Minhui Liu1,2,3, Susan M McCurry4,5, Basia Belza2, Diana T Buchanan2, Adrian Dobra2,6,7, Michael Von Korff8, Michael V Vitiello2,5. 1. Center for Innovative Care in Aging, Johns Hopkins University School of Nursing, Baltimore, MD. 2. Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA. 3. Xiangya Nursing School, Central South University, Changsha, Hunan, China. 4. Department of Psychosocial and Community Health, University of Washington School of Nursing. 5. Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine. 6. Department of Statistics. 7. Center for Statistics and the Social Sciences, University of Washington. 8. Kaiser Permanente Washington Health Research Institute, Seattle, WA.
Abstract
BACKGROUND: Determinants of prescribing psychoactive medications for symptom management in older adults remain underexamined despite known risks and cautions concerning these medications. OBJECTIVE: To examine independent and combined effects of pain, concurrent insomnia and depression symptoms on psychoactive medications supplied to older adults with osteoarthritis (OA). RESEARCH DESIGN: Survey data on pain, insomnia, and depression obtained from OA patients screened for a randomized controlled trial were used to identify predictors of psychoactive medication supply [opioids, sedatives, tricyclic antidepressants (TCAs), and non-TCAs] over a 4-year period. SUBJECTS:Group Health Cooperative patients with a diagnosis of OA (N=2976). MEASURES: Survey data on pain (Graded Chronic Pain Scale), insomnia (Insomnia Severity Index), and depression (Patient Health Questionnaire-8); and medications supply assessed from electronic medical records. RESULTS: In negative binomial models, pain [incidence rate ratio (IRR), 2.8-3.5; P<0.001], insomnia (IRR, 2.0; P<0.001), and depression (IRR, 1.5; P<0.05) each independently predicted opioid supply. Insomnia (IRR, 3.2; P<0.001) and depression (IRR, 3.0; P<0.001) each independently predicted sedative supply. Pain (IRR, 2.1; P<0.05) and insomnia (IRR, 2.0; P<0.05) independently predicted TCA supply, whereas only depression (IRR, 2.2; P<0.001) independently predicted non-TCA supply. Combined effects of pain and insomnia/depression on these medications were additive and increased the rate of medication supply 1.5-7.5 times. Combined effects increased with insomnia or depression severity. CONCLUSIONS: Concurrent insomnia and depressive symptoms predicted increased supply of opioids, sedatives, and antidepressants after accounting for pain, indicating the importance of sleep and mood disorders as factors increasing supply of these medications.
RCT Entities:
BACKGROUND: Determinants of prescribing psychoactive medications for symptom management in older adults remain underexamined despite known risks and cautions concerning these medications. OBJECTIVE: To examine independent and combined effects of pain, concurrent insomnia and depression symptoms on psychoactive medications supplied to older adults with osteoarthritis (OA). RESEARCH DESIGN: Survey data on pain, insomnia, and depression obtained from OApatients screened for a randomized controlled trial were used to identify predictors of psychoactive medication supply [opioids, sedatives, tricyclic antidepressants (TCAs), and non-TCAs] over a 4-year period. SUBJECTS: Group Health Cooperative patients with a diagnosis of OA (N=2976). MEASURES: Survey data on pain (Graded Chronic Pain Scale), insomnia (Insomnia Severity Index), and depression (Patient Health Questionnaire-8); and medications supply assessed from electronic medical records. RESULTS: In negative binomial models, pain [incidence rate ratio (IRR), 2.8-3.5; P<0.001], insomnia (IRR, 2.0; P<0.001), and depression (IRR, 1.5; P<0.05) each independently predicted opioid supply. Insomnia (IRR, 3.2; P<0.001) and depression (IRR, 3.0; P<0.001) each independently predicted sedative supply. Pain (IRR, 2.1; P<0.05) and insomnia (IRR, 2.0; P<0.05) independently predicted TCA supply, whereas only depression (IRR, 2.2; P<0.001) independently predicted non-TCA supply. Combined effects of pain and insomnia/depression on these medications were additive and increased the rate of medication supply 1.5-7.5 times. Combined effects increased with insomnia or depression severity. CONCLUSIONS: Concurrent insomnia and depressive symptoms predicted increased supply of opioids, sedatives, and antidepressants after accounting for pain, indicating the importance of sleep and mood disorders as factors increasing supply of these medications.
Authors: Michael R Irwin; Richard Olmstead; Carmen Carrillo; Nina Sadeghi; John D Fitzgerald; Veena K Ranganath; Perry M Nicassio Journal: Sleep Date: 2012-04-01 Impact factor: 5.849
Authors: Susan M McCurry; Michael Von Korff; Michael V Vitiello; Kathleen Saunders; Benjamin H Balderson; Amy L Moore; Bruce D Rybarczyk Journal: J Psychosom Res Date: 2011-07-01 Impact factor: 3.006
Authors: Jennifer Brennan Braden; Mark D Sullivan; G Thomas Ray; Kathleen Saunders; Joseph Merrill; Michael J Silverberg; Carolyn M Rutter; Constance Weisner; Caleb Banta-Green; Cynthia Campbell; Michael Von Korff Journal: Gen Hosp Psychiatry Date: 2009-08-27 Impact factor: 3.238
Authors: Susan M McCurry; Michael Von Korff; Charles M Morin; Amy Cunningham; Kenneth C Pike; Manu Thakral; Robert Wellman; Kai Yeung; Weiwei Zhu; Michael V Vitiello Journal: Contemp Clin Trials Date: 2019-10-13 Impact factor: 2.226