Association of Hospitalization With First-Line Antidepressant Polypharmacy Among Veterans of Iraq and Afghanistan With Post-Traumatic Stress Disorder: Examining the Influence of Methodological Approaches

Eileen M Stock; Laurel A Copeland; Jack Y Tsan; John E Zeber; Michael A Veronin; Alexander W Thompson

doi:10.7205/MILMED-D-15-00327

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Association of Hospitalization With First-Line Antidepressant Polypharmacy Among Veterans of Iraq and Afghanistan With Post-Traumatic Stress Disorder: Examining the Influence of Methodological Approaches

Journal article

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Peer reviewed

Association of Hospitalization With First-Line Antidepressant Polypharmacy Among Veterans of Iraq and Afghanistan With Post-Traumatic Stress Disorder: Examining the Influence of Methodological Approaches

Eileen M Stock, Laurel A Copeland, Jack Y Tsan, John E Zeber, Michael A Veronin and Alexander W Thompson

Military medicine, Vol.181(10), pp.1248-1257

10/2016

DOI: 10.7205/MILMED-D-15-00327

PMID: 27753560

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Abstract

To compare the influence of various statistical analysis approaches while assessing the marginal effect of polypharmacy (prescription of multiple psychotropics including a first-line antidepressant) on all-cause hospital admission among veterans diagnosed with post-traumatic stress disorder. Data were obtained on 398 Iraq/Afghanistan veterans being followed in a southwestern U.S. health care system from October 2005 through September 2009, diagnosed with post-traumatic stress disorder and receiving first-line antidepressants (serotonin selective or serotonin norepinephrine reuptake inhibitors). High-dimensional propensity score (hd-PS) approaches were considered, examining both covariate adjustment per PS deciles and propensity weighting, with results compared to those of standard multivariable logistic regression. Veterans prescribed polypharmacy did not appear to have increased odds of admission in either the decile-adjusted hd-PS model (odds ratio [OR] = 2.1; 95% confidence interval [CI]: 0.9-4.9, not significant [ns]) or traditional covariate-adjusted logistic model (OR = 2.1; 0.9-5.0, ns). Inverse probability of treatment (OR = 2.1; 1.3-3.3) and standardized-morbidity-ratio-weighted (OR = 2.2; 1.3-3.6) hd-PS models estimated similar odds of admission with narrower CIs. Future research should incorporate alternate analytical methods for observational data and investigate their respective biases relative to clinician treatment decision-making. For several analytical approaches, greater risk of admission among patients prescribed antidepressant-related polypharmacy was observed despite recommended guidelines, suggesting the need to investigate why clinicians may deviate from guidelines.

Adult

Afghan Campaign 2001

Antidepressive Agents - therapeutic use

Cohort Studies

Female

Hospitalization - statistics & numerical data

Humans

Iraq War, 2003-2011

Male

Polypharmacy

Retrospective Studies

Stress Disorders, Post-Traumatic - drug therapy

Stress Disorders, Post-Traumatic - psychology

Veterans - psychology

Veterans - statistics & numerical data

Details

Title: Subtitle: Association of Hospitalization With First-Line Antidepressant Polypharmacy Among Veterans of Iraq and Afghanistan With Post-Traumatic Stress Disorder: Examining the Influence of Methodological Approaches
Creators: Eileen M Stock - Central Texas Veterans Health Care System
Laurel A Copeland - Central Texas Veterans Health Care System
Jack Y Tsan - Texas A&M Health Science Center, 8447 Highway 47, Bryan, TX 77807.
John E Zeber - Central Texas Veterans Health Care System
Michael A Veronin - Texas A&M Health Science Center
Alexander W Thompson - Scott & White Hospital
Resource Type: Journal article
Publication Details: Military medicine, Vol.181(10), pp.1248-1257
DOI: 10.7205/MILMED-D-15-00327
PMID: 27753560
NLM abbreviation: Mil Med
ISSN: 0026-4075
eISSN: 1930-613X
Language: English
Date published: 10/2016
Academic Unit: Psychiatry; Emergency Medicine
Record Identifier: 9984296259802771

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