anxiety symptoms, personality disorders, and severe medical comorbidities. The DTD group also had a higher prescription rate of antidepressants. Differences were observed in the use of antidepressant augmentation strategies and in the prescription of anticoagulant/antiplatelet drugs and analgesics, with higher prescription rates in the DTD group. We found correlations between DM-TRD and CCI scores, and between DM-TRD scores and all service use variables. <i>Conclusions</i>: Our results are consistent with a similar study in the United Kingdom, highlighting the need for a different approach to the management of DTD patients, who continue to live with a significant burden despite usual pharmacological and non-pharmacological treatments. |
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| language | English |
| publishDate | 2024-10-01 |
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| series | Medicina |
| spelling | doaj-art-dbf7feb607394f68afe9cc610247f6f02024-11-26T18:12:10ZengMDPI AGMedicina1010-660X1648-91442024-10-016011173410.3390/medicina60111734Comorbidity, Treatment, and Service Utilization Patterns in Difficult-to-Treat Depression Patients: A Retrospective Study in a Portuguese Community Mental Health TeamJoão Gouveia0Marta Moura Neves1Nuno Madeira2Vítor Santos3António Macedo4Faculty of Medicine, University of Coimbra (UC), 3004-531 Coimbra, PortugalFaculty of Medicine, University of Coimbra (UC), 3004-531 Coimbra, PortugalFaculty of Medicine, University of Coimbra (UC), 3004-531 Coimbra, PortugalFaculty of Medicine, University of Coimbra (UC), 3004-531 Coimbra, PortugalFaculty of Medicine, University of Coimbra (UC), 3004-531 Coimbra, Portugal<i>Background and Objectives</i>: Observational studies with data from real-world clinical practice with patients with difficult-to-treat depression (DTD) are rare. This study aims to collect observational data from the real-world clinical practice of a Portuguese community mental health team (CMHT) on the prevalence of DTD and to explore differences between DTD and non-DTD groups. <i>Materials and Methods</i>: We conducted a retrospective chart review study using data from Electronic Health Records (EHRs) of adult patients with psychiatric disorders followed by a CMHT from the Department of Psychiatry of the Coimbra Local Health Unit (between 1 December 2020–31 December 2022). The Dutch Measure for quantification of Treatment Resistance in Depression (DM-TRD) was used to assess the degree of treatment resistance and the Charlson Comorbidity Index (CCI) to measure medical comorbidity. <i>Results</i>: A quantity of 473 patients were referred to Cantanhede CMHT for a first assessment. Of these, 219 patients met the criteria for a primary diagnosis of any depressive disorder. Assistant psychiatrists identified 57 patients with DTD during follow-up (approximately 26%). The DTD group had higher rates of depressive episodes, greater depression severity, increased service use, higher DM-TRD scores, and a higher prevalence of comorbid anxiety symptoms, personality disorders, and severe medical comorbidities. The DTD group also had a higher prescription rate of antidepressants. Differences were observed in the use of antidepressant augmentation strategies and in the prescription of anticoagulant/antiplatelet drugs and analgesics, with higher prescription rates in the DTD group. We found correlations between DM-TRD and CCI scores, and between DM-TRD scores and all service use variables. <i>Conclusions</i>: Our results are consistent with a similar study in the United Kingdom, highlighting the need for a different approach to the management of DTD patients, who continue to live with a significant burden despite usual pharmacological and non-pharmacological treatments.https://www.mdpi.com/1648-9144/60/11/1734difficult-to-treat depressionPortuguese community mental health teamreal-world data |
| spellingShingle | João Gouveia Marta Moura Neves Nuno Madeira Vítor Santos António Macedo Comorbidity, Treatment, and Service Utilization Patterns in Difficult-to-Treat Depression Patients: A Retrospective Study in a Portuguese Community Mental Health Team Medicina difficult-to-treat depression Portuguese community mental health team real-world data |
| title | Comorbidity, Treatment, and Service Utilization Patterns in Difficult-to-Treat Depression Patients: A Retrospective Study in a Portuguese Community Mental Health Team |
| title_full | Comorbidity, Treatment, and Service Utilization Patterns in Difficult-to-Treat Depression Patients: A Retrospective Study in a Portuguese Community Mental Health Team |
| title_fullStr | Comorbidity, Treatment, and Service Utilization Patterns in Difficult-to-Treat Depression Patients: A Retrospective Study in a Portuguese Community Mental Health Team |
| title_full_unstemmed | Comorbidity, Treatment, and Service Utilization Patterns in Difficult-to-Treat Depression Patients: A Retrospective Study in a Portuguese Community Mental Health Team |
| title_short | Comorbidity, Treatment, and Service Utilization Patterns in Difficult-to-Treat Depression Patients: A Retrospective Study in a Portuguese Community Mental Health Team |
| title_sort | comorbidity treatment and service utilization patterns in difficult to treat depression patients a retrospective study in a portuguese community mental health team |
| topic | difficult-to-treat depression Portuguese community mental health team real-world data |
| url | https://www.mdpi.com/1648-9144/60/11/1734 |
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