Relationship between pharmacotherapy for major depressive disorder and healthcare utilisation in British Columbia, Canada: a retrospective population-based cohort
Bibliographic record
Abstract
OBJECTIVES: To describe the population that meets the criteria for major depressive disorder (MDD) in British Columbia (BC), compare patterns of healthcare utilisation between those with MDD who are and are not prescribed pharmacotherapy, and assess these relationships in models that control for potential confounding variables. DESIGN: We used a population cross-sectional study design among a cohort of individuals living with MDD and examined the relationship between pharmacotherapy and healthcare utilisation between 2019 and 2020 using linked billing and administrative data. SETTING: This study identified individuals with MDD using a validated case definition of International Classification of Diseases (ICD) codes in BC, Canada. PARTICIPANTS: The final study cohort included 549 029 adult participants who met the MDD case definition. EXPLANATORY VARIABLE: Explanatory variable was the use of prescription antidepressant medication during the study period, based on BC PharmaNet data. COVARIATES: Covariates include sociodemographic characteristics (age, sex, urban/rural residence, neighbourhood income quintile and comorbidities). PRIMARY OUTCOME MEASURE: Primary outcome measure was healthcare utilisation (outpatient physician visits, emergency department (ED) visits and hospitalisations). RESULTS: We stratified our analysis based on whether study participants were classified as 'recently incident' or 'actively prevalent'. The odds ratio (OR) for health service utilisation between the pharmacotherapy group and the non-pharmacotherapy group for individuals who were recently incident was 8.14 (95% CI 7.40, 8.95) for outpatient physician visits, 1.04 (95% CI 1.02, 1.07) for ED visits and 1.05 (95% CI 1.00, 1.10) for hospitalisations, after adjusting for comorbidities and other sociodemographic variables in our regression analyses, whereas for the actively prevalent group the ORs were 7.57 (7.27, 8.49), 0.91 (0.89, 0.92) and 1.00 (0.98, 1.02), respectively. CONCLUSION: This study examined the association of pharmacotherapy on healthcare utilisation for adults with MDD in BC. The study revealed higher outpatient physician visits for the pharmacotherapy group and no major association for inpatient visits. For ED visits, recently incident individuals on pharmacotherapy had slightly higher odds of having an ED visit, whereas individuals who were actively prevalent and on pharmacotherapy had a slight decrease in odds. This may suggest a protective effect of pharmacotherapy against a utilisation of resource-intensive healthcare services.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.004 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".