憂鬱症現階段治療仍以藥物治療為主，然而有研究指出憂鬱症與使用抗憂鬱藥造成跌墜、慢性病與骨折的風險提高，跌倒與慢性病則是造成骨折的原因之一，以上綜述無法確立出是憂鬱症還是抗憂鬱藥的使用造成骨折，且真正導致骨折的原因也無法確立，因此本研究目的在探討跌墜、慢性病對憂鬱症患者或使用抗憂鬱藥物其骨折之多元同步中介效果研究。 本研究以 LHID2000 健保資料庫 20 萬人承保抽樣歸人檔為研究材料，以就醫資料 2001 年至 2004 年期間之患者做為研究對象，篩選憂鬱症病患就醫時間先於骨折，研究樣本數為 861 人。 研究結果發現有使用抗憂鬱藥造成骨折之勝算比以男性較高(Odds Ratio= 18.35，95% CI= 10.16-33.17 )，年齡層中以 41-50 歲較高( OR= 60.24，95% CI= 16.00-226.73 )，投保金額中以≧ 40000 較高( OR= 40.75，95% CI= 12.99-127.77 )，投保分局以東區較高( OR= 38.5，95% CI= 2.92-508.46 )；使用SNRI抗憂鬱藥造成骨折為最高( OR= 87.08，95% CI= 5.20-1457.36 )。使用抗憂鬱藥造成骨折有顯著關連，然而憂鬱症造成骨折無顯著關連，其憂鬱症與使用抗憂鬱藥對跌墜、慢性病皆有顯著關連，但慢性病造成骨折無顯著關連，因此多元同步中介模式不成立，簡單中介模式中，跌墜為使用抗憂鬱藥造成骨折之部分中介變項。 Depression is one of the plagued diseases of the many countries. Drug therapy for depression treatment at this stage is still dominated. However, studies had pointed out that the suffering from depression and the use of antidepressants cause to raise the risk of falling down, chronic diseases and fractures. Falling down and chronic diseases were also one of the causes of fractures. The above studies did not make sure that the use of antidepressants or the suffering from depression was for the cause of fractures. And the true reason of causing fractures could not be established. Therefore, this study aimed to investigate the simultaneous mediator’s models of the depression in patients and the use of antidepressants in patients whose fractures were due to falling down, and chronic diseases. In this study, the 200 thousand insured cohort sample of LHID 2000 from the National Health Insurance Research Database (NHIRD) was for the study material. Medical records of patients within the period from 2001 to 2004 were the samples of the study. Screening of fracture prior to suffered depression, study sample size was 861. Research findings show that the use of antidepressants relative to the non-use of antidepressants patients fractured in men was higher (OR = 18.35, 95% CI= 10.16-33.17 ), of ages 41-50 years old was to the highest (OR = 60.24, 95% CI= 16.00-226.73 ), of the insured amount to ≧ 40000 was higher (OR = 40.75, 95% CI= 12.99-127.76 ), and in insurance the Eastern Branch was higher (OR = 38.50, 95% CI= 2.92-508.46 ). Using SNRI among antidepressants caused a fracture to the highest (OR = 87.08, 95% CI= 5.20-1457.37 ). Fractures and the use of antidepressants were significantly related. However, the relation of depression and causing a fracture was not significant. There were significant related between both depression and use of antidepressant drugs and both to the down fall and the chronic diseases. However, the chronic diseases and fractures had no significant related. Therefore, the simultaneous mediator’s models were not established. We found out a simple mediation model which falling down was a partial mediator variable of the use of antidepressants to cause some fractures.
