|
Appendix I.
Description of Outcome Variables Before and After the Index Date
|
Mean Value/Percentage |
AD only
(N=2096) |
MS only
(N=504) |
AD-MS
(N=1137) |
|
Mania-related visits |
|
|
|
|
Patients with at least one pre-index
visit |
2.7% |
12.9% |
10.4% |
|
Patients with at least one post-index
visit |
11.7% |
21.8% |
21.3% |
|
Number of visits before index |
0.07 |
0.46 |
0.32 |
|
Number of visits after index |
0.55 |
1.53 |
1.38 |
|
Depression-related visits |
|
|
|
|
Number of visits before index |
0 |
0 |
0 |
|
Number of visits after index |
3.20 |
4.58 |
3.11 |
Note: MS only = mood stabilizer monotherapy,
AD only = antidepressant monotherapy, AD-MS = antidepressant-mood
stabilizer combination therapy.
Appendix II. Negative Binomial Models on Number of Depression-related
Visits with Propensity Score Matching, Incidence Rate Ratios (with 95%
Confidence Intervals)
|
|
Comparison One:
AD only vs MS only
(N=694) |
Comparison Two:
AD-MS vs MS only
(N=756) |
|
AD only (or AD-MS) |
0.68 (0.56, 0.82)** |
0.65 (0.52, 0.81)*** |
|
MS only (reference) |
|
|
|
Mania-related visits before index |
0.89 (0.79, 1.01) |
0.94 (0.86, 1.03) |
|
All bipolar visits before index |
0.91 (0.86, 0.97)** |
0.94 (0.88, 1.00)* |
|
Age categories |
|
|
|
Age1: 18-24 (reference) |
|
|
|
Age2: 25-34 |
0.83 (0.55, 1.27) |
0.99 (0.66, 1.49) |
|
Age3: 35-44 |
1.22 (0.80, 1.84) |
1.11 (0.76, 1.62) |
|
Age4: 45-54 |
1.16 (0.75, 1.77) |
1.15 (0.81, 1.64) |
|
Age5: 55-64 |
0.80 (0.49, 1.29) |
0.71 (0.46, 1.10) |
|
Female (reference: male) |
0.76 (0.60, 0.96)* |
0.83 (0.65, 1.06) |
|
Insurance plan type |
|
|
|
HMO |
0.88 (0.65, 1.19) |
0.89 (0.67, 1.18) |
|
POS |
0.55 (0.33, 0.90)* |
0.53 (0.34, 0.85)** |
|
PPO (reference) |
|
|
|
Other insurance |
0.86 (0.55, 1.36) |
0.66 (0.44, 0.99)* |
|
Geographic region |
|
|
|
Middle Atlantic |
1.78 (1.31, 2.41)*** |
1.81 (1.35, 2.42)*** |
|
New England |
1.47 (1.08, 1.98)* |
1.47 (1.10, 1.96)* |
|
All other regions (reference) |
|
|
|
Use of tricyclics and MAOIs |
1.23 (0.85, 1.80) |
1.37 (0.94, 1.99) |
|
Use of antipsychotics |
1.80 (1.25, 2.58)* |
1.48 (1.11, 1.98)** |
|
Use of benzodiazepines |
1.20 (0.92, 1.55) |
1.79 (1.31, 2.43)*** |
|
Use of psychotherapy or ECT |
6.62 (4.85, 9.04)*** |
5.28 (3.82, 7.30)*** |
|
Type of medical provider |
|
|
|
General/family practitioner |
0.64 (0.40, 1.03) |
0.82 (0.52, 1.27) |
|
Internal medicine specialist |
1.21 (0.77, 1.90) |
0.82 (0.56, 1.20) |
|
Psychiatrist (reference) |
|
|
|
Others |
0.84 (0.64, 1.10) |
0.94 (0.72, 1.22) |
|
Selected comorbidities |
|
|
|
Neurotic disorders |
1.13 (0.87, 1.47) |
1.22 (0.96, 1.57) |
|
Personality disorder |
1.21 (0.78, 1.88) |
1.69 (1.19, 2.39)** |
|
Alcohol abuse/dependence |
1.49 (0.89, 2.49) |
1.64 (1.07, 2.53)* |
|
Drug abuse/dependence |
0.72 (0.42, 1.24) |
0.63 (0.40, 0.99)* |
|
Other mental disorders |
1.30 (0.99, 1.69) |
1.30 (1.02, 1.65)* |
|
Diabetes |
0.80 (0.47, 1.37) |
0.75 (0.48, 1.19) |
|
Charlson comorbidity index score |
1.05 (0.95, 1.16) |
0.96 (0.88, 1.06) |
Note:
MS only = mood stabilizer monotherapy, AD only = antidepressant
monotherapy, AD-MS = antidepressant-mood stabilizer combination therapy.
AD: antidepressant, PPO: preferred provider organization, HMO: health
maintenance organization, POS: point of service, MAOIs: monoamine
oxidase inhibitors, ECT: electroconvulsive therapy.
p<.05, ** p<.01, *** p<.001.
Appendix III. Cox Models on Time to First
Mania-related Visit with Propensity Score Matching, Hazard Ratios (with
95% Confidence Intervals)
|
|
Comparison One:
AD only vs MS only
(N=694) |
Comparison Two:
AD-MS vs MS only
(N=756) |
|
AD only (or AD-MS) |
0.83 (0.60, 1.16) |
1.08 (0.82, 1.41) |
|
MS only (reference) |
|
|
|
Mania-related visits before index |
1.43 (1.34, 1.54)*** |
1.12 (1.09, 1.14)*** |
|
Age categories |
|
|
|
Age1: 18-24 (reference) |
|
|
|
Age2: 25-34 |
0.92 (0.46, 1.82) |
0.85 (0.49, 1.50) |
|
Age3: 35-44 |
0.67 (0.34, 1.34) |
0.95 (0.55, 1.65) |
|
Age4: 45-54 |
0.92 (0.47, 1.80) |
1.00 (0.59, 1.71) |
|
Age5: 55-64 |
1.20 (0.59, 2.45) |
1.30 (0.72, 2.37) |
|
Female (reference: male) |
0.82 (0.59, 1.14) |
1.04 (0.79, 1.38) |
|
Insurance plan type |
|
|
|
HMO |
0.93 (0.61, 1.43) |
0.92 (0.65, 1.30) |
|
POS |
0.72 (0.37, 1.42) |
0.85 (0.49, 1.47) |
|
PPO (reference) |
|
|
|
Other insurance |
0.98 (0.55, 1.73) |
0.83 (0.50, 1.39) |
|
Geographic region |
|
|
|
Middle Atlantic |
1.35 (0.85, 2.15) |
1.29 (0.88, 1.88) |
|
New England |
1.61 (1.04, 2.51)* |
1.37 (0.95, 1.99) |
|
All other regions (reference) |
|
|
|
Use of tricyclics and MAOIs |
1.64 (1.02, 2.66)* |
1.05 (0.68, 1.62) |
|
Use of antipsychotics |
2.38 (1.60, 3.54)*** |
1.79 (1.30, 2.47)*** |
|
Use of benzodiazepines |
0.95 (0.65, 1.39) |
1.03 (0.75, 1.42) |
|
Use of psychotherapy or ECT |
2.32 (1.49, 3.62)*** |
2.10 (1.46, 3.00)*** |
|
Type of medical provider |
|
|
|
General/family practitioner |
0.81 (0.40, 1.66) |
0.92 (0.49, 1.70) |
|
Internal medicine specialist |
1.39 (0.77, 2.51) |
0.87 (0.49, 1.55) |
|
Psychiatrist (reference) |
|
|
|
Others |
1.00 (0.68, 1.47) |
1.18 (0.87, 1.61) |
|
Selected comorbidities |
|
|
|
Neurotic disorders |
0.89 (0.61, 1.31) |
0.78 (0.56, 1.09) |
|
Personality disorder |
0.83 (0.39, 1.75) |
1.04 (0.62, 1.76) |
|
Alcohol abuse/dependence |
0.61 (0.27, 1.38) |
1.24 (0.71, 2.16) |
|
Drug abuse/dependence |
0.90 (0.40, 2.01) |
0.99 (0.53, 1.85) |
|
Other mental disorders |
1.13 (0.78, 1.64) |
1.13 (0.84, 1.53) |
|
Diabetes |
0.90 (0.44, 1.82) |
1.09 (0.61, 1.96) |
|
Charlson comorbidity index score |
1.13 (0.99, 1.29) |
1.10 (0.99, 1.22) |
Note:
MS only = mood stabilizer monotherapy, AD only = antidepressant
monotherapy, AD-MS = antidepressant-mood stabilizer combination therapy.
AD: antidepressant, PPO: preferred provider organization, HMO: health
maintenance organization, POS: point of service, MAOIs: monoamine
oxidase inhibitors, ECT: electroconvulsive therapy.
p<.05, *** p<.001.
Appendix IV. Cox Models on Time to First Depression-related Visit with
Propensity Score Matching, Hazard Ratios (with 95% Confidence Intervals)
|
|
Comparison One:
AD only vs MS only
(N=694) |
Comparison Two:
AD-MS vs MS only
(N=756) |
|
AD only (or AD-MS) |
0.55 (0.44, 0.68)*** |
0.59 (0.48, 0.73)*** |
|
MS only (reference) |
|
|
|
Mania-related visits before index |
0.96 (0.84, 1.11) |
0.95 (0.86, 1.05) |
|
All bipolar visits before index |
0.89 (0.83, 0.96)** |
0.94 (0.88, 1.00)* |
|
Age categories |
|
|
|
Age1: 18-24 (reference) |
|
|
|
Age2: 25-34 |
0.72 (0.47, 1.09) |
1.05 (0.70, 1.56) |
|
Age3: 35-44 |
0.74 (0.49, 1.12) |
0.86 (0.57, 1.28) |
|
Age4: 45-54 |
0.80 (0.53, 1.21) |
0.90 (0.61, 1.33) |
|
Age5: 55-64 |
0.53 (0.32, 0.86)* |
0.60 (0.37, 0.97)* |
|
Female (reference: male) |
0.87 (0.70, 1.09) |
0.98 (0.79, 1.21) |
|
Insurance plan type |
|
|
|
HMO |
1.10 (0.83, 1.44) |
0.99 (0.76, 1.28) |
|
POS |
0.92 (0.60, 1.42) |
0.97 (0.64, 1.47) |
|
PPO (reference) |
|
|
|
Other insurance |
1.18 (0.79, 1.77) |
0.96 (0.64, 1.43) |
|
Geographic region |
|
|
|
Middle Atlantic |
1.35 (1.00, 1.82) |
1.18 (0.89, 1.57) |
|
New England |
1.03 (0.77, 1.38) |
0.99 (0.75, 1.30) |
|
All other regions (reference) |
|
|
|
Use of tricyclics and MAOIs |
0.91 (0.63, 1.32) |
1.03 (0.73, 1.46) |
|
Use of antipsychotics |
1.35 (1.00, 1.81)* |
1.14 (0.87, 1.49) |
|
Use of benzodiazepines |
1.35 (1.04, 1.75)* |
1.35 (1.06, 1.72)* |
|
Use of psychotherapy or ECT |
3.46 (2.54, 4.70)*** |
3.01 (2.25, 4.00)*** |
|
Type of medical provider |
|
|
|
General/family practitioner |
0.79 (0.49, 1.29) |
0.69 (0.42, 1.14) |
|
Internal medicine specialist |
1.01 (0.65, 1.57) |
0.96 (0.65, 1.42) |
|
Psychiatrist (reference) |
|
|
|
Others |
0.90 (0.69, 1.16) |
0.89 (0.71, 1.13) |
|
Selected comorbidities |
|
|
|
Neurotic disorders |
1.39 (1.08, 1.80)* |
1.41 (1.11, 1.78)** |
|
Personality disorder |
1.05 (0.68, 1.62) |
1.37 (0.94, 2.00) |
|
Alcohol abuse/dependence |
1.31 (0.80, 2.15) |
1.52 (1.02, 2.26)* |
|
Drug abuse/dependence |
0.77 (0.44, 1.33) |
0.81 (0.52, 1.26) |
|
Other mental disorders |
1.18 (0.92, 1.52) |
1.21 (0.96, 1.53) |
|
Diabetes |
1.20 (0.73, 1.97) |
1.46 (0.90, 2.38) |
|
Charlson comorbidity index score |
1.00 (0.89, 1.12) |
0.96 (0.86, 1.07) |
Note:
MS only = mood stabilizer monotherapy, AD only = antidepressant
monotherapy, AD-MS = antidepressant-mood stabilizer combination therapy.
AD: antidepressant, PPO: preferred provider organization, HMO: health
maintenance organization, POS: point of service, MAOIs: monoamine
oxidase inhibitors, ECT: electroconvulsive therapy.
p<.05, ** p<.01, *** p<.001. |
