Tuesday, April 5, 2016

Race, Medical Comorbidity May Predict Antidepressant Nonadherence Among Veterans

Race and general medical comorbidity appear to be the main predictors of nonadherence to antidepressant medication among veterans treated for depression, according to a study appearing in Psychiatric Services in Advance. The findings suggest ways that integrated care models, such as the VA’s Primary Care Mental Health Integration (PC-MHI) initiative, may be able to address nonadherence among veterans.

Researchers at the University of Michigan and the Veterans Administration, Ann Arbor, evaluated correlates of antidepressant nonadherence among 311 older veterans aged 60 and older with depression whose physicians had recommended antidepressant treatment. Study participants were recruited from three VA medical centers in Michigan (Ann Arbor, Detroit, and Battle Creek) from 2008 to 2011.

Participants were interviewed shortly after receiving the recommendation for antidepressant treatment and again four months later. During the initial interview, researchers collected patient demographic data, including age, gender, race, education level, and marital status, and assessed medical illness burden and cognitive function of the participants. During the follow-up interview, the researchers asked participants how consistently they took their medication in the week prior to the interview. Patients who never initiated the antidepressant medication or who missed two or more daily doses in a given week were rated nonadherent.

At the four-month follow-up, overall self-reported nonadherence to antidepressant treatment was 29%. Nonadherent individuals were significantly more likely than adherent participants to be African American, have no spouse or significant other, and have greater general medical comorbidity. Nonadherent participants were also significantly more likely than adherent participants to have been prescribed the antidepressant in a primary care setting rather than a mental health setting.

“Such patients may require interventions more tailored to their specific needs and barriers. ... the beliefs associated with nonadherence are amenable to intervention strategies, such as the Treatment Initiation Program, which blend elements of psychoeducation, motivational interviewing, and problem solving and have been successfully used with older adults,” the authors wrote. “Similarly, PC-MHI providers could assist individuals with high levels of medical comorbidity linked to polypharmacy with strategies to enhance adherence, such as using pillboxes or electronic medication dispensers. Patients may also need encouragement to discuss concerns about side effects with their providers.”

For related information, see the Psychiatric News article “How a VA Facility Integrates Primary and Mental Health Care.”

(Image: Paul Matthew Photography/Shutterstock)


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