Discontinuation of antidepressant medication among Latinos in the USA

On-Site Prescription Dispensing Improves Antidepressant Adherence among Uninsured Depressed Patients

The successful treatment of depressive disorders critically depends on adherence to prescribed treatment regimens. Despite increasing rates of antidepressant medication prescription, adherence to the full treatment course remains poor. Rates of antidepressant non-adherence are higher for uninsured patients and members of some marginalized racial and ethnic communities due to factors such as inequities in healthcare and access to insurance. Among patients treated in a free, student-run and faculty-supervised clinic serving uninsured patients in a majority Hispanic community in East Harlem, adherence rates are lower than those observed in patients with private or public New York State health insurance coverage. A prior study of adherence in these patients revealed that difficulty in obtaining medications from an off-site hospital pharmacy was a leading factor that patients cited for non-adherence. To alleviate this barrier to obtaining prescriptions, we tested the effectiveness of on-site, in-clinic medication dispensing for improving antidepressant medication adherence rates among uninsured patients. We found that dispensing medications directly to patients in clinic was associated with increased visits at which patients self-reported proper adherence and increased overall adherence rates. Furthermore, we found evidence that higher rates of antidepressant medication adherence were associated with more favorable treatment outcomes. All patients interviewed reported increased satisfaction with on-site dispensing. Overall, this study provides promising evidence that on-site antidepressant dispensing in a resource-limited setting improves medication adherence rates and leads to more favorable treatment outcomes with enhanced patient satisfaction.

Brand-Name Antidepressants Outperform Their Generic Counterparts in Preventing Hospitalization for Depression: The Real-World Evidence from Taiwan

BACKGROUND

Generic antidepressants are approved on the market based on evidence of bioequivalence to their brand-name versions. We aimed to assess whether generic antidepressants exert equal effectiveness as their brand-name counterparts for treating patients with depressive disorders.

METHODS

In a nationwide, population-based cohort in Taiwan from 1997 through 2013, patients with a diagnosis of a depressive disorder aged between 18 and 65 years who were new users of antidepressant drugs were classified into either the brand-name group or the generic group. All patients were followed up until medication discontinuation or the end of the study period. We assessed the risk for hospitalization as a primary outcome and augmentation therapy, daily dose, medication discontinuation, or switching to another antidepressant as secondary outcomes.

RESULTS

A total of 277 651 brand-name users (35.8% male; mean age: 41.2 years) and 270 583 generic users (35.8% male; mean age: 41.0 years) were divided into 10 different antidepressant groups (fluoxetine, sertraline, paroxetine, escitalopram, citalopram, venlafaxine, mirtazapine, moclobemide, imipramine, and bupropion). We found that patients treated with the generic form of sertraline, paroxetine, escitalopram, venlafaxine, mirtazapine, and bupropion demonstrated significantly higher risks of psychiatric hospitalization (adjusted hazard ratios ranged from 1.20-2.34), compared to their brand-name counterparts. The differences between brand-name antidepressants and their generic counterparts in secondary outcomes varied across different drugs.

CONCLUSIONS

Compared to most generic antidepressants, brand-name drugs exhibited more protective effects on psychiatric hospitalization for depressive patients. These findings could serve as an important reference for clinicians when encountering patients with depressive disorder.

Selection Into Mental Health Services Among Persons With Depression

OBJECTIVE

This study aimed to identify sociodemographic and health characteristics associated with use of different mental health services (medication only, counseling only, or both) among persons with depression.

METHODS

The analytic sample consisted of adults who had a major depressive episode in the past year and received outpatient professional mental health services (N=4,169). Multinomial logistic regressions were computed with data from the 2015 and 2016 National Survey on Drug Use and Health to identify factors associated with the relative odds of receiving each modality of mental health service.

RESULTS

Sixty-nine percent of the sample received both prescription medication and counseling (talking to a professional health care provider about depression), 22% received counseling only, and 9% received medication only. Being ordered into care and higher probability of having a severe mental illness were associated with higher odds of receiving both medication and counseling.

CONCLUSIONS

How people with depression enter care and select into different mental health service modalities might be an indicator of access. Factors that affect selection into these modalities might also be associated with outcomes of care. Findings could inform efforts to remove modality-specific barriers to treatment, improve timely access to care, and reduce unmet need for mental health care among persons with depression.

The Role of Faith-Based Organizations in the Depression Care of African Americans and Hispanics in Los Angeles

OBJECTIVE

This study examined use of depression care provided by faith-based organizations (FBOs) by African Americans and Hispanics and factors associated with the receipt of such care, including mental illness severity and use of traditional mental health services.

METHODS

The study used baseline data from the Community Partners in Care study, a group-randomized trial comparing a community-partnered approach with a technical-assistance approach to improving depression care in underresourced communities in Los Angeles. A sample of 947 individuals (48% African American, 27% non-U.S.-born Hispanic, 15% U.S.-born Hispanic, and 10% non-Hispanic white) were surveyed about recent visits to a religious or spiritual place and receipt of FBO depression care. Descriptive analyses compared racial-ethnic, sociodemographic, and health service use variables for three groups: those who did not attend a religious place, those who attended a religious place and did not receive FBO depression services, and those who received FBO depression services. Multinomial logistic regression was used to identify predictors of receipt of FBO depression care.

RESULTS

A larger proportion of African Americans and non-U.S.-born Hispanics received FBO faith-based depression services compared with non-Hispanic whites and with U.S.-born Hispanics. Receipt of FBO depression services was associated with younger age, lifetime diagnosis of mania, use of primary care depression services, and receipt of a mental health service from a substance abuse agency.

CONCLUSIONS

FBO depression services were used in the community, especially by persons from racial-ethnic minority groups. Collaborative efforts between FBOs and traditional health services may increase access to depression services for African Americans and Latinos.

A systematic review of depression psychotherapies among Latinos

For decades, the literature has reported persistent treatment disparities among depressed Latinos. Fortunately, treatment development and evaluation in this underserved population has expanded in recent years. This review summarizes outcomes across 36 unique depression treatment studies that reported treatment outcomes for Latinos. Results indicated that there was significant variability in the quality of RCT and type/number of cultural adaptations. The review suggested that there might a relation between cultural adaptations with treatment outcomes; future studies are warranted to confirm this association. Cognitive Behavioral Therapy was the most evaluated treatment (CBT; n=18, 50% of all evaluations), followed by Problem Solving Therapy (PST; n=4), Interpersonal Therapy (IPT; n=4), and Behavioral Activation (BA; n=3). CBT seems to fare better when compared to usual care, but not when compared to a contact-time matched control condition or active treatment. There is growing support for PST and IPT as efficacious depression interventions among Latinos. IPT shows particularly positive results for perinatal depression. BA warrants additional examination in RCT. Although scarce, telephone and in-home counseling have shown efficacy in reducing depression and increasing retention. Promotora-assisted trials require formal assessment. Limitations and future directions of the depression psychotherapy research among Latinos are discussed.

Optimizing the management of depression: primary care experience

This article is intended to identify some of the most important challenges faced by family physicians when treating MDD and to provide practical solutions. Key issues, reviewed from a primary care view point will include: treating to remission (and not just response), identification of high-risk groups, diagnosis, acute treatment approaches (including pharmacotherapy and the management of related side effects), the use of psychotherapy and somatic therapies, assessment of the adequacy of treatment including the assessment of remission, response measurement, optimal follow-up care throughout the phase of treatment, the key components of patient education and strategies for partial/limited response to the first-line antidepressant (switching, augmentation and combination strategies), how to provide support for improved treatment adherence, and approaches to prevent the recurrence of depressive episodes.

Perspective of community pharmacists on their practice with patients who have an antidepressant drug treatment: findings from a focus group study

BACKGROUND

Around 2/3 of patients with major depression discontinue their antidepressant drug treatment (ADT) prematurely. Community pharmacists can rely on their regular contacts with patients to identify and support those experiencing difficulties with their ADT.

OBJECTIVE

The aim of this study is to describe pharmacists' perceptions with respect to their practices related to patients having an ADT.

METHODS

A qualitative study was conducted based on 6 focus groups involving 43 community pharmacists in 5 regions of Quebec province, Canada. Verbatim transcripts of focus groups were analyzed using computer-assisted thematic analysis.

RESULTS

The discussions revealed three major aspects of the participants' pharmacy practice: convincing patients to initiate ADT, dealing with side effects in the first weeks of the treatment, and taking a reactive approach to managing the treatment for the remainder of the follow-up. Discussions also enabled participants to identify the challenges they face concerning their practice with patients who have an ADT, and voice their recommendations for improving pharmacy practice and ultimately patient adherence to ADT.

CONCLUSIONS

Pharmacists wishing to help their patients to adequately manage their ADT face important barriers. Potential solutions include tools designed to help pharmacists better detect and intervene in ADT-related problems. Study findings will guide the on-going development of training and tools to support pharmacists' practice in this context.

Enhancing Hispanic participation in mental health clinical research: development of a Spanish-speaking depression research site

BACKGROUND

Hispanics, particularly those with limited English proficiency, are underrepresented in psychiatric clinical research studies. We developed a bilingual and bicultural research clinic dedicated to the recruitment and treatment of Spanish-speaking subjects in the Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) study, a large clinical trial of treatment-naïve subjects with major depressive disorder (MDD).

METHODS

Demographic and clinical data derived from screening evaluations of the first 1,174 subjects presenting for participation were compared between the Spanish-speaking site (N = 275) and the primary English-speaking site (N = 899). Reasons for ineligibility (N = 888) for the PReDICT study were tallied for each site.

RESULTS

Compared to English speakers, Spanish speakers had a lower level of education and were more likely to be female, uninsured, and have uncontrolled medical conditions. Clinically, Spanish speakers demonstrated greater depression severity, with higher mean symptom severity scores, and a greater number of previous suicide attempts. Among the subjects who were not randomized into the PReDICT study, Spanish-speaking subjects were more likely to have an uncontrolled medical condition or refuse participation, whereas English-speaking subjects were more likely to have bipolar disorder or a non-MDD depressive disorder.

CONCLUSION

Recruitment of Hispanic subjects with MDD is feasible and may enhance efforts at signal detection, given the higher severity of depression among Spanish-speaking participants presenting for clinical trials. Specific approaches for the recruitment and retention of Spanish-speaking participants are required.

Assessing racial/ethnic disparities in treatment across episodes of mental health care

OBJECTIVE

To investigate disparities in mental health care episodes, aligning our analyses with decisions to start or drop treatment, and choices made during treatment.

STUDY DESIGN

We analyzed whites, blacks, and Latinos with probable mental illness from Panels 9-13 of the Medical Expenditure Panel Survey, assessing disparities at the beginning, middle, and end of episodes of care (initiation, adequate care, having an episode with only psychotropic drug fills, intensity of care, the mixture of primary care provider (PCP) and specialist visits, use of acute psychiatric care, and termination).

FINDINGS

Compared with whites, blacks and Latinos had less initiation and adequacy of care. Black and Latino episodes were shorter and had fewer psychotropic drug fills. Black episodes had a greater proportion of specialist visits and Latino episodes had a greater proportion of PCP visits. Blacks were more likely to have an episode with acute psychiatric care.

CONCLUSIONS

Disparities in adequate care were driven by initiation disparities, reinforcing the need for policies that improve access. Many episodes were characterized only by psychotropic drug fills, suggesting inadequate medication guidance. Blacks' higher rate of specialist use contradicts previous studies and deserves future investigation. Blacks' greater acute mental health care use raises concerns over monitoring of their treatment.

The impact of the type of insurance plan on adherence and persistence with antidepressants: a matched cohort study

OBJECTIVE

To compare adherence to, and persistence with, antidepressants (AD) in Quebec patients who are covered by private and public drug insurance.

METHOD

A matched cohort study was conducted using prescription claims databases: reMed, a medication data registry for Quebec residents covered by private drug insurance, and Régie de l'assurance maladie du Québec database for Quebec residents with public drug insurance. Patients were aged 18 to 64 years and filled at least 1 prescription for an AD in monotherapy between December 2007 and September 2009 (194 privately and 2055 publicly insured patients). Adherence over 1 year was estimated using the proportion of prescribed days covered (PPDC). The difference in mean PPDC between patients with private and public drug insurance was estimated with linear regression. Persistence was compared between the groups with a Cox regression model.

RESULTS

The PPDC was 86.4% (95% CI 83.3% to 89.5%) in privately insured and 82.2% (95% CI 78.5% to 85.9%) in publicly insured patients and the adjusted mean difference was 5.1% (95% CI 1.6% to 8.6%). Persistence was 51.0% in the private group and 19.7% in the public group at 1 year (P < 0.001); the adjusted hazard ratio was 0.49 (95% CI 0.30 to 0.79).

CONCLUSION

Better adherence and persistence were observed in privately insured patients. Adherence difference may be due to lower copayment among privately insured patients.

Retention in mental health care of Portuguese-speaking patients

We compared service outcomes of dedicated language and cultural competency services in adequacy of care, ER, and inpatient care among Portuguese-speaking patients in ethnic- and non-ethnic-specific behavioral health clinics. We assessed adequacy of mental health care, and use of inpatient emergency department among Portuguese-speaking patients, comparing individuals receiving care from a culturally and linguistically competent mental health care setting (the Portuguese Mental Health Program [PMHP]) with usual mental health care in a community health care system in the USA. Propensity score matching was used to balance patients in treatment and control groups on gender, marital status, age, diagnosis of mental disorder, and insurance status. We used de-identified, longitudinal, administrative data of 854 Portuguese-speaking patients receiving care from the PMHP and 541 Portuguese-speaking patients receiving usual care from 2005-2008. Adequate treatment was defined as receipt of at least eight outpatient psychotherapy visits, or at least four outpatient visits of which one was a psychopharmacological visit. PMHP patients were more likely to receive adequate care. No differences were found in rates of ER use or inpatient mental health care. The present study suggests increased quality of care for patients that have contact with a clinic that dedicates resources specifically to a minority/immigrant group. Advantages of this setting include greater linguistic and cultural concordance among providers and patients. Further research is warranted to better understand the mechanisms by which culturally appropriate mental health care settings benefit minority/immigrant patients.

Impact of Motivational Pharmacotherapy on Treatment Retention among Depressed Latinos

Compared to non-Latino Whites, U.S. racial/ethnic minority groups show higher non-adherence with outpatient antidepressant therapy, including lower retention, despite adjusting for sociodemographic and insurance covariates. Culturally salient concerns about antidepressants leading to ambivalence about treatment engagement may contribute to this discrepancy. To improve treatment adherence among depressed Latinos, we developed motivational pharmacotherapy, a novel approach that combines motivational interviewing, standard pharmacotherapy, and attention to Latino cultural concerns about antidepressants. This 12-week, open-trial, pre-post pilot study assessed the impact of motivational pharmacotherapy on antidepressant therapy retention, response (symptoms, functioning, and quality of life), and visit duration among n = 50 first-generation Latino outpatients with major depressive disorder. At study endpoint, 20% of patients discontinued treatment, with a mean therapy duration of 74.2 out of 84 days. Patients' symptoms, psychosocial functioning, and quality of life improved significantly. Mean visit length was 36.7 minutes for visit 1 and 24.3 minutes for subsequent visits, compatible with use in community clinics. Responder and remitter rates were 82% and 68%. Compared to published Latino proportions of non-retention (32-53%) and previous studies at our clinic with similar samples and medications (36-46%), Motivational pharmacotherapy appears to improve Latino retention in antidepressant therapy and should be investigated further in controlled designs.

[Integral Care Guide for Early Detection and Diagnosis of Depressive Episodes and Recurrent Depressive Disorder in Adults. Integral Attention of Adults with a Diagnosis of Depressive Episodes and Recurrent Depressive Disorder: Part II: General Aspects of Treatment, Management of the Acute Phase, Continuation and Maintenance of Patients with a Depression Diagnosis]

INTRODUCTION

This article presents recommendations based on evidence gathered to answer a series of clinical questions concerning the depressive episode and the recurrent depressive disorder, with emphasis on general treatment aspects, treatment in the acute phase and management of the continuation/maintenance, all intended to grant health care parameters based on the best and more updated available evidence for achieving minimum quality standards with adult patients thus diagnosed.

METHODOLOGY

A practical clinical guide was elaborated according to standards of the Methodological Guide of the Ministry of Social Protection. Recommendation from NICE90 and CANMAT guides were adopted and updated so as to answer the questions posed while de novo questions were developed.

RESULTS

Recommendations 5-22 corresponding to management of depression are presented.

The self-stigma of depression for women

BACKGROUND

Self-stigmatizing women who avoid seeking treatment for depression could believe that they have pragmatic personal reasons for their decision. As a preliminary step towards testing this hypothesis, the aim of this study was to assess diverse, low-income working women for shared self-stigmatizing beliefs about depression.

METHODS

Depression and depression self-stigma were assessed in a targeted sample of African American, Caucasian and Latina women who qualify for public health services and have access to health care services.

RESULTS

Depression and self-stigmatizing beliefs about depression were positively correlated (r = .30-.64). Over one third of the women in the study (37.5%) said they would do what they could to keep their depression secret. Over half (55%) indicated that the person they normally would disclose depression to is their best friend. A majority (80%) of the women in the study said they would choose not to disclose personal depression to a health care professional. Pairwise t tests for group differences showed that Caucasian women, women recently seen by a health care professional and women with more years of education had higher self-stigma scores.

CONCLUSION

Self-stigmatizing women who feel depressed could knowingly decide to keep their depression secret with the hope of avoiding loss.

Overall health and healthcare utilization among Latino American women in the United States

PURPOSE

The purpose of this study was to examine the chronic conditions, behavioral-mental health and service utilization of Latino American women in the first epidemiologic survey in the United States.

METHODS

Using a national sample (n=1427) from the National Latino and Asian American Study, we assessed and compared the prevalence of overall health and service use in three major subgroups, Cuban, Mexican, and Puerto Rican, and in other Latino American women. Service use included general medical, mental health, and subspecialists.

RESULTS

In physical health, Puerto Rican American women reported the highest rate of asthma, whereas Mexican American women reported the highest rate of diabetes. Cuban American women reported the highest rate of hypertension and heart diseases. Body mass index (BMI) indicated that overweight (BMI 25-29.9 kg/m(2)) and obesity (BMI≥30 kg/m(2)) were prevalent in all three subgroups: two thirds of Mexicans and Puerto Ricans, respectively, and >50% of Cuban Americans. Of the sample, 11.6% rated their mental health status as fair or poor, and 10.8% reported at least one major depressive disorder (MDD) in the past 12 months. Puerto Rican American women had the highest rates on depression, substance abuse, and seeking mental health service, and Cuban American women saw specialists most frequently.

CONCLUSIONS

Patterns of overall health issues varied among Latino American subgroup women, yet they have low rates of healthcare use. It is critical to further examine factors associated with the sex-specific health issues and with their health services underuse.

Perceptions of and attitudes toward antidepressants: stigma attached to their use--a review

The aim of this study was to ascertain whether there is any evidence of stigma related to the use of antidepressants. Using the PubMed and MEDLINE databases, we searched for the terms stigma, antidepressants, and depression. A protocol was developed to extract information from the papers, which were identified and explored further. Thirty-two papers were identified. We found that the stigma against depression differs from stigma against the use of antidepressants. Stigma against depression does not impact on therapeutic adherence to antidepressant use. Stigma related to antidepressant use appears to be linked with perceived emotional weakness, severity of illness, an inability to deal with problems, and a lack of belief in the therapeutic efficacy of antidepressants. Stigma against medication can be a useful target for interventions, just like the stigma related to depression. However, clinicians must be careful in avoiding the medicalization of symptoms.

"Guardarse las cosas adentro" (keeping things inside): Latina violence survivors' perceptions of depression

BACKGROUND

Latinos are less likely than non-Hispanic whites to be adequately treated for depression. Intimate partner violence (IPV) is strongly associated with depression. Less is known about how Latina IPV survivors understand depression.

OBJECTIVE

To understand Latina women's beliefs, attitudes, and recommendations regarding depression and depression care, with a special focus on the impact of gender, ethnicity, violence, and social stressors.

DESIGN

Focus group study.

PARTICIPANTS

Spanish-speaking Latina women with a lifetime history of IPV and moderate to severe depressive symptoms.

APPROACH

We used a community-based participatory research (CBPR) approach to conduct a thematic analysis using an inductive approach.

RESULTS

Thirty-one women participated in five focus groups. Women felt depression is caused by "keeping things inside". They also felt that keeping things inside could lead to physical illness or an inability to function. Their inability to talk was fueled by issues such as stigma, fear, isolation, cultural norms, or simply "not having the words". They felt that the key to treating depression was finding a way to talk about the things that they had kept inside. They greatly valued information about depression and appreciated learning from providers that their physical symptoms were caused by depression. They wanted confidential depression care programs that not only helped them deal with their depression, but also addressed the violence in their lives, gave them practical skills, and attended to practical issues such as childcare. They had negative attitudes toward antidepressants, primarily due to experiences with side effects. Negative experiences with the health care system were primarily attributed to lack of good healthcare insurance.

CONCLUSIONS

The concept of "keeping things inside" was key to participants' understanding of the cause of depression and other health problems. Clinicians and depression care programs can potentially use such information to provide culturally-appropriate depression care to Latina women.

The effectiveness of music listening in reducing depressive symptoms in adults: a systematic review

OBJECTIVES

We aim to review trials of the effectiveness of music listening in reducing depressive symptoms in adults, and identify areas requiring further study.

BACKGROUND

Little is known about the efficacy of music listening in the mediation of depressive symptoms.

METHODS

We systematically search 9 databases and reviewed 17 studies included randomized controlled and quasi-experimental trails of music listening in reducing depressive symptoms in adults. The Joanna Briggs Institute-Meta Analysis of Statistics Assessment and Review Instrument was used for quality assessment of included studies.

RESULTS

Music listening over a period of time helps to reduce depressive symptoms in the adult population. Daily intervention does not seem to be superior over weekly intervention and it is recommended that music listening session be conducted repeatedly over a time span of more than 3weeks to allow an accumulative effect to occur.

CONCLUSIONS

All types of music can be used as listening material, depending on the preferences of the listener. So, it is recommended that the listeners are given choices over the kind of music which they listen to. There is a need to conduct more studies, which replicate the designs used in the existing studies that met the inclusion criteria, on the level of efficacy of music listening on the reduction of depressive symptoms for a more accurate meta-analysis of the findings and reflect with greater accuracy the significant effects that music has on the level of depressive symptoms.

Health care quality perceptions among foreign-born Latinos and the importance of speaking the same language

OBJECTIVES

To examine the relationship between patients' English proficiency, patient-provider language concordance, and health care quality among foreign-born Latinos in the United States.

METHODS

National probability sample data (from the Pew Hispanic Center/Robert Wood Johnson Foundation Latino Health Survey) were analyzed from telephone interviews with foreign-born Latino adults (n = 2921; aged 18 years and older). There were 3 main outcomes related to clinical experiences using self-reports of confusion, frustration, and perception of poor quality of care received because of English-speaking ability and accent bias, as well as an overall rating of care quality. Patients' English proficiency and patient-provider language concordance were the chief predictors.

RESULTS

Patients' English proficiency was not significantly associated with the 3 clinical experiences measures and marginally so with overall care quality ratings. Language concordance was significantly associated with a lower likelihood of confusion, frustration, and language-related poor quality ratings, and was positively associated with patient-reported overall quality of care. In addition, providers' language concordance attenuated the statistical significance of the effects of patients' English proficiency when both were modeled simultaneously.

CONCLUSION

Patient-provider language concordance plays an important role in communication barriers among foreign-born Latino patients. Our findings indicate that although patients' language proficiency is important to health care quality ratings, what may matter more is when patient and provider speak the same language.

Achieving adolescent adherence to treatment of major depression

When treatments are ordered for adolescent major depression, or for other adolescent medical illnesses, adherence and clinical outcomes are likely to be unsatisfactory, unless 4 basic principles of the medical treatment of adolescent illness are implemented. These comprise providing effective patient and parent/caregiver education, establishing effective patient and caregiver therapeutic alliances, providing effective treatment, and managing other factors associated with treatment adherence as indicated. The goals of treatment are to achieve the earliest possible response and remission. Failure to treat adolescent major depression successfully has potentially serious consequences, including worsened adherence, long-term morbidity, and suicide attempt. Accordingly, prescribed treatment must be aggressively managed. Doses of an antidepressant medication should be increased as rapidly as can be tolerated, preferably every 1-2 weeks, until full remission is achieved or such dosing is limited by the emergence of unacceptable adverse effects. A full range of medication treatment options must be employed if necessary. Treatment adherence, occurrence of problematic adverse effects, clinical progress, and safety must be systematically monitored. Adolescents with major depression must be assessed for risk of harm to self or others. When this risk appears significant, likelihood of successful outcomes will be enhanced by use of treatment plans that comprehensively address factors associated with treatment nonadherence. Abbreviated and comprehensive plans for the treatment of potentially fatal adolescent illnesses are outlined in this review.

Addressing stigma of depression in Latino primary care patients

OBJECTIVES

To develop a validated stigma checklist to assist physicians in addressing depression in Latino patients.

METHOD

Two hundred low-income, Spanish-speaking, Latino patients in primary care clinics were screened for depression using Patient Health Questionnaires (PHQ-2 and PHQ-9), and medical records were reviewed. With the use of a wide pool of stigma items, empirical methods were used to develop a stigma checklist from this primary care sample and patient information was used to demonstrate construct validity.

RESULTS

Patients reporting higher levels of perceived stigma using the stigma checklist were less likely to disclose their depression diagnosis to their family and friends (P<.05) and also less likely to be taking depression medication (OR=.78; 95% CI, .62-.99). Patients with stigma were less likely to be able to manage their depression (OR=.79; 95% CI, .65-.96) and more likely to have missed scheduled appointment visits (OR=1.44; 95% CI, 1.03-2.02).

CONCLUSION

Given the strong relationship between stigma and care of depression, primary care clinicians should be aware of and address stigma among their depressed Latino patients. The stigma checklist presented for treating Spanish-speaking Latino patients in primary care may be used to assess depressed patients for stigma to help inform clinical management of patients.

A systematic review on the effectiveness of music listening in reducing depressive symptoms in adults

BACKGROUND

The use of pharmacotherapy in the treatment of depressive symptoms has its disadvantages, therefore various complementary treatments have been sought and included to reduce depressive symptoms. The use of music as a healing intervention has been well documented throughout history. Even though there are many benefits to the use of music as a potential intervention, little is known about the efficacy of music listening in the mediation of depressive symptoms.

OBJECTIVES

The objective of this review was to determine the effectiveness of music listening in reducing depressive symptoms in adults.

INCLUSION CRITERIA

Types of participants This review included studies on adult men and women (aged 18 years and above) with depression or depressive symptoms.Types of intervention The review focused on studies that investigated music listening as an intervention for depressive symptoms.Types of outcomes The primary outcome measures examined were changes in depressive symptoms as quantified via validated depression scale scores.Types of studies Randomised controlled trials, quasi-experimental studies, interrupted time series (ITSs) and controlled before and after designs were included.

SEARCH STRATEGY

A literature search ranging from the 1989 to January 2010, was conducted using major electronic databases. A three-stage search strategy was utilized in the process of the search to ensure that all studies that met the inclusion criteria were included.

METHODOLOGICAL QUALITY

The quality of the included studies was subjected to assessment by two independent reviewers using the critical appraisal checklists for experimental studies from the JBI-MAStARI (Joanna Briggs Institute-Meta Analysis of Statistics Assessment and Review Instrument).

DATA EXTRACTION/DATA SYNTHESIS

Data were extracted from included papers using the standardized extraction tool from the JBI -MAStARI. Quantitative data were grouped together and combined into a meta-analysis for the assessment of the overall efficacy of an intervention were appropriate. Narrative formats were used when meta-analysis was not appropriate.

CONCLUSIONS

From the overall results, the evidence offers some support that music listening over a period of time helps to reduce depressive symptoms in the adult population.

IMPLICATIONS FOR PRACTICE

IMPLICATIONS FOR RESEARCH: There is a need to conduct more studies, which replicate the designs used in the existing studies that met the inclusion criteria, on the level of efficacy of music listening on the reduction of depressive symptoms for a more accurate meta-analysis of the findings and reflect with greater accuracy the significant effects that music has on the level of depressive symptoms.

Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. III. Pharmacotherapy

BACKGROUND

In 2001, the Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety Treatments (CANMAT) partnered to produce evidence-based clinical guidelines for the treatment of depressive disorders. A revision of these guidelines was undertaken by CANMAT in 2008-2009 to reflect advances in the field.

METHODS

The CANMAT guidelines are based on a question-answer format to enhance accessibility to clinicians. An evidence-based format was used with updated systematic reviews of the literature and recommendations were graded according to Level of Evidence using pre-defined criteria. Lines of Treatment were identified based on criteria that included Levels of Evidence and expert clinical support. This section on "Pharmacotherapy" is one of 5 guideline articles.

RESULTS

Despite emerging data on efficacy and tolerability differences amongst newer antidepressants, variability in patient response precludes identification of specific first choice medications for all patients. All second-generation antidepressants have Level 1 evidence to support efficacy and tolerability and most are considered first-line treatments for MDD. First-generation tricyclic and monoamine oxidase inhibitor antidepressants are not the focus of these guidelines but generally are considered second- or third-line treatments. For inadequate or incomplete response, there is Level 1 evidence for switching strategies and for add-on strategies including lithium and atypical antipsychotics.

LIMITATIONS

Most of the evidence is based on trials for registration and may not reflect real-world effectiveness.

CONCLUSIONS

Second-generation antidepressants are safe, effective and well tolerated treatments for MDD in adults. Evidence-based switching and add-on strategies can be used to optimize response in MDD that is inadequately responsive to monotherapy.

Psychotropic medication nonadherence among United States Latinos: a comprehensive literature review

OBJECTIVE

Psychotropic medication nonadherence is a major public health problem, but few studies have focused on Latinos. The authors systematically reviewed the literature on rates of and factors influencing antipsychotic, antidepressant, and mood stabilizer nonadherence among U.S. Latinos.

METHODS

MEDLINE and PsycINFO were searched by using the keywords adherence, compliance, Latino, Hispanic, psychotropic, and related terms; bibliographies from relevant reviews and studies were also searched. Twenty-one studies met inclusion criteria: published since 1980 in English or Spanish and measured psychotropic medication nonadherence rates among U.S. Latino adults. Information was extracted about study design and objective, location, population, medication type, participant demographic characteristics, adherence measures, adherence rates, and factors related to adherence.

RESULTS

In the 17 studies that included Latinos and other minority groups, mean nonadherence rates were 41%, 31%, and 43%, respectively, among Latinos, Euro-Americans, and African Americans, with an overall effect size of .64 between Latinos and Euro-Americans. In the four studies that included only Latinos, the mean nonadherence rate was 44%. Ten of 16 studies found that Latinos had significantly lower adherence rates than Euro-Americans. Risk factors for nonadherence included being a monolingual Spanish speaker, lacking health insurance, experiencing access barriers to high-quality care, and having lower socioeconomic status. Protective factors included family support and psychotherapy.

CONCLUSIONS

Rates of nonadherence to psychotropic medications were found to be higher for Latinos than for Euro-Americans. Further investigation is needed to understand the potentially modifiable individual and society-level mechanisms of this discrepancy. Clinical and research interventions to improve adherence should be culturally appropriate and incorporate identified factors.