Multimorbidity representation in randomized controlled trials of selective serotonin reuptake inhibitors: A systematic analysis of published trials

Dawn Hei Lum; Mandy Man Choi; Jacky On Hei Cheung; Dora Wai Yee Ng; Janice Ching Nam Leung; Lingyue Zhou; Francisco Tsz Tsun Lai

doi:10.1016/j.jad.2023.10.074

Multimorbidity representation in randomized controlled trials of selective serotonin reuptake inhibitors: A systematic analysis of published trials

J Affect Disord. 2024 Jan 1:344:261-266. doi: 10.1016/j.jad.2023.10.074. Epub 2023 Oct 12.

Authors

Dawn Hei Lum¹, Mandy Man Choi¹, Jacky On Hei Cheung¹, Dora Wai Yee Ng¹, Janice Ching Nam Leung², Lingyue Zhou¹, Francisco Tsz Tsun Lai³

Affiliations

¹ Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
² Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
³ Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Laboratory of Data Discovery for Health (D(2)4H), Hong Kong Science Park, Hong Kong Science and Technology Park, Hong Kong, China. Electronic address: fttlai@hku.hk.

PMID: 37838264
DOI: 10.1016/j.jad.2023.10.074

Abstract

Background: Previous research has suggested a bidirectional relationship between multimorbidity and depression, with an increasing number of people living with both conditions. Therefore, we investigated how multimorbidity is represented in randomized controlled trials (RCT) of selective serotonin reuptake inhibitors (SSRI).

Methods: We conducted a comprehensive keyword search in PubMed, Cochrane Central Library, PsycINFO, and EMBASE for RCTs published in 2011 or later. Multimorbidity representation was categorized into 'inclusion' or 'exclusion' within the study with studies including multimorbidity further categorized as conducting 'multivariable adjustment' or 'effect modification/stratification'. Logistic regression was used to examine the association of different study characteristics with multimorbidity representation among the studies.

Results: In total, 183 trials were included for analysis. Nearly 60 %, i.e., 106 trials, excluded people with multimorbidity, and only four studies either conducted multivariable adjustment for baseline health conditions or examined potential effect modifications from multimorbidity. Studies based in Asia had significantly increased odds of multimorbidity exclusion compared to North America (odds ratio 3.18, 95 % confidence interval 1.09-1.39). A larger sample size was estimated to be associated with greater odds of conducting effect modification analysis for multimorbidity (odds ratio 1.006, 95 % confidence interval 1.001-1.011).

Limitations: Studies are limited to published, English-language studies where the short timespan may hinder the visibility of the multimorbidity trend.

Conclusions: Only a minority of RCTs on SSRIs considered multimorbidity within their study design. As both mental health awareness and multimorbidity are becoming increasingly ubiquitous within the global population, it is important for future studies to consider multimorbidity.

Keywords: Antidepressant; Bibliometric analysis; Comorbidity; Depression; Mental health; Psychopharmacology.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Asia
Humans
Multimorbidity*
North America
Randomized Controlled Trials as Topic
Selective Serotonin Reuptake Inhibitors* / therapeutic use

Substances

Selective Serotonin Reuptake Inhibitors