일 대학병원 외래 우울증 환자의 항우울제 순응도와 이에 미치는 요인

The Factors Associated with Antidepressant Adherence in Outpatients with Depressive Disorder

본 연구에서는 일 대학병원 우울증 환자들의 약물 순응도에 영향을 주는 요인에 대해 조사하였다. 연구 결과 순응군의 비율은 12주 54.6%, 24주 42.3%로 나타났다. 연령이 높을수록, 교육기간이 짧을수록 순응도가 높았다. 젊은 연령의 특히 낮은 순응도를 높이기 위해서는, 정신건강의학과 진료가 사보험 가입 및 취업에 불리할 것이라는 염려 등에 대해 사회적, 제도적 접근이 요구된다. 향후 외래 우울증 환자의 순응도 증진을 위해 교육 프로그램 개발 및 근거 마련을 위한 임상연구가 필요할 것이다.

Objective Although clinical guidelines recommend that antidepressant treatment should be continued for at least 4 to 9 months, naturalistic studies show that the average length of treatment is shorter than 6 months and that dropout rates are high. But factors leading patients to discontinuation of therapy are not well understood yet. In this study, we investigated factors associated with adherence to antidepressant in Korean patients with depressive disorder. Methods Patients who were diagnosed as depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders-4th edition criteria and took prescribed antidepressants were included in this study. Medical records of 194 patients were reviewed retrospectively. To find adherence to antidepressant treatment, we calculated Medication Possession Ratio at 2 wks, 4 wks, 8 wks, 12 wks, 24 wks after their 1st visit. Patient-related factors, illness-related factors including measurement scales (Beck Depression Inventory, Patient Health Questionnare-15, Global Assessment of Recent Stress Scale scores), and treatment-related factors were compared between adherent group and non-adherent group using chi-square test or student t-test. Multivariate logistic regression was used to predict factors associated with adherence to antidepressant treatment. Results Analyzing data of 194 patients, 106 patients (54.6%), and 82 patients (42.3%) were adherent group at 12 wks and 24 wks, respectively. In patient-related factors, old age and low education periods were significantly associated with adherent group. In illness-related factors and treatment-related factors, none of the factors showed a significant difference between groups. In multivariate logistic regression, old age was significantly associated with sustained adherence at 12 wks. Conclusion We found some factors associated with adherence to antidepressant treatment. Old age was associated with sustained adherence to antidepressant. To enhance adherence to antidepressant, our findings suggest that outpatient education program is needed. And social policy is also essential to reduce stigma in psychiatric department especially among young patients.