title: 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.
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.
authors.affiliation: Center for Applied Health Research, Central Texas Veterans Health Care System jointly with Baylor Scott & White Health, 2102 Birdcreek Drive, Temple, TX 76502.
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Stock
authors.affiliation: Center for Applied Health Research, Central Texas Veterans Health Care System jointly with Baylor Scott & White Health, 2102 Birdcreek Drive, Temple, TX 76502.
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Copeland
authors.affiliation: Texas A&M Health Science Center, 8447 Highway 47, Bryan, TX 77807.
authors.forename: Jack Y
authors.initials: JY
authors.lastname: Tsan
authors.affiliation: Center for Applied Health Research, Central Texas Veterans Health Care System jointly with Baylor Scott & White Health, 2102 Birdcreek Drive, Temple, TX 76502.
authors.forename: John E
authors.initials: JE
authors.lastname: Zeber
authors.affiliation: Department of Pharmaceutical Sciences, Texas A&M Health Science Center, 1010 West Avenue B, Kingsville, TX 78363.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Veronin
authors.affiliation: Texas A&M Health Science Center, 8447 Highway 47, Bryan, TX 77807.
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Thompson
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D019338:Polypharmacy; D012189:Retrospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy* / Q000523:psychology; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data
chemical_list: D000928:Antidepressive Agents