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Harris AHS, Liu P, Breland JY, Nieser KJ, Schmidt EM. Differences across race and ethnicity in the quality of antidepressant medication management. Health Serv Res 2024; 59:e14347. [PMID: 38965913 PMCID: PMC11366953 DOI: 10.1111/1475-6773.14347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024] Open
Abstract
OBJECTIVE To illustrate the importance of a multidimensional view of disparities in quality of antidepressant medication management (AMM), as well as discriminating "within-facility" disparities from disparities that exist between facilities. DATA SOURCES AND STUDY SETTING We used data from the Veterans Health Administration's (VA) Corporate Data Warehouse (CDW) which contains clinical and administrative data from VA facilities nationally. STUDY DESIGN CDW data were used to measure five indicators of AMM quality, including the HEDIS Effective Acute-Phase and Effective Continuation-Phase measures. Mixed effects regression models were used to examine differences in quality indicators between racial/ethnic groups, controlling for other demographic and clinical factors. An adaptation of the Kitagawa-Blinder-Oaxaca (KBO) method was used to decompose mean differences in treatment quality between racial and ethnic groups into within- and between-facility effects. DATA EXTRACTION METHODS Demographic, clinical, and health service utilization data were extracted for patients in fiscal year 2017 with a diagnosis of depression and a new start of an antidepressant medication. PRINCIPAL FINDINGS The decomposition of the overall differences between White and Black patients on receiving an initial 90-day prescription (46.7% vs. 32.7%), Effective Acute-Phase (79.7% vs. 66.8%), and Effective Continuation-Phase (64.0% vs. 49.6%) HEDIS measures revealed that most of the overall effects were "within-facility," meaning that Black patients are less likely to meet these measures regardless of where they are treated. Although the overall magnitude of disparities between White and Hispanic patients on these three measures was very similar (46.7% vs. 32.7%; 79.7% vs. 69.2%; 64.0% vs. 53.6%), the differences were more attributable to Hispanic patients being treated in facilities with overall lower performance on these measures. CONCLUSIONS Discriminating within- and between-facility disparities and taking a multidimensional view of quality are essential to informing efforts to address disparities in AMM quality.
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Affiliation(s)
- Alex H. S. Harris
- Center for Innovation to ImplementationVeterans Affairs Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
- Department of Surgery, School of MedicineStanford UniversityStanfordCaliforniaUSA
| | - Pingyang Liu
- Center for Innovation to ImplementationVeterans Affairs Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
| | - Jessica Y. Breland
- Center for Innovation to ImplementationVeterans Affairs Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
| | - Kenneth J. Nieser
- Center for Innovation to ImplementationVeterans Affairs Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
- Department of Surgery, School of MedicineStanford UniversityStanfordCaliforniaUSA
| | - Eric M. Schmidt
- Center for Innovation to ImplementationVeterans Affairs Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
- Office of Performance Measurement, Analytics and Performance Integration, Quality and Patient SafetyVeterans Health AdministrationWashingtonDCUSA
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Petimar J, Young JG, Yu H, Rifas-Shiman SL, Daley MF, Heerman WJ, Janicke DM, Jones WS, Lewis KH, Lin PID, Prentice C, Merriman JW, Toh S, Block JP. Medication-Induced Weight Change Across Common Antidepressant Treatments : A Target Trial Emulation Study. Ann Intern Med 2024; 177:993-1003. [PMID: 38950403 DOI: 10.7326/m23-2742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Antidepressants are among the most commonly prescribed medications, but evidence on comparative weight change for specific first-line treatments is limited. OBJECTIVE To compare weight change across common first-line antidepressant treatments by emulating a target trial. DESIGN Observational cohort study over 24 months. SETTING Electronic health record (EHR) data from 2010 to 2019 across 8 U.S. health systems. PARTICIPANTS 183 118 patients. MEASUREMENTS Prescription data determined initiation of treatment with sertraline, citalopram, escitalopram, fluoxetine, paroxetine, bupropion, duloxetine, or venlafaxine. The investigators estimated the population-level effects of initiating each treatment, relative to sertraline, on mean weight change (primary) and the probability of gaining at least 5% of baseline weight (secondary) 6 months after initiation. Inverse probability weighting of repeated outcome marginal structural models was used to account for baseline confounding and informative outcome measurement. In secondary analyses, the effects of initiating and adhering to each treatment protocol were estimated. RESULTS Compared with that for sertraline, estimated 6-month weight gain was higher for escitalopram (difference, 0.41 kg [95% CI, 0.31 to 0.52 kg]), paroxetine (difference, 0.37 kg [CI, 0.20 to 0.54 kg]), duloxetine (difference, 0.34 kg [CI, 0.22 to 0.44 kg]), venlafaxine (difference, 0.17 kg [CI, 0.03 to 0.31 kg]), and citalopram (difference, 0.12 kg [CI, 0.02 to 0.23 kg]); similar for fluoxetine (difference, -0.07 kg [CI, -0.19 to 0.04 kg]); and lower for bupropion (difference, -0.22 kg [CI, -0.33 to -0.12 kg]). Escitalopram, paroxetine, and duloxetine were associated with 10% to 15% higher risk for gaining at least 5% of baseline weight, whereas bupropion was associated with 15% reduced risk. When the effects of initiation and adherence were estimated, associations were stronger but had wider CIs. Six-month adherence ranged from 28% (duloxetine) to 41% (bupropion). LIMITATION No data on medication dispensing, low medication adherence, incomplete data on adherence, and incomplete data on weight measures across time points. CONCLUSION Small differences in mean weight change were found between 8 first-line antidepressants, with bupropion consistently showing the least weight gain, although adherence to medications over follow-up was low. Clinicians could consider potential weight gain when initiating antidepressant treatment. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Joshua Petimar
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts (J.P., J.G.Y.)
| | - Jessica G Young
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts (J.P., J.G.Y.)
| | - Han Yu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (H.Y., S.L.R.-S., P.-I.D.L., S.T., J.P.B.)
| | - Sheryl L Rifas-Shiman
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (H.Y., S.L.R.-S., P.-I.D.L., S.T., J.P.B.)
| | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado (M.F.D.)
| | - William J Heerman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee (W.J.H.)
| | - David M Janicke
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida (D.M.J.)
| | - W Schuyler Jones
- Division of Cardiology, Duke University Department of Medicine, and Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina (W.S.J.)
| | - Kristina H Lewis
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina (K.H.L.)
| | - Pi-I D Lin
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (H.Y., S.L.R.-S., P.-I.D.L., S.T., J.P.B.)
| | - Carly Prentice
- Faith Family Medical Center, Nashville, Tennessee (C.P.)
| | - John W Merriman
- Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida (J.W.M.)
| | - Sengwee Toh
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (H.Y., S.L.R.-S., P.-I.D.L., S.T., J.P.B.)
| | - Jason P Block
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (H.Y., S.L.R.-S., P.-I.D.L., S.T., J.P.B.)
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Mavroeides G, Basta M, Vgontzas A, Karademas EC, Simos P, Koutra K. Prospective Associations Between Personality Traits and Major Depressive Disorder Symptom Severity: The Mediating Role of Illness Representations. Psychiatr Q 2024:10.1007/s11126-024-10074-x. [PMID: 38874738 DOI: 10.1007/s11126-024-10074-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2024] [Indexed: 06/15/2024]
Abstract
Major depressive disorder (MDD) patients' personality traits and illness representations are linked to MDD severity. However, the associations between personality and illness representations in MDD and the mediating role of illness representations between personality and MDD severity have not been investigated. This study aimed to prospectively investigate the aforementioned associations and the possible mediating role of illness representations between personality and MDD severity. One hundred twenty-five patients with a MDD diagnosis, aged 48.18 ± 13.92 (84% females), participated in the study. Personality traits were measured with the Traits Personality Questionnaire at baseline. Illness representations were measured with the Illness Perception Questionnaire-Mental Health about five months later (mean = 5.08 ± 1.14 months). MDD severity was measured about 10 months after the baseline assessment (mean = 9.53 ± 2.36 months) with the Beck Depression Inventory. SPSS 29 and AMOS 27 were used to conduct correlational and parallel mediation analyses. According to the results, Neuroticism was positively and Extraversion was negatively linked to MDD severity. Negative MDD impact representations fully mediated these associations. Neuroticism and Extraversion are linked to future MDD severity through patients' representations of MDD's impact. Restructuring maladaptive representations about MDD's impact can be a promising way to reduce symptom severity in patients with high Neuroticism and low Extraversion levels.
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Affiliation(s)
- Giorgos Mavroeides
- Department of Psychology, School of Social Sciences, University of Crete, Gallos Campus, Rethymno, 74100, Crete, Greece.
| | - Maria Basta
- Department of Psychiatry & Behavioral Sciences, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Alexandros Vgontzas
- Mobile Mental Health Unit, Psychiatric Clinic, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Evangelos C Karademas
- Department of Psychology, School of Social Sciences, University of Crete, Gallos Campus, Rethymno, 74100, Crete, Greece
| | - Panagiotis Simos
- Department of Psychiatry & Behavioral Sciences, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Katerina Koutra
- Department of Psychology, School of Social Sciences, University of Crete, Gallos Campus, Rethymno, 74100, Crete, Greece
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Abrahams AB, Beckenstrom AC, Browning M, Dias R, Goodwin GM, Gorwood P, Kingslake J, Morriss R, Reif A, Ruhé HG, Simon J, Dawson GR. Exploring the incidence of inadequate response to antidepressants in the primary care of depression. Eur Neuropsychopharmacol 2024; 83:61-70. [PMID: 38678794 DOI: 10.1016/j.euroneuro.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 05/01/2024]
Abstract
Data from the UK suggests 13-55 % of depression patients experience some level of treatment resistance. However, little is known about how physicians manage inadequate response to antidepressants in primary care. This study aimed to explore the incidence of inadequate response to antidepressants in UK primary care. One-hundred-eighty-four medication-free patients with low mood initiated antidepressant treatment and monitored severity of depression symptoms, using the QIDS-SR16, for 48 weeks. Medication changes, visits to healthcare providers, and health-related quality of life were also recorded. Patients were classified into one of four response types based on their QIDS scores at three study timepoints: persistent inadequate responders (<50 % reduction in baseline QIDS at all timepoints), successful responders (≥50 % reduction in baseline QIDS at all timepoints), slow responders (≥50 % reduction in QIDS at week 48, despite earlier inadequate responses), and relapse (initial ≥50 % reduction in baseline QIDS, but inadequate response by week 48). Forty-eight weeks after initiating treatment 47 % of patients continued to experience symptoms of depression (QIDS >5), and 20 % of patients had a persistent inadequate response. Regardless of treatment response, 96 % (n = 176) of patients did not visit their primary care physician over the 40-week follow-up period. These results suggest that despite receiving treatment, a considerable proportion of patients with low mood remain unwell and fail to recover. Monitoring depression symptoms remotely can enable physicians to identify inadequate responders, allowing patients to be reassessed or referred to secondary services, likely improving patients' quality of life and reducing the socioeconomic impacts of chronic mental illness.
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Affiliation(s)
| | | | - Michael Browning
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Trust, Oxford, UK
| | - Rebecca Dias
- P1vital Products Ltd, Howbery Park, Wallingford, Oxfordshire, UK
| | | | - Philip Gorwood
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, 75014 Paris, France; GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, F-75014 Paris, France
| | | | - Richard Morriss
- Academic Unit of Mental Health and Neuroscience, University of Nottingham, Nottingham, United Kingdom
| | - Andreas Reif
- Goethe University Frankfurt, University Hospital, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Frankfurt, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Henricus G Ruhé
- Department of Psychiatry, Radboudumc, Reinier Postlaan 4, 6525 GC, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University, Kapittelweg 29, 6525 EN, Nijmegen, Netherlands
| | - Judit Simon
- Department of Psychiatry, University of Oxford, UK; Department of Health Economics, Center for Public Health, Medical University of Vienna, 1090 Vienna, Austria
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del Pino-Sedeño T, González-Pacheco H, González de León B, Serrano-Pérez P, Acosta Artiles FJ, Valcarcel-Nazco C, Hurtado-Navarro I, Rodríguez Álvarez C, Trujillo-Martín MM. Effectiveness of interventions to improve adherence to antidepressant medication in patients with depressive disorders: a cluster randomized controlled trial. Front Public Health 2024; 12:1320159. [PMID: 38633230 PMCID: PMC11022850 DOI: 10.3389/fpubh.2024.1320159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/29/2024] [Indexed: 04/19/2024] Open
Abstract
Aim To assess the effectiveness of two interventions of knowledge transfer and behavior modification to improve medication adherence in patients with depressive disorders. Methods An open, multicenter, three-arm clinical trial with random allocation by cluster to usual care or to one of the two interventions. The intervention for psychiatrists (PsI) included an educational program based on a patient-centered care model. The intervention for patients and relatives (PtI) included a collaborative care program plus a reminder system that works using an already available medication reminder application. The primary outcome was patient adherence to antidepressant treatment assessed through the Sidorkiewicz Adherence Instrument. Secondary measures were depression severity, comorbid anxiety and health-related quality of life. Mixed regression models with repeated measures were used for data analysis. Results Ten psychiatrists and 150 patients diagnosed with depressive disorder from eight Community Mental Health Units in the Canary Islands (Spain) were included. Compared with usual care, no differences in long-term adherence were observed in either group PsI or PtI. The PsI group had significantly improved depression symptoms (B = -0.39; 95%CI: -0.65, -0.12; p = 0.004) during the follow-up period. The PtI group presented improved depression symptoms (B = -0.63; 95%CI: -0.96, -0.30; p < 0.001) and mental quality of life (B = 0.08; 95%CI: 0.004, 0.15; p = 0.039) during the follow-up period. Conclusion The assessed interventions to improve adherence in patients with depressive disorder were effective for depression symptoms and mental quality of life, even over the long term. However, no effect on antidepressant adherence was observed.
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Affiliation(s)
- Tasmania del Pino-Sedeño
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
- Faculty of Health Sciences, Universidad Europea de Canarias, Tenerife, Spain
| | - Himar González-Pacheco
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Beatriz González de León
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
- Multiprofessional Teaching Unit of Family and Community Care La Laguna-Tenerife Norte, Management of Primary Care of Tenerife, Santa Cruz de Tenerife, Spain
| | - Pedro Serrano-Pérez
- Department of Psychiatry, Hospital Álvaro Cunqueiro, SERGAS, Vigo, Spain
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IIS-Galicia Sur), SERGAS-UVIGO, CIBERSAM, Vigo, Spain
| | - Francisco Javier Acosta Artiles
- Service of Mental Health, General Management of Healthcare Programs, The Canary Islands Health Service, Las Palmas, Gran Canaria, Spain
- Department of Psychiatry, University Hospital of Gran Canaria Doctor Negrín, Las Palmas, The Canary Islands, Spain
| | - Cristina Valcarcel-Nazco
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Isabel Hurtado-Navarro
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
- Health Services Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), Valencia, Spain
| | | | - María M. Trujillo-Martín
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
- Institute of Biomedical Technologies (ITB), University of La Laguna, Tenerife, Canary Islands, Spain
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Xie P, Li HQ, Peng WL, Yang H. Eliciting Depression Patients' Preferences for Medication Management: A Protocol for Discrete Choice Experiment. Patient Prefer Adherence 2024; 18:289-300. [PMID: 38327728 PMCID: PMC10849879 DOI: 10.2147/ppa.s444800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/24/2024] [Indexed: 02/09/2024] Open
Abstract
Introduction Depression threatens people's lives and imposes huge economic burden. Antidepressant therapy is the first-line treatment for depression, and patient adherence to medication is the key to successful treatment. Depression patients have poor medication adherence, which leads to failure of depression management and significantly poorer clinical outcomes. Incorporating patient preferences into clinical decisions can improve uptake rates, optimize treatment adherence. A discrete choice experiment (DCE) can elicit and quantify individual preferences. Previous DCE studies were conducted in developed countries and ignored the influences of factors other than the medication. This paper outlines an ongoing DCE that aims to (1) explore medication-management-related characteristics that may affect depression patients' adherence to antidepressant, (2) elicit how depression patients consider the trade-offs among different medication managements. Methods The six attributes and their levels were developed through a literature review, semi-structured interviews and experts and focus group discussions. A fractional factorial design in the software Ngene 1.2 version was used to generate 36 choice sets, and they were divided into 3 blocks. A mixed logit model will be used to explore the patients' preferences, willingness to pay and uptake rate of depression patients for medication management attributes. Results The final questionnaire consists of three parts. The first is the introduction, which introduces the purpose of the study and the requirements of completing the questionnaire. This was followed by a general information questionnaire, which included sociodemographic characteristics. The last part is DCE tasks, which include 13 DCE choice sets, and each choice set include two alternative and one "opt-out" option. The pilot-test results showed the questionnaire was easy to understand and could be used in formal surveys. Conclusion Our study shows how the development process of the study can be conducted and reported systematically and rigorously according to the theoretical foundation and design principles in DCE.
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Affiliation(s)
- Peng Xie
- People’s Hospital of Deyang City, Deyang City, Sichuan, 618000, People’s Republic of China
| | - Hui-Qin Li
- People’s Hospital of Deyang City, Deyang City, Sichuan, 618000, People’s Republic of China
| | - Wan-Lin Peng
- School of Nursing, Guangxi University of Chinese Medicine, Nanning, Guangxi, 530004, People’s Republic of China
| | - Hao Yang
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, 610041, People’s Republic of China
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Del Pino-Sedeño T, Infante-Ventura D, Hernández-González D, González-Hernández Y, González de León B, Rivero-Santana A, Hurtado I, Acosta Artiles FJ. Sociodemographic and clinical predictors of adherence to antidepressants in depressive disorders: a systematic review with a meta-analysis. Front Pharmacol 2024; 15:1327155. [PMID: 38318137 PMCID: PMC10839896 DOI: 10.3389/fphar.2024.1327155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/03/2024] [Indexed: 02/07/2024] Open
Abstract
Introduction: Current evidence reveals concerning rates of non-adherence to antidepressant treatment, possibly influenced by various relevant determinants such as sociodemographic factors or those related to the health system and their professionals. The aim of this paper is to review the scientific evidence on sociodemographic and clinical predictors of adherence to pharmacological treatment in patients diagnosed with a depressive disorder. Methods: a systematic review (SR) was conducted. The search for a previous SR was updated and de novo searches were performed in Medline, EMBASE, Web of Science (WoS) and PsycInfo (last 10 years). The risk of bias was assessed using the Cochrane tool for non-randomized studies-of Exposure (ROBINS-E). Meta-analyses were conducted. Results: Thirty-nine studies (n = 2,778,313) were included, 24 of them in the meta-analyses. In the initiation phase, no association of adherence was found with any of the predictors studied. In the implementation and discontinuation phases, middle-aged and older patients had better adherence rates and lower discontinuation rates than younger ones. White patients adhered to treatment better than African-American patients. Discussion: Age and ethnicity are presented as the predictive factors of pharmacological adherence. However, more research is needed in this field to obtain more conclusive results on other possible factors. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023414059], identifier [CRD42023414059].
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Affiliation(s)
- Tasmania Del Pino-Sedeño
- Canary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, Spain
- Research Network on Chronicity, Primary Care and Prevention and Health Promotion (RICAPPS), Tenerife, Spain
- Faculty of Health Sciences, Universidad Europea de Canarias, Tenerife, Spain
- Department of Clinical Psychology, Psychobiology and Methodology, University of La Laguna, Tenerife, Spain
| | - Diego Infante-Ventura
- Canary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, Spain
- Department of Clinical Psychology, Psychobiology and Methodology, University of La Laguna, Tenerife, Spain
| | | | - Yadira González-Hernández
- Canary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, Spain
| | - Beatriz González de León
- Multiprofessional Teaching Unit of Family and Community Care La Laguna-Tenerife Norte, Management of Primary Care of Tenerife, Santa Cruz de Tenerife, Spain
| | - Amado Rivero-Santana
- Canary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, Spain
- Research Network on Chronicity, Primary Care and Prevention and Health Promotion (RICAPPS), Tenerife, Spain
| | - Isabel Hurtado
- Research Network on Chronicity, Primary Care and Prevention and Health Promotion (RICAPPS), Tenerife, Spain
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), Valencia, Spain
| | - Francisco Javier Acosta Artiles
- Department of Mental Health, General Management of Health care Programs, Canary Islands Health Service, Las Palmas de Gran Canaria, Spain
- Department of Psychiatry, Insular University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain
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Biskupiak Z, Ha VV, Rohaj A, Bulaj G. Digital Therapeutics for Improving Effectiveness of Pharmaceutical Drugs and Biological Products: Preclinical and Clinical Studies Supporting Development of Drug + Digital Combination Therapies for Chronic Diseases. J Clin Med 2024; 13:403. [PMID: 38256537 PMCID: PMC10816409 DOI: 10.3390/jcm13020403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Limitations of pharmaceutical drugs and biologics for chronic diseases (e.g., medication non-adherence, adverse effects, toxicity, or inadequate efficacy) can be mitigated by mobile medical apps, known as digital therapeutics (DTx). Authorization of adjunct DTx by the US Food and Drug Administration and draft guidelines on "prescription drug use-related software" illustrate opportunities to create drug + digital combination therapies, ultimately leading towards drug-device combination products (DTx has a status of medical devices). Digital interventions (mobile, web-based, virtual reality, and video game applications) demonstrate clinically meaningful benefits for people living with Alzheimer's disease, dementia, rheumatoid arthritis, cancer, chronic pain, epilepsy, depression, and anxiety. In the respective animal disease models, preclinical studies on environmental enrichment and other non-pharmacological modalities (physical activity, social interactions, learning, and music) as surrogates for DTx "active ingredients" also show improved outcomes. In this narrative review, we discuss how drug + digital combination therapies can impact translational research, drug discovery and development, generic drug repurposing, and gene therapies. Market-driven incentives to create drug-device combination products are illustrated by Humira® (adalimumab) facing a "patent-cliff" competition with cheaper and more effective biosimilars seamlessly integrated with DTx. In conclusion, pharma and biotech companies, patients, and healthcare professionals will benefit from accelerating integration of digital interventions with pharmacotherapies.
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Affiliation(s)
- Zack Biskupiak
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Victor Vinh Ha
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Aarushi Rohaj
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
- The Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84113, USA
| | - Grzegorz Bulaj
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
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Donneyong MM, Bynum M, Kemavor A, Crossnohere NL, Schuster A, Bridges J. Patient satisfaction with the quality of care received is associated with adherence to antidepressant medications. PLoS One 2024; 19:e0296062. [PMID: 38180988 PMCID: PMC10769059 DOI: 10.1371/journal.pone.0296062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 12/05/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND There is a paucity of evidence on the association between satisfaction with quality of care and adherence to antidepressants. OBJECTIVES To examine the association between patient satisfaction with healthcare and adherence to antidepressants. METHODS A cohort study design was used to identify antidepressant users from the 2010-2016Medical Expenditure Panel Survey data, a national longitudinal complex survey study design on the cost and healthcare utilization of the noninstitutionalized population in the United States. The Consumer Assessment of Healthcare Providers and Systems were used to measure participants' satisfaction with access and quality of care, patient-provider communication and shared decision-making (SDM). Patients were considered satisfied if they ranked the quality of care at ≥9 (range: 0[worst]- 10[best]). Antidepressant adherence was measured based on medication refill and complete discontinuation. MEPS sampling survey-weighted multivariable-adjusted logistic regression models were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between satisfaction and adherence to antidepressants. We tested for the potential presence of reverse associations by restricting the analysis to new users of antidepressants. The roles of patient-provider communication and SDM on the satisfaction-adherence association were examined through structural equation models (SEM). RESULTS Among 4,990 (weighted counts = 8,661,953) antidepressant users, 36% were adherent while 39% discontinued antidepressants therapy. Half of antidepressant users were satisfied with the healthcare received. Satisfied patients were 26% (OR = 1.26, 95%CI: 1.08, 1.47) more likely to adhere and 17% (OR = 0.83, 95%CI: 0.71, 0.96) less likely to discontinue, compared to unsatisfied antidepressant users. Patient satisfaction was also associated with higher odds (OR = 1.41, 95%CI: 1.06, 1.88) of adherence among a subgroup of new users of antidepressants. The SEM analysis revealed that satisfaction was a manifestation of patient-provider communication (β = 2.03, P-value<0.001) and SDM (β = 1.14, P-value<0.001). CONCLUSIONS Patient satisfaction is a potential predictor of antidepressant adherence. If our findings are confirmed through intervention studies, improving patient-provider communication and SDM could likely drive both patient satisfaction and adherence to antidepressants.
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Affiliation(s)
- Macarius M. Donneyong
- Division of Outcomes and Translational Sciences, College of Pharmacy, The Ohio State University, Columbus, OH, United States of America
| | - Mary Bynum
- Healthcare Management, Franklin University, Columbus, Ohio, United States of America
| | - Ameena Kemavor
- ADAMH Board of Franklin County, Columbus, OH, United States of America
| | - Norah L. Crossnohere
- Division of General Internal Medicine, The Ohio State College of Medicine, Columbus, Ohio, United States of America
| | - Anne Schuster
- Department of Biomedical Informatics, The Ohio State College of Medicine, Columbus, Ohio, United States of America
| | - John Bridges
- Department of Biomedical Informatics, The Ohio State College of Medicine, Columbus, Ohio, United States of America
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Gutiérrez-Abejón E, Pedrosa-Naudín MA, Fernández-Lázaro D, Alvarez FJ. Medication economic burden of antidepressant non-adherence in Spain. Front Pharmacol 2023; 14:1266034. [PMID: 38035007 PMCID: PMC10682177 DOI: 10.3389/fphar.2023.1266034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction: Non-adherence to antidepressants is associated with worse disease outcomes (morbidity and mortality) and correlates with higher healthcare resource utilization and costs. Methods: A population-based registry study was conducted to assess non-adherence and to analyze the economic burden of treatment and from non-adherence to antidepressants in 2021. Non-adherence was measured by the Medication Possession Ratio and those below 80% were classified as non-adherent. Results: In 2021, 246,718 patients (10.60% [95% CI: 10.48-10.72]) received antidepressants at a cost of €29 million. The median antidepressant cost per patient/year was €70.08€, ranging from €7.58 for amitriptyline to €396.66 for agomelatine. Out-of-pocket costs represented 6.09% of total expenditures, with a median copayment of €2.78 per patient. The 19.87% [95% CI 19.52-20.22)] of patients were non-adherent to antidepressants, costing €3.9 million (13.30% of total antidepressant costs). Non-adherence rates exceeded 20% for the tricyclic antidepressants, fluoxetine (23.53%), fluvoxamine (22.42%), and vortioxetine (20.58%). Venlafaxine (14.64%) and citalopram (14.88%) had the lowest non-adherence rates, of less than 15%. The median cost of non-adherent medications per patient/year was €18.96 and ranged from €2.50 (amitriptyline) to €133.42 (agomelatine). Conclusion: Reducing non-adherence to antidepressants is critical to improving clinical and economic outcomes. The implementation of interventions and standardized measures, including early detection indicators, is urgently needed. Antidepressants differ with regard to non-adherence and their cost, and this should be considered when prescribing this medication. The Medication Possession Ratio could be used by the healthcare provider and clinician to identify non-adherent patients for monitoring, and to take necessary corrective actions.
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Affiliation(s)
- Eduardo Gutiérrez-Abejón
- Pharmacological Big Data Laboratory, Department of Cell Biology, Genetics, Histology and Pharmacology, Faculty of Medicine, University of Valladolid, Valladolid, Spain
- Valladolid Este Primary Care Department, Valladolid, Spain
- Pharmacy Directorate, Castilla y León Health Council, Valladolid, Spain
- Facultad de Empresa y Comunicación, Universidad Internacional de la Rioja (UNIR), Logroño, Spain
| | | | - Diego Fernández-Lázaro
- Department of Cellular Biology, Genetics, Histology and Pharmacology, Faculty of Health Sciences, Campus of Soria, University of Valladolid, Soria, Spain
- Neurobiology Research Group, Faculty of Medicine, University of Valladolid, Valladolid, Spain
| | - F. Javier Alvarez
- Pharmacological Big Data Laboratory, Department of Cell Biology, Genetics, Histology and Pharmacology, Faculty of Medicine, University of Valladolid, Valladolid, Spain
- CEIm, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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11
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Liu Q, Ni W, Zhang L, Zhao M, Bai X, Zhang S, Ding Y, Yin H, Chen L. Comparative efficacy of various exercise interventions on depression in older adults with mild cognitive impairment: A systematic review and network meta-analysis. Ageing Res Rev 2023; 91:102071. [PMID: 37704052 DOI: 10.1016/j.arr.2023.102071] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Exercise is a promising nonpharmacological treatment for improving depression in older adults with MCI, but it is unclear which exercises are most effective. The objectives of this study were to compare and rank the effectiveness of various exercise interventions for depression in mild cognitive impairment (MCI) and to investigate the effects of exercise on depression. METHODS The PRISMA-NMA guidelines were applied to the development and reporting of review criteria. The Cochrane Library, Web of Science, PsycINFO, PubMed, EMBASE, CINAHL, and Scopus databases were systematically searched by combining search terms for randomized controlled trial studies (RCTs) published in English from individual databases with the earliest available date set to March 10, 2023. Two evaluators independently selected and evaluated eligible studies of changes in depression in older adults with MCI after an exercise intervention. A protocol for this systematic review was registered in PROSPERO (Registration number: CRD42022377052). RESULTS A network meta-analysis was conducted on 15 eligible RCTs consisting of 4271 subjects, including aerobic (n = 6), mind-body (n = 6) and multicomponent (n = 3) exercise trials. Compared to controls, mind-body exercise showed the strongest improvement in depressive symptoms (SMD = -0.63, 95% CI: -1.13, -0.14), followed by aerobic (SMD = -0.57, 95% CI: -0.88, -0.26) and multicomponent exercise (SMD = -0.53, 95% CI: -1.02, -0.03). Notably, there were no statistically significant differences between exercise types: aerobic vs. mind-body (SMD = 0.06, 95% PrI: -0.71, 0.84), multicomponent vs. mind-body (SMD = 0.11, 95% PrI: -0.75, 0.97), or multicomponent vs. aerobic (SMD = 0.04, 95% PrI: -0.771, 0.86). CONCLUSIONS In this review, we found that mind-body exercise was most effective when compared to conventional controls and that multiple exercise modalities (aerobic, mind-body, and multicomponent exercise) had beneficial and comparable effects in reducing depressive states in older adults with MCI. These findings may guide clinical geriatric stakeholders and allied health professionals in providing more scientifically optimal exercise prescriptions for older adults with MCI. In the future, more high-quality, long-term clinical trials are needed to support the exploration of longer-term dynamic effects.
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Affiliation(s)
- Qian Liu
- Jilin University School of Nursing, Changchun, China
| | - Weiguang Ni
- Jilin University Physical Education College, Changchun, China
| | - Lijia Zhang
- The First Hospital of Hebei Medicine University, Shijiazhuang, China
| | - Mingzhu Zhao
- Jilin University School of Nursing, Changchun, China
| | - Xuechun Bai
- Jilin University School of Nursing, Changchun, China
| | - Sitao Zhang
- Jilin University School of Nursing, Changchun, China
| | - Yiwen Ding
- Jilin University School of Nursing, Changchun, China
| | - Huiru Yin
- Jilin University School of Nursing, Changchun, China.
| | - Li Chen
- Jilin University School of Nursing, Changchun, China.
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12
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Sinnappah KA, Hughes DA, Stocker SL, Vrijens B, Aronson JK, Wright DFB. A framework for understanding sources of bias in medication adherence research. Br J Clin Pharmacol 2023; 89:3444-3453. [PMID: 37496213 DOI: 10.1111/bcp.15863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/07/2023] [Accepted: 07/23/2023] [Indexed: 07/28/2023] Open
Abstract
The sources of bias in medication adherence research have not been comprehensively explored. We aimed to identify biases expected to affect adherence research and to develop a framework for mapping these onto the phases of adherence (initiation, implementation and discontinuation). A literature search was conducted, key papers were reviewed and a Catalogue of Bias was consulted. The specific biases related to adherence measurement and metrics were mapped onto the phases of adherence using a tabular matrix. Twenty-three biases were identified, of which 11 were specifically relevant to adherence measures and metrics. The mapping framework showed differences in the numbers and types of biases associated with each measure and metric while highlighting those common to many adherence study designs (e.g., unacceptability bias and apprehension bias). The framework will inform the design of adherence studies and the development of risk of bias tools for adherence research.
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Affiliation(s)
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Sophie L Stocker
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Bernard Vrijens
- AARDEX Group, Seraing, Belgium
- Liège University, Liège, Belgium
| | - Jeffrey K Aronson
- Centre for Evidence-based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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13
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Hamlin M, Holmén J, Wentz E, Aiff H, Ali L, Steingrimsson S. Patient Experience of Digitalized Follow-up of Antidepressant Treatment in Psychiatric Outpatient Care: Qualitative Analysis. JMIR Ment Health 2023; 10:e48843. [PMID: 37819697 PMCID: PMC10600645 DOI: 10.2196/48843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Nonadherence to pharmaceutical antidepressant treatment is common among patients with depression. Digitalized follow-up (ie, self-monitoring systems through mobile apps) has been suggested as an effective adjunct to conventional antidepressant treatment to increase medical adherence, improve symptoms of depression, and reduce health care resource use. OBJECTIVE The aim of this study was to determine patients' experience of digitalized follow-up using a mobile app as an adjunct to treatment concurrent with a new prescription, a change of antidepressant, or a dose increase. METHODS This was a qualitative, descriptive study. Patients at 2 psychiatric outpatient clinics were recruited at the time of changing antidepressant medication. After using a mobile app (either a commercial app or a public app) for 4-6 weeks with daily registrations of active data, such as medical intake and questions concerning general mental health status, individual semistructured interviews were conducted. Recorded data were transcribed and then analyzed using content analysis. RESULTS In total, 13 patients completed the study. The mean age was 35 (range 20-67) years, 8 (61.5%) were female, and all reported high digital literacy. Overall, the emerging themes indicated that the patients found the digital app to be a valuable adjunct to antidepressant treatment but with potential for improvement. Both user adherence and medical adherence were positively affected by a daily reminder and the app's ease of use. User adherence was negatively affected by the severity of depression. The positive experience of visually presented data as graphs was a key finding, which was beneficial for self-awareness, the patient-physician relationship, and user adherence. Finally, the patients had mixed reactions to the app's content and requested tailored content. CONCLUSIONS The patients identified several factors addressing both medical adherence and user adherence to a digital app when using it for digitalized follow-up concurrent with the critical time related to changes in antidepressant medication. The findings highlight the need for rigorous evidence-based empirical studies to generate sustainable research results.
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Affiliation(s)
- Matilda Hamlin
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Psychiatry, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Joacim Holmén
- Department of Psychiatry, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Elisabet Wentz
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Psychiatry, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Harald Aiff
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Psychiatry, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Lilas Ali
- Department of Psychiatry, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Steinn Steingrimsson
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Psychiatry, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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14
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Subhas N, Ang JK, Tan KA, Ahmad SNA. Relations between clinical characteristics and cognitive deficits among adult patients diagnosed with major depressive disorder. Int J Psychiatry Clin Pract 2023; 27:219-231. [PMID: 36448673 DOI: 10.1080/13651501.2022.2149415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 10/20/2022] [Accepted: 11/08/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE The present study examined the relations between clinical characteristics and cognitive deficits in adult patients with major depressive disorder (MDD) from a local outpatient psychiatric clinic in Malaysia. METHODS The present sample included 110 participants aged 20-60 years old. Participants were invited to provide their information on sociodemographic variables (age, gender, and educational level) and clinical characteristics (age at onset of depression and duration of illness) and to complete a series of cognitive performance measures including the Trail Making Tests A (psychomotor speed) and B (executive function), the Digit Symbol Substitution Test (attention), and the Auditory Verbal Learning Test (immediate free recall, acquisition phase, and delayed recall). The Mini International Neuropsychiatric Interview Version 6.0 was used to confirm the diagnosis of MDD and the Montgomery-Åsberg Depression Rating Scale was used to assess illness severity. RESULTS At the bivariate level, relations of age and educational level to all cognitive deficit domains were significant. At the multivariate level, only educational level and illness severity consistently and significantly predicted all cognitive deficits domains. CONCLUSIONS Therapeutic modalities should be individualised whilst considering the impacts of cognitive deficits in an attempt to prevent further deterioration in psychosocial functioning of MDD patients.KEY POINTSCognitive deficits are an elemental component of Major Depressive Disorder (MDD) persisting during a current major depressive episode or during remission, altering individuals' ability to process information and changes the way they perceive and interact with the environment.Cognitive deficits in MDD are evident among the upper-middle income groups in South-Eastern Asian countries warranting more local research as such deficits could lead to functional decline and work performance such as absenteeism and presenteeism.Therapeutic modalities should be individualised by taking the impacts of cognitive deficits into consideration to promote psychosocial functioning of MDD patients.
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Affiliation(s)
- Natasha Subhas
- Department of Psychiatry and Mental Health, Hospital Kuala Lumpur, Ministry of Health, Kuala Lumpur, Malaysia
| | - Jin Kiat Ang
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Kit-Aun Tan
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Siti Nor Aizah Ahmad
- Department of Psychiatry and Mental Health, Hospital Umum Sarawak, Ministry of Health, Kuching, Malaysia
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Magill E, Demartis S, Gavini E, Permana AD, Thakur RRS, Adrianto MF, Waite D, Glover K, Picco CJ, Korelidou A, Detamornrat U, Vora LK, Li L, Anjani QK, Donnelly RF, Domínguez-Robles J, Larrañeta E. Solid implantable devices for sustained drug delivery. Adv Drug Deliv Rev 2023; 199:114950. [PMID: 37295560 DOI: 10.1016/j.addr.2023.114950] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 06/02/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023]
Abstract
Implantable drug delivery systems (IDDS) are an attractive alternative to conventional drug administration routes. Oral and injectable drug administration are the most common routes for drug delivery providing peaks of drug concentrations in blood after administration followed by concentration decay after a few hours. Therefore, constant drug administration is required to keep drug levels within the therapeutic window of the drug. Moreover, oral drug delivery presents alternative challenges due to drug degradation within the gastrointestinal tract or first pass metabolism. IDDS can be used to provide sustained drug delivery for prolonged periods of time. The use of this type of systems is especially interesting for the treatment of chronic conditions where patient adherence to conventional treatments can be challenging. These systems are normally used for systemic drug delivery. However, IDDS can be used for localised administration to maximise the amount of drug delivered within the active site while reducing systemic exposure. This review will cover current applications of IDDS focusing on the materials used to prepare this type of systems and the main therapeutic areas of application.
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Affiliation(s)
- Elizabeth Magill
- School of Pharmacy, Queen's University Belfast, 97, Lisburn Road, Belfast BT9 7BL, UK
| | - Sara Demartis
- Department of Chemical, Physical, Mathematical and Natural Sciences, University of Sassari, Sassari, 07100, Italy
| | - Elisabetta Gavini
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, 07100, Italy
| | - Andi Dian Permana
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Hasanuddin, Makassar 90245, Indonesia
| | - Raghu Raj Singh Thakur
- School of Pharmacy, Queen's University Belfast, 97, Lisburn Road, Belfast BT9 7BL, UK; Re-Vana Therapeutics, McClay Research Centre, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Muhammad Faris Adrianto
- School of Pharmacy, Queen's University Belfast, 97, Lisburn Road, Belfast BT9 7BL, UK; Re-Vana Therapeutics, McClay Research Centre, 97 Lisburn Road, Belfast BT9 7BL, UK; Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Airlangga University, Surabaya, East Java 60115, Indonesia
| | - David Waite
- School of Pharmacy, Queen's University Belfast, 97, Lisburn Road, Belfast BT9 7BL, UK; Re-Vana Therapeutics, McClay Research Centre, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Katie Glover
- School of Pharmacy, Queen's University Belfast, 97, Lisburn Road, Belfast BT9 7BL, UK
| | - Camila J Picco
- School of Pharmacy, Queen's University Belfast, 97, Lisburn Road, Belfast BT9 7BL, UK
| | - Anna Korelidou
- School of Pharmacy, Queen's University Belfast, 97, Lisburn Road, Belfast BT9 7BL, UK
| | - Usanee Detamornrat
- School of Pharmacy, Queen's University Belfast, 97, Lisburn Road, Belfast BT9 7BL, UK
| | - Lalitkumar K Vora
- School of Pharmacy, Queen's University Belfast, 97, Lisburn Road, Belfast BT9 7BL, UK
| | - Linlin Li
- School of Pharmacy, Queen's University Belfast, 97, Lisburn Road, Belfast BT9 7BL, UK
| | - Qonita Kurnia Anjani
- School of Pharmacy, Queen's University Belfast, 97, Lisburn Road, Belfast BT9 7BL, UK; Fakultas Farmasi, Universitas Megarezky, Jl. Antang Raya No. 43, Makassar 90234, Indonesia
| | - Ryan F Donnelly
- School of Pharmacy, Queen's University Belfast, 97, Lisburn Road, Belfast BT9 7BL, UK
| | - Juan Domínguez-Robles
- School of Pharmacy, Queen's University Belfast, 97, Lisburn Road, Belfast BT9 7BL, UK; Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, Universidad de Sevilla, 41012 Seville, Spain.
| | - Eneko Larrañeta
- School of Pharmacy, Queen's University Belfast, 97, Lisburn Road, Belfast BT9 7BL, UK.
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De las Cuevas C. Psychiatric Patients' Perceived Health Control and Reactance: Implications for Medication Adherence. Patient Prefer Adherence 2023; 17:1591-1601. [PMID: 37448759 PMCID: PMC10337681 DOI: 10.2147/ppa.s417608] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
Adherence to prescribed treatment is a major challenge in psychiatry, with non-adherence rates estimated to be as high as 50%. Two factors that have been suggested to influence medication adherence in psychiatric patients are perceived health control and psychological reactance. Perceived health control refers to the belief that one can control their own health outcomes, while psychological reactance refers to the negative response that occurs when individuals perceive their freedom or autonomy to be threatened. The aim of this review is to explore the possible relevance and interaction of perceived health control and psychological reactance in the adherence of psychiatric patients to their treatment. Several studies have suggested that higher levels of perceived health control are associated with better medication adherence, while higher levels of psychological reactance are associated with poorer adherence. Moreover, it has been suggested that patients with high levels of perceived health control may be more likely to experience psychological reactance if they feel that their autonomy is threatened by the treatment regimen. Taken together, these findings suggest that perceived health control and psychological reactance may interact to influence medication adherence in psychiatric patients. Future research could explore ways to enhance patients' perceived health control while minimizing psychological reactance in order to improve treatment adherence in this population.
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Affiliation(s)
- Carlos De las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry, Universidad de La Laguna, San Cristóbal de La Laguna, Canary Islands, Spain
- Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, San Cristóbal de La Laguna, Canary Islands, Spain
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Hadzi Boskovic D, Liang S, Parab P, Wiggins E, Liberman JN. Real-World Evidence of Aripiprazole Tablets with Sensor: Treatment Patterns and Impacts on Psychiatric Healthcare Resource Utilization. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:487-498. [PMID: 37377843 PMCID: PMC10292208 DOI: 10.2147/ceor.s402357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/18/2023] [Indexed: 06/29/2023] Open
Abstract
Purpose Maintaining adherence to antipsychotic (AP) medication is often challenging. Aripiprazole tablets with sensor (AS) contain an ingestible event marker and communicate with wearable patches and a smartphone app to provide objective medication ingestion data. This study evaluated real-world treatment patterns of AS usage and its impact on psychiatric healthcare resource utilization (HCRU). Patients and Methods This retrospective, observational cohort study identified individuals who initiated AS between 1/1/2019 and 6/30/2020 with 3 months baseline and 6 months of follow-up data using a commercial medical and pharmacy claims database (Clarivate). Controls were propensity score-matched (4:1) to AS initiators based on age (±2 years), sex, diagnosis (major depressive disorder [MDD], schizophrenia, bipolar I disorder [BP-I], other), insurance, and baseline oral AP use (yes/no). Days of AP supply were evaluated using a general regression model. The frequency of psychiatric HCRU during follow-up was compared between groups using a zero-inflated regression model. Results Most AS initiators were diagnosed with MDD (61.2%) and were women (61.2%); mean age was 37.7 years (standard deviation: 14.1). Most AS initiators (53.1%) continued treatment for >60 days (mean days of supply = 77). After adjusting for covariates, AS initiators had 41% more days of AP supply during follow-up compared with controls (P <0.0001) and significantly lower adjusted odds ratios (ORs) for psychiatric outpatient visits (adjusted OR = 0.80; P <0.05), emergency department visits (adjusted OR = 0.11; P <0.05), inpatient visits (adjusted OR = 0.42; P <0.05), and other medical services (adjusted OR = 0.25; P <0.05). Conclusion Participants who implemented AS had significantly more days of AP supply and fewer psychiatric care visits. These preliminary results suggest AS usage can help build regular medication-taking habits and holds promise for reducing psychiatric HCRU. Additional studies with larger sample sizes are warranted to inform clinical practice and coverage decisions.
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Breslau J, Haviland AM, Klein DJ, Martino S, Adams J, Dembosky JW, Tamayo L, Gaillot S, Overton Y, Elliott MN. Income-related disparities in Medicare advantage behavioral health care quality. Health Serv Res 2023; 58:579-588. [PMID: 36579742 PMCID: PMC10154171 DOI: 10.1111/1475-6773.14124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To inform efforts to improve equity in the quality of behavioral health care by examining income-related differences in performance on HEDIS behavioral health measures in Medicare Advantage (MA) plans. DATA SOURCES AND STUDY SETTING Reporting Year 2019 MA HEDIS data were obtained and analyzed. STUDY DESIGN Logistic regression models were used to estimate differences in performance related to enrollee income, adjusting for sex, age, and race-and-ethnicity. Low-income enrollees were identified by Dual Eligibility for Medicare and Medicaid or receipt of the Low-Income Subsidy (DE/LIS). Models without and with random effects for plans were used to estimate overall and within-plan differences in measure performance. Heterogeneity by race-and-ethnicity in the associations of low-income with behavioral health quality were examined using models with interaction terms. DATA COLLECTION/EXTRACTION METHODS Data were included for all MA contracts in the 50 states and the District of Columbia that collect HEDIS data. PRINCIPAL FINDINGS For six of the eight measures, enrollees with DE/LIS coverage were more likely to have behavioral health conditions that qualify for HEDIS measures than higher income enrollees. In mixed-effects logistic regression models, DE/LIS coverage was associated with statistically significantly worse overall performance on five measures, with four large (>5 percentage point) differences (-7.5 to -11.1 percentage points) related to follow-up after hospitalization and avoidance of drug-disease interactions. Where the differences were large, they were primarily within-plan rather than between-plan. Interactions between DE/LIS and race-and-ethnicity were statistically significant (p < 0.05) for all measures; income-based quality gaps were larger for White enrollees than for Black or Hispanic enrollees. CONCLUSIONS Low income is associated with lower performance on behavioral health HEDIS measures in MA, but these associations differ across racial-and-ethnic groups. Improving care integration and addressing barriers to care for low-income enrollees may improve equity across income levels in behavioral health care.
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Affiliation(s)
| | - Amelia M. Haviland
- RAND CorporationPittsburghPennsylvaniaUSA
- Public Policy & ManagementCarnegie Mellon UniversityPittsburghPennsylvaniaUSA
| | | | | | - John Adams
- Kaiser Permanente Center for Effectiveness & Safety Research and Kaiser Permanente Bernard J. Tyson School of MedicinePasadenaCaliforniaUSA
| | | | - Loida Tamayo
- Centers for Medicare & Medicaid ServicesBaltimoreMarylandUSA
| | - Sarah Gaillot
- Centers for Medicare & Medicaid ServicesBaltimoreMarylandUSA
| | - Yvette Overton
- Centers for Medicare & Medicaid ServicesBaltimoreMarylandUSA
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Pitanupong J, Sammathit J. Knowledge and attitudes on medication adherence and residual symptoms in individuals with depression: a survey at a University Hospital. BMC Psychiatry 2023; 23:210. [PMID: 36991351 PMCID: PMC10053551 DOI: 10.1186/s12888-023-04706-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/21/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Depression is a common disease and the relapse of depression can cause functional impairment. Good medication adherence and relapse prevention should be targeted to achieve normal functioning. This study aimed to evaluate the levels of knowledge, attitude toward depression, and medication adherence among individuals with depression. METHODS A cross-sectional study surveyed Thai individuals with depression at the psychiatric outpatient clinic of Songklanagarind Hospital; from April to August 2022. The questionnaires inquired about:1) demographic information, 2) knowledge and attitude toward depression questionnaire, 3) the medication adherence scale in Thais (MAST), 4) the Patient Health Questionnaire-9 (PHQ-9), 5) the stigma questionnaire, 6) a patient-doctor relationship questionnaire (PDRQ-9), and 7) the Revised Thai Multidimensional Scale of Perceived Social Support (rMSPSS). All data were analyzed using descriptive statistics. Chi-square or Fisher's exact test, and Wilcoxon rank sum test were used. RESULTS Of all 264 participants, the majority of them were female (78.4%). The overall mean age was 42.3 ± 18.3 years. Most participants had good knowledge and a positive attitude regarding any relationship problems, childhood trauma or bad memories, or having a chemical imbalance in the brain as one of the main causes that result in depression (86.4, 82.6, 77.3%, respectively). They disagreed with common stereotypical assumptions towards individuals with depression. Most of them had good medication adherence (97.0%), low or no level of stigma (92.5%), high perceived social support from family (64.4%), and good doctor-patient relationships (82.2%). Due to most participants reporting having good medication adherence, then an attempt to indicate the factors associated with medication adherence could not be established in this study. This study found that individuals reporting residual symptoms of depression had higher levels of knowledge and perceived stigma, but lower levels of family support compared to those without residual symptoms. CONCLUSION Most participants reported good knowledge and a positive attitude toward depression. They exhibited good medication adherence, a low level of stigma, and a high level of social support. This study revealed a correlation between the presence of residual symptoms of depression and increased levels of knowledge, perceived stigma, and reduced family support.
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Affiliation(s)
- Jarurin Pitanupong
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
| | - Jakkapon Sammathit
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
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Wang M, Liu Q, Yang X, Dou Y, Wang Y, Zhang Z, Luo R, Ma Y, Wang Q, Li T, Ma X. Relationship of insight to neurocognitive function and risk of recurrence in depression: A naturalistic follow-up study. Front Psychiatry 2023; 14:1084993. [PMID: 37009118 PMCID: PMC10060510 DOI: 10.3389/fpsyt.2023.1084993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/17/2023] [Indexed: 03/18/2023] Open
Abstract
IntroductionMajor depressive disorder (MDD) is a highly recurrent mental illness accompanied by impairment of neurocognitive function. Lack of insight may affect patients’ motivation to seek treatment, resulting in poor clinical outcomes. This study explores the relationship of insight to neurocognitive function and the risk of recurrence of depressive episodes in patients with MDD.MethodsDemographic, clinical variables, and neurocognitive function measured with Intra-Extra Dimensional Set Shift (IED) from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were collected from 277 patients with MDD. Among them, 141 participants completed a follow-up visit within 1–5 years. Insight was measured using the 17-item Hamilton Depression Rating Scale (HAM-D). To explore the factors associated with recurrence, binary logistic regression models were used.ResultsPatients with MDD, without insight, had significantly higher total and factor scores (anxiety/somatization, weight, retardation, and sleep) on the HAM-D and worse performance in the neurocognition task, compared to those with insight. Furthermore, binary logistic regression revealed that insight and retardation can predict recurrence.ConclusionLack of insight is associated with recurrence and impaired cognitive flexibility in patients with MDD.
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Affiliation(s)
- Min Wang
- Psychiatric Laboratory and Mental Health Center, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, China
- Huaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Qiong Liu
- Psychiatric Laboratory and Mental Health Center, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, China
- Huaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Xiao Yang
- Psychiatric Laboratory and Mental Health Center, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, China
- Huaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Yikai Dou
- Psychiatric Laboratory and Mental Health Center, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, China
- Huaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Yu Wang
- Psychiatric Laboratory and Mental Health Center, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, China
- Huaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Zijian Zhang
- Psychiatric Laboratory and Mental Health Center, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, China
- Huaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Ruiqing Luo
- Psychiatric Laboratory and Mental Health Center, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, China
- Huaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Yangrui Ma
- Golden Apple Jincheng No.1 Secondary School, Chengdu, China
| | - Qiang Wang
- Psychiatric Laboratory and Mental Health Center, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, China
- Huaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Tao Li
- Psychiatric Laboratory and Mental Health Center, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, China
- Huaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaohong Ma
- Psychiatric Laboratory and Mental Health Center, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, China
- Huaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
- *Correspondence: Xiaohong Ma,
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21
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Dhungana S, Rijal R, Regmi B, Bajracharya JS, Sharma S, Singh S, Karn N, Chapagai M. Protocol for the systematic review and meta-analysis of factors associated with non-adherence to antidepressants in depressive disorders in those more than 18 years of age. PLoS One 2023; 18:e0281366. [PMID: 36745620 PMCID: PMC9901773 DOI: 10.1371/journal.pone.0281366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/23/2023] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE We have developed a protocol for the systematic review and meta-analysis of the factors associated with nonadherence to antidepressants in depressive patients more than 18 years of age. METHODS We will search articles with the databases PubMed- Medline, Scopus, Embase and PsychINFO. All the published literature reporting factors associated with nonadherence to antidepressants in depressive disorders in patients more than 18 years of age and fulfilling all the eligibility criteria till October 2022 will be included. The data will then be extracted and examined to be included in the systematic review. Finally, we will conduct meta-analysis for factors associated with non-adherence. CONCLUSION We will do extensive search on the proposed topic within the available literature and come up with a robust review of factors associated with nonadherence to antidepressants in patients age more than 18 years globally. The evidence generated would assist in designing interventions to address non-adherence in this group of patients leading to better productivity and quality of life.
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Affiliation(s)
- Saraswati Dhungana
- Department of Psychiatry and Mental Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
- * E-mail: ,
| | | | - Binit Regmi
- Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | | | | | | | | | - Manisha Chapagai
- Department of Psychiatry and Mental Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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22
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Benatti B, Girone N, Conti D, Cocchi M, Achilli F, Leo S, Putti G, Bosi M, Dell’Osso B. The Role of Lifestyle on Adherence to Treatment in a Sample of Patients with Unipolar and Bipolar Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20031994. [PMID: 36767361 PMCID: PMC9915922 DOI: 10.3390/ijerph20031994] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 06/01/2023]
Abstract
Introduction: Poor adherence to treatment is currently stated to be one of the causes of depression relapse and recurrence. The aim of the present study is to assess potential differences in terms of clinical and lifestyle features related to adherence to treatment in a sample of patients with unipolar and bipolar depression. Methods: One hundred and eight patients with a diagnosis of unipolar or bipolar depressive episode were recruited from January 2021 to October 2022. Adherence to psychopharmacological treatment was assessed using the clinician rating scale. Descriptive and association analyses were performed to compare subgroups based on adherence to treatment. Results: Lower levels of adherence to treatment were associated with fewer years of education, work impairment, manic prevalent polarity lifetime, and greater comorbidity with alcohol and drug abuse. The majority of patients with positive adherence did not report any hospitalization and involuntary commitment lifetime. Conclusions: Patients with a positive treatment adherence showed significant differences in terms of lifestyle and clinical features compared to non-adherent patients. Our results may help to identify patients more likely to have poor medication adherence, which seem to lead to a worse disease course and quality of life.
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Affiliation(s)
- Beatrice Benatti
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, 20122 Milan, Italy
- “Aldo Ravelli” Center for Neurotechnology and Brain Therapeutic, University of Milan, 20122 Milan, Italy
| | - Nicolaja Girone
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, 20122 Milan, Italy
| | - Dario Conti
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, 20122 Milan, Italy
| | - Maddalena Cocchi
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, 20122 Milan, Italy
| | - Francesco Achilli
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, 20122 Milan, Italy
| | - Silvia Leo
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, 20122 Milan, Italy
| | - Gianmarco Putti
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, 20122 Milan, Italy
| | - Monica Bosi
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, 20122 Milan, Italy
| | - Bernardo Dell’Osso
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, 20122 Milan, Italy
- “Aldo Ravelli” Center for Neurotechnology and Brain Therapeutic, University of Milan, 20122 Milan, Italy
- Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford University, Stanford, CA 94305, USA
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23
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Leiz M, Pfeuffer N, Rehner L, Stentzel U, van den Berg N. Telemedicine as a Tool to Improve Medicine Adherence in Patients with Affective Disorders - A Systematic Literature Review. Patient Prefer Adherence 2022; 16:3441-3463. [PMID: 36605330 PMCID: PMC9809413 DOI: 10.2147/ppa.s388106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/17/2022] [Indexed: 12/31/2022] Open
Abstract
Affective disorders are a common psychological impairment. A major problem with respect to treatment is medication non-adherence. eHealth interventions are already widely used in the treatment of patients living with affective disorders. The aim of this systematic literature review is to obtain the current scientific evidence to eHealth as a tool to improve medication adherence in patients with affective disorders. A systematic search was performed across PubMed, Cochrane Library, Web of Science and PsycInfo. Studies in English and German published between 2007 and 2020 were included. The review followed the PRISMA guidelines and were performed with the CADIMA online tool. A total of 17 articles were included in this review. Eleven studies were randomized controlled trials, two were controlled clinical trials, and four had a pre-/post-design. Three different types of interventions could be identified: internet-based self-management programs (n=4), multi-faceted interventions addressing different dimensions of medication adherence (n=4), and single-faceted interventions (n=9) comprising four mobile interventions and five telehealth interventions. Eleven interventions addressed patients with (comorbid) depressions and six addressed patients with bipolar disorders. Six interventions showed a statistically significant positive effect on medication adherence. None of the studies showed a statistically significant negative effect. All interventions which had a statistically significant positive effect on medication adherence involved personal contacts between therapists and patients. All included eHealth interventions are at least as effective as control conditions and seems to be effective for patients with depression as well as with bipolar disorders. Personal contacts seem to improve the effectiveness of eHealth interventions. eHealth interventions are an effective way to improve medication adherence in patients with affective disorders. In rural or underserved regions, eHealth can supplement usual care interventions on medication adherence by expanding access. More analyses are needed in order to understand determinants for the effectiveness of eHealth interventions on medication adherence enhancement.
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Affiliation(s)
- Maren Leiz
- Institute for Community Medicine, University Medicine, Greifswald, Germany
| | - Nils Pfeuffer
- Institute for Community Medicine, University Medicine, Greifswald, Germany
| | - Laura Rehner
- Institute for Nursing Science and Interprofessional Learning, University Medicine, Greifswald, Germany
| | - Ulrike Stentzel
- Institute for Community Medicine, University Medicine, Greifswald, Germany
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González de León B, Abt-Sacks A, Acosta Artiles FJ, del Pino-Sedeño T, Ramos-García V, Rodríguez Álvarez C, Bejarano-Quisoboni D, Trujillo-Martín MM. Barriers and Facilitating Factors of Adherence to Antidepressant Treatments: An Exploratory Qualitative Study with Patients and Psychiatrists. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16788. [PMID: 36554679 PMCID: PMC9779577 DOI: 10.3390/ijerph192416788] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/30/2022] [Accepted: 12/10/2022] [Indexed: 06/17/2023]
Abstract
This study examines the experiences and expectations of patients with depressive disorders regarding the disease and different antidepressants, as well as examining the barriers and facilitating factors that could affect their adherence to medications. An exploratory qualitative study was carried out. The study involved two focus groups made up of patients and caregivers and six semi-structured interviews with psychiatrists. In both cases, the participants were selected by intentional theoretical sampling, seeking maximum significance variation of social types. Prejudice about the side effects of medication was relevant. The importance of patients being well informed about the disease/treatments was noteworthy. The stigmatization of antidepressants by patients was identified as a barrier to medication adherence. The involvement of family members and the motivation of patients to be actively involved in the process to recover from the disease were identified as facilitating factors. The work carried out suggests the need for patients to have rigorous information about the disease/treatment to reduce the possible prejudices generated by beliefs. Maintaining greater contact and monitoring of patients/caregivers to help therapeutic adherence in patients with depressive disorders was also identified as being of great importance.
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Affiliation(s)
- Beatriz González de León
- Multiprofessional Teaching Unit of Family and Community Care La Laguna-Tenerife Norte, Management of Primary Care of Tenerife, 38320 Santa Cruz de Tenerife, Spain
| | - Analía Abt-Sacks
- Canary Islands Health Research Institute Foundation, 38320 Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), 38109 Santa Cruz de Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 38109 Santa Cruz de Tenerife, Spain
| | - Francisco Javier Acosta Artiles
- Department of Mental Health, General Management of Healthcare Programs, Canary Islands Health Service, 35071 Las Palmas de Gran Canaria, Spain
- Research Network on Health Services for Chronic Conditions (REDISSEC), Carlos III Health Institute, 28029 Madrid, Spain
- Department of Psychiatry, Insular University Hospital of Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
| | - Tasmania del Pino-Sedeño
- Canary Islands Health Research Institute Foundation, 38320 Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), 38109 Santa Cruz de Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 38109 Santa Cruz de Tenerife, Spain
| | - Vanesa Ramos-García
- Canary Islands Health Research Institute Foundation, 38320 Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), 38109 Santa Cruz de Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 38109 Santa Cruz de Tenerife, Spain
| | | | - Daniel Bejarano-Quisoboni
- Research Network on Health Services for Chronic Conditions (REDISSEC), Carlos III Health Institute, 28029 Madrid, Spain
- Center for Public Health Research (CSISP-FISABIO), 46020 Valencia, Spain
- Institute of Biomedical Technologies, University of La Laguna, 38200 Santa Cruz de Tenerife, Spain
| | - María M. Trujillo-Martín
- Canary Islands Health Research Institute Foundation, 38320 Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), 38109 Santa Cruz de Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 38109 Santa Cruz de Tenerife, Spain
- Research Network on Health Services for Chronic Conditions (REDISSEC), Carlos III Health Institute, 28029 Madrid, Spain
- Institute of Biomedical Technologies, University of La Laguna, 38200 Santa Cruz de Tenerife, Spain
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25
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Slomp C, Morris E, Edwards L, Hoens AM, Landry G, Riches L, Ridgway L, Bryan S, Austin J. Pharmacogenomic Testing for Major Depression: A Qualitative Study of the Perceptions of People with Lived Experience and Professional Stakeholders. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022:7067437221140383. [PMID: 36437757 DOI: 10.1177/07067437221140383] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES With increasing evidence for the clinical utility of pharmacogenomic (PGx) testing for depression, there is a growing need to consider issues related to the clinical implementation of this testing. The perspectives of key stakeholders (both people with lived experience [PWLE] and providers) are critical, but not frequently explored. The purpose of this study was to understand how PWLE and healthcare providers/policy experts (P/HCPs) perceive PGx testing for depression, to inform the consideration of clinical implementation within the healthcare system in British Columbia (BC), Canada. METHODS We recruited two cohorts of participants to complete individual 1-h, semi-structured interviews: (a) PWLE, recruited from patient and research engagement networks and organizations and (b) P/HCPs, recruited via targeted invitation. Interviews were audiotaped, transcribed verbatim, de-identified, and analysed using interpretive description. RESULTS Seventeen interviews were completed with PWLE (7 with experience of PGx testing for depression; 10 without); 15 interviews were completed with P/HCPs (family physicians, psychiatrists, nurses, pharmacists, genetic counsellors, medical geneticists, lab technologists, program directors, and insurers). Visual models of PWLE's and P/HCP's perceptions of and attitudes towards PGx testing were developed separately, but both were heavily influenced by participants' prior professional and/or personal experiences with depression and/or PGx testing. Both groups expressed a need for evidence and numerous considerations for the implementation of PGx testing in BC, including the requirement for conclusive economic analyses, patient and provider education, technological and clinical support, local testing facilities, and measures to ensure equitable access to testing. CONCLUSIONS While hopeful about the potential for therapeutic benefit from PGx testing, PWLE and P/HCPs see the need for robust evidence of utility, and BC-wide infrastructure and policies to ensure equitable and effective access to PGx testing. Further research into the accessibility, effectiveness, and cost-effectiveness of various implementation strategies is needed to inform PGx testing use in BC.
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Affiliation(s)
- Caitlin Slomp
- Department of Psychiatry, 8166University of British Columbia, Vancouver, Canada
- BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada
| | - Emily Morris
- Department of Psychiatry, 8166University of British Columbia, Vancouver, Canada
- BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada
| | - Louisa Edwards
- School of Population & Public Health, 8166University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Alison M Hoens
- Department of Physical Therapy, 8166University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada
| | | | | | | | - Stirling Bryan
- School of Population & Public Health, 8166University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Jehannine Austin
- Department of Psychiatry, 8166University of British Columbia, Vancouver, Canada
- BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada
- Department of Medical Genetics, 8166University of British Columbia, Vancouver, Canada
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McCue M, Blair C, Fehnert B, King J, Cormack F, Sarkey S, Eramo A, Kabir C, Khatib R, Kemp D. Mobile App to Enhance Patient Activation and Patient-Provider Communication in Major Depressive Disorder Management: Collaborative, Randomized Controlled Pilot Study. JMIR Form Res 2022; 6:e34923. [PMID: 36301599 PMCID: PMC9650572 DOI: 10.2196/34923] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 06/21/2022] [Accepted: 06/27/2022] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Enhanced patient-provider engagement can improve patient health outcomes in chronic conditions, including major depressive disorder (MDD). OBJECTIVE We evaluated the impact of a digitally enabled care mobile app, Pathway, designed to improve MDD patient-provider engagement. Patients used a mobile interface to assess treatment progress and share this information with primary care providers (PCPs). METHODS In this 52-week, real-world effectiveness and feasibility study conducted in primary care clinics, 40 patients with MDD who were recently prescribed antidepressant monotherapy were randomized to use a mobile app with usual care (20/40, 50%) or usual care alone (20/40, 50%). Patients in the app arm engaged with the app daily for 18 weeks; a report was generated at 6-week intervals and shared with the PCPs to facilitate shared treatment decision-making discussions. The patients discontinued the app at week 18 and were followed through year 1. Coprimary outcome measures, assessed via research visits, included change from baseline in the 13-item Patient Activation Measure (PAM-13) and 7-item Patient-Provider Engagement Scale scores at week 18. Additional outcome measures included depression severity (9-item Patient Health Questionnaire [PHQ-9]) and cognitive symptoms (5-item Perceived Deficits Questionnaire-Depression). RESULTS All 37 patients (app arm: n=18, 49%; usual care arm: n=19, 51%) who completed the 18-week follow-up period (n=31, 84% female, mean age 36, SD 11.3 years) had moderate to moderately severe depression. Improvements in PAM-13 and PHQ-9 scores were observed in both arms. Increases in PAM-13 scores from baseline to 18 weeks were numerically greater in the app arm than in the usual care arm (mean 10.5, SD 13.2 vs mean 8.8, SD 9.4; P=.65). At 52 weeks, differences in PAM-13 scores from baseline demonstrated significantly greater improvements in the app arm than in the usual care arm (mean 20.2, SD 17.7 vs mean 1.6, SD 14.2; P=.04). Compared with baseline, PHQ-9 scores decreased in both the app arm and the usual care arm at 18 weeks (mean 7.8, SD 7.2 vs mean 7.0, SD 6.5; P=.73) and 52 weeks (mean 9.5, SD 4.0 vs mean 4.7, SD 6.0; P=.07). Improvements in 7-item Patient-Provider Engagement Scale and WHO-5 scores were observed in both arms at 18 weeks and were sustained through 52 weeks in the app arm. Improvements in WHO-5 scores at 52 weeks were significantly greater in the app arm than in the usual care arm (41.5 vs 20.0; P=.02). CONCLUSIONS Patients with MDD will engage with a mobile app designed to track treatment and disease progression. PCPs will use the data generated as part of their assessment to inform clinical care. The study results suggest that an app-enabled clinical care pathway may enhance patient activation and benefit MDD management. TRIAL REGISTRATION ClinicalTrials.gov NCT03242213; https://clinicaltrials.gov/ct2/show/NCT03242213.
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Affiliation(s)
- Maggie McCue
- Takeda Pharmaceuticals USA, Inc, Lexington, MA, United States
| | | | - Ben Fehnert
- Cognition Kit, Cambridge, United Kingdom
- Ctrl Group, London, United Kingdom
| | - James King
- Cognition Kit, Cambridge, United Kingdom
- Ctrl Group, London, United Kingdom
| | - Francesca Cormack
- Cognition Kit, Cambridge, United Kingdom
- Cambridge Cognition, Cambridge, United Kingdom
| | - Sara Sarkey
- Takeda Pharmaceuticals USA, Inc, Lexington, MA, United States
| | - Anna Eramo
- Lundbeck LLC, Deerfield, IL, United States
| | - Christopher Kabir
- Advocate Research Institute, Advocate Health Care, Downers Grove, IL, United States
| | - Rasha Khatib
- Advocate Research Institute, Advocate Health Care, Downers Grove, IL, United States
| | - David Kemp
- Advocate Aurora Health, Downers Grove, IL, United States
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Wang H, Liao Y, Guo L, Zhang H, Zhang Y, Lai W, Teopiz KM, Song W, Zhu D, Li L, Lu C, Fan B, McIntyre RS. Association between childhood trauma and medication adherence among patients with major depressive disorder: the moderating role of resilience. BMC Psychiatry 2022; 22:644. [PMID: 36241986 PMCID: PMC9563806 DOI: 10.1186/s12888-022-04297-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/04/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Suboptimal medication adherence is a major reason for failure in the management of major depressive disorder (MDD), childhood trauma might be an essential risk factor of suboptimal medication adherence. This study aimed to comprehensively explore the associations between different types of childhood trauma and medication adherence among patients with MDD, and to test whether resilience has moderating effects on the foregoing associations. METHODS Participants were from the Depression Cohort in China (ChiCTR registry number 1900022145), 282 MDD patients with completed both baseline and 12-weeks follow-up investigations were included in this study. The diagnosis of MDD was assessed by trained psychiatrists using the Mini-International Neuropsychiatric Interview (M.I.N.I.). Childhood trauma was evaluated using the Childhood Trauma Questionnaire-28 item Short Form (CTQ-SF), and resilience was evaluated using the Connor-Davidson Resilience Scale (CD-RISC). Demographic characteristics, depression symptoms, anxiety symptoms, suicidal ideation, suicidal attempt, insomnia symptoms, and painful somatic symptoms were also investigated. Participants were divided into groups of optimal and suboptimal adherence based on their Medication Adherence Rating Scale scores. Logistic regression and stratified analyses were performed. RESULTS A total of 234 participants (83%) reported suboptimal medication adherence. After adjusting for covariates, CTQ total scores (AOR = 1.03, 95%CI = 1.01-1.06), CTQ measures of sexual abuse (AOR = 1.17, 95%CI = 1.01-1.37), and CTQ measures of physical neglect (AOR = 1.12, 95%CI = 1.02-1.23) were all associated with an increased likelihood of suboptimal adherence. There were significant moderating effects of resilience on the associations of childhood trauma (P = 0.039) and physical neglect (P = 0.034) with medication adherence. The stratification analyses showed that CTQ total scores and CTQ measures of physical neglect were independently associated with an increased risk of suboptimal adherence among patients with MDD with low-resilience or moderate-resilience, while not significantly associated with suboptimal adherence in those with high-resilience. CONCLUSION Childhood trauma was a significant risk factor of suboptimal adherence among patients with MDD, and resilience moderated the foregoing association. Obtaining a history of childhood trauma and assessing resilience may help identify patients with suboptimal adherence when providing MDD pharmacotherapy. Psychiatrists may consider enhancing resilience to cope with the adverse effects of childhood trauma on medication adherence.
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Affiliation(s)
- Hongqiong Wang
- grid.12981.330000 0001 2360 039XDepartment of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Rd 2, Guangzhou, 510080 People’s Republic of China ,grid.12981.330000 0001 2360 039XGuangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-Sen University, Guangzhou, People’s Republic of China ,Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, People’s Republic of China
| | - Yuhua Liao
- grid.12981.330000 0001 2360 039XDepartment of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Rd 2, Guangzhou, 510080 People’s Republic of China ,grid.12981.330000 0001 2360 039XGuangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-Sen University, Guangzhou, People’s Republic of China ,Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, People’s Republic of China ,grid.512745.00000 0004 8015 6661Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, 7Huaming road, Shenzhen, 518000 People’s Republic of China
| | - Lan Guo
- grid.12981.330000 0001 2360 039XDepartment of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Rd 2, Guangzhou, 510080 People’s Republic of China ,grid.12981.330000 0001 2360 039XGuangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-Sen University, Guangzhou, People’s Republic of China ,Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, People’s Republic of China
| | - Huimin Zhang
- grid.512745.00000 0004 8015 6661Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, 7Huaming road, Shenzhen, 518000 People’s Republic of China
| | - Yingli Zhang
- grid.452897.50000 0004 6091 8446Department of Depressive Disorder, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, People’s Republic of China
| | - Wenjian Lai
- grid.12981.330000 0001 2360 039XDepartment of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Rd 2, Guangzhou, 510080 People’s Republic of China ,grid.12981.330000 0001 2360 039XGuangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-Sen University, Guangzhou, People’s Republic of China ,Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, People’s Republic of China
| | - Kayla M. Teopiz
- grid.17063.330000 0001 2157 2938Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8 Canada
| | - Weidong Song
- grid.512745.00000 0004 8015 6661Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, 7Huaming road, Shenzhen, 518000 People’s Republic of China
| | - Dongjian Zhu
- grid.512745.00000 0004 8015 6661Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, 7Huaming road, Shenzhen, 518000 People’s Republic of China
| | - Lingjiang Li
- grid.216417.70000 0001 0379 7164Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Rd 2, Guangzhou, 510080, People's Republic of China. .,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-Sen University, Guangzhou, People's Republic of China. .,Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, People's Republic of China.
| | - Beifang Fan
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, 7Huaming road, Shenzhen, 518000, People's Republic of China.
| | - Roger S. McIntyre
- grid.17063.330000 0001 2157 2938Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8 Canada ,grid.231844.80000 0004 0474 0428Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON M5T 2S8 Canada
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Vortioxetine for Major Depressive Disorder in Adolescents: 12-Week Randomized, Placebo-Controlled, Fluoxetine-Referenced, Fixed-Dose Study. J Am Acad Child Adolesc Psychiatry 2022; 61:1106-1118.e2. [PMID: 35033635 DOI: 10.1016/j.jaac.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 11/23/2021] [Accepted: 01/06/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of vortioxetine in adolescents with major depressive disorder (MDD). METHOD After 4 weeks of single-blind lead-in treatment with a Brief Psychosocial Intervention (BPI) plus placebo, patients (aged 12-17 years) with MDD (DSM-5) who did not meet response criteria (Children's Depression Rating Scale-Revised [CDRS-R]; total score ≥40 plus <40% reduction and a Parent Global Assessment score >2) were randomized 1:1:1:1 to 8 weeks of BPI plus double-blind treatment with vortioxetine 10 mg, vortioxetine 20 mg, fluoxetine 20 mg, or placebo. The primary endpoint was change from randomization in CDRS-R total score at week 8; the primary comparison was the average effect of 2 vortioxetine doses vs placebo. RESULTS Of 784 patients enrolled in the lead-in, 616 were randomized. At week 8, the mean change in CDRS-R total score averaged for vortioxetine doses was -18.01 (SE = 0.98) and the mean difference vs placebo was 0.21 (P = .878; not significant). For fluoxetine, the mean change in CDRS-R total score was -21.95 and the mean difference vs placebo was -3.73 (P = .015). Treatment-emergent adverse events occurring in ≥5% of patients in either vortioxetine arm and at least twice more frequently than placebo were nausea, headache, vomiting, and dizziness. CONCLUSION Patients in all groups showed reduction in CDRS-R scores by the end of the study, with no difference between combined doses of vortioxetine and placebo. The primary endpoint was not met, thereby rendering the study negative. The overall favorable safety profile of vortioxetine in an adolescent patient population was consistent with that seen in adults. CLINICAL TRIAL REGISTRATION INFORMATION Active Reference (Fluoxetine) Fixed-Dose Study of Vortioxetine in Paediatric Patients Aged 12 to 17 Years With Major Depressive Disorder (MDD); http://clinicaltrials.gov; NCT02709746.
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Rangu N, Frank-Pearce SG, Alexander AC, Hébert ET, Ra C, Kendzor DE, Businelle MS. Non-adherence to psychiatric medication in adults experiencing homelessness is associated with incurred concussions. Front Hum Neurosci 2022; 16:958169. [PMID: 35966999 PMCID: PMC9366846 DOI: 10.3389/fnhum.2022.958169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/13/2022] [Indexed: 11/24/2022] Open
Abstract
This study investigated the relationship between concussions and medication adherence among 247 adults experiencing homelessness in Oklahoma City, Oklahoma, who were prescribed medication for a psychiatric disorder. Participants were asked whether they had “ever experienced a blow to the head that caused a concussion,” and medication adherence was measured by asking participants whether they had taken their psychiatric medication yesterday. The data were analyzed using univariate and multivariable logistic regressions. Results showed that more than half of the sample had a concussion history (61.9%), and homeless adults with a concussion history had higher odds of non-adherence to psychiatric medications compared with those who reported no concussion history [OR = 2.13 (95% CI = 1.08, 4.18)]. Findings suggest that medication non-adherence is associated with incurred concussions. Raising awareness among service providers of the relationship between traumatic brain injury and medication adherence may increase efforts to improve adherence in this underserved population.
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Affiliation(s)
- Neal Rangu
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Sumer G. Frank-Pearce
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Adam C. Alexander
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- *Correspondence: Adam C. Alexander
| | - Emily T. Hébert
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Chaelin Ra
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Darla E. Kendzor
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Michael S. Businelle
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
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González de León B, del Pino-Sedeño T, Serrano-Pérez P, Rodríguez Álvarez C, Bejarano-Quisoboni D, Trujillo-Martín MM. Effectiveness of interventions to improve medication adherence in adults with depressive disorders: a meta-analysis. BMC Psychiatry 2022; 22:487. [PMID: 35858887 PMCID: PMC9301839 DOI: 10.1186/s12888-022-04120-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 07/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-adherence to medication is a major obstacle in the treatment of depressive disorders. We systematically reviewed the literature to evaluate the effectiveness of interventions aimed at improving adherence to medication among adults with depressive disorders with emphasis on initiation and implementation phase. METHODS We searched Medline, EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, Social Science Citation Index and Science Citation Index for randomized or non-randomized controlled trials up to January 2022. Risk of bias was assessed using the criteria of the Cochrane Collaboration. Meta-analyses, cumulative and meta-regression analyses for adherence were conducted. RESULTS Forty-six trials (n = 24,324) were included. Pooled estimate indicates an increase in the probability of adherence to antidepressants at 6 months with the different types of interventions (OR 1.33; 95% CI: 1.09 to 1.62). The improvement in adherence is obtained from 3 months (OR 1.62, 95% CI: 1.25 to 2.10) but it is attenuated at 12 months (OR 1.25, 95% CI: 1.02 to 1.53). Selected articles show methodological differences, mainly the diversity of both the severity of the depressive disorder and intervention procedures. In the samples of these studies, patients with depression and anxiety seem to benefit most from intervention (OR 2.77, 95% CI: 1.74 to 4.42) and collaborative care is the most effective intervention to improve adherence (OR 1.88, 95% CI: 1.40 to 2.54). CONCLUSIONS Our findings indicate that interventions aimed at improving adherence to medication among adults with depressive disorders are effective up to six months. However, the evidence on the effectiveness of long-term adherence is insufficient and supports the need for further research efforts. TRIAL REGISTRATION International Prospective Register for Systematic Reviews (PROSPERO) number: CRD42017065723 .
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Affiliation(s)
- Beatriz González de León
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria “La Laguna ‑ Tenerife Norte”, Gerencia de Atención Primaria del Área de Salud de Tenerife, Santa Cruz de Tenerife, Spain
| | - Tasmania del Pino-Sedeño
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Spain ,grid.467039.f0000 0000 8569 2202Servicio de Evaluación y Planificación del Servicio Canario de La Salud, Santa Cruz de Tenerife, Spain
| | - Pedro Serrano-Pérez
- grid.411083.f0000 0001 0675 8654Servicio de Psiquiatría, Hospital Universitario Vall d’Hebron, Barcelona, Spain ,grid.7080.f0000 0001 2296 0625Departamento de Psiquiatría Y Medicina Legal, Universidad Autónoma de Barcelona, Barcelona, Spain ,grid.430994.30000 0004 1763 0287Grupo de Investigación en Psiquiatría, Salud Mental Y Adicciones, Vall d’Hebron Instituto de Investigación (VHIR), Barcelona, Spain
| | - Cristobalina Rodríguez Álvarez
- grid.10041.340000000121060879Campus Ciencias de La Salud. Área de Medicina Preventiva y Salud Pública. Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Daniel Bejarano-Quisoboni
- Centro Superior de Investigación en Salud Pública (CSISP-FISABIO), Valencia, Spain ,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - María M. Trujillo-Martín
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Spain ,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
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Park KH, Tickle L, Cutler H. A systematic review and meta-analysis on impact of suboptimal use of antidepressants, bisphosphonates, and statins on healthcare resource utilisation and healthcare cost. PLoS One 2022; 17:e0269836. [PMID: 35767543 PMCID: PMC9242484 DOI: 10.1371/journal.pone.0269836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 05/28/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Depression, osteoporosis, and cardiovascular disease impose a heavy economic burden on society. Understanding economic impacts of suboptimal use of medication due to nonadherence and non-persistence (non-MAP) for these conditions is important for clinical practice and health policy-making. OBJECTIVE This systematic literature review aims to assess the impact of non-MAP to antidepressants, bisphosphonates and statins on healthcare resource utilisation and healthcare cost (HRUHC), and to assess how these impacts differ across medication classes. METHODS A systematic literature review and an aggregate meta-analysis were performed. Using the search protocol developed, PubMed, Cochrane Library, ClinicalTrials.gov, JSTOR and EconLit were searched for articles that explored the relationship between non-MAP and HRUHC (i.e., use of hospital, visit to healthcare service providers other than hospital, and healthcare cost components including medical cost and pharmacy cost) published from November 2004 to April 2021. Inverse-variance meta-analysis was used to assess the relationship between non-MAP and HRUHC when reported for at least two different populations. RESULTS Screening 1,123 articles left 10, seven and 13 articles on antidepressants, bisphosphonates, and statins, respectively. Of those, 27 were rated of good quality, three fair and none poor using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. In general, non-MAP was positively associated with HRUHC for all three medication classes and most prominently for bisphosphonates, although the relationships differed across HRUHC components and medication classes. The meta-analysis found that non-MAP was associated with increased hospital cost (26%, p = 0.02), outpatient cost (10%, p = 0.01), and total medical cost excluding pharmacy cost (12%, p<0.00001) for antidepressants, and increased total healthcare cost (3%, p = 0.07) for bisphosphonates. CONCLUSIONS This systematic literature review is the first to compare the impact of non-MAP on HRUHC across medications for three prevalent conditions, depression, osteoporosis and cardiovascular disease. Positive relationships between non-MAP and HRUHC highlight inefficiencies within the healthcare system related to non-MAP, suggesting a need to reduce non-MAP in a cost-effective way.
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Affiliation(s)
- Kyu Hyung Park
- Macquarie Business School, Macquarie University, North Ryde, New South Wales, Australia
| | - Leonie Tickle
- Macquarie Business School, Macquarie University, North Ryde, New South Wales, Australia
| | - Henry Cutler
- Macquarie Business School, Macquarie University, North Ryde, New South Wales, Australia
- Macquarie University Centre for the Health Economy, North Ryde, Australia
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Kim M, Choi EJ, Kwon OJ, Park HJ, Kim AR, Seo BN, Chung SY, Lee JH, Kim JH. Electroacupuncture plus moxibustion for major depressive disorder: A randomized, sham-controlled, pilot clinical trial. Integr Med Res 2022; 11:100802. [PMID: 34840949 PMCID: PMC8605331 DOI: 10.1016/j.imr.2021.100802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/14/2021] [Accepted: 10/21/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The first treatment option for major depressive disorder (MDD) is antidepressants, however, there is substantial demand for alternative therapies due to its low compliance and remission rates. This study was aimed to explore the effectiveness, safety, and feasibility of electroacupuncture plus moxibustion therapy for MDD. METHODS Thirty adults with MDD were randomly assigned to the treatment group (TG) or control group (CG). The TG was treated with electroacupuncture plus moxibustion, and the CG received sham interventions at non-acupoints for 8 weeks. The primary outcome measure was the intergroup difference of the mean change of total score of the Hamilton rating scale for depression (HRSD) between baseline and week 9. Secondary outcome measures were Beck's depression inventory, insomnia severity index, the state-trait anxiety inventory, the EuroQol-5 dimension index, the measure yourself medical outcome profile version 2, and frontal alpha asymmetry measured by electroencephalography. Adverse events (AEs) were monitored for safety assessment. RESULTS The primary outcome measure was not significantly different between the two groups (p=0.2641), although the scores of HRSD in both groups improved significantly after treatment. No significant difference was identified between groups in secondary outcome measures. The incidence of AE was not significantly different between the two groups (p=0.1067). CONCLUSION A clinical trial using electroacupuncture plus moxibustion for MDD seems feasible. However, further studies with the larger size, adopting ideal controls are warranted to provide a confirmative conclusion to the efficacy and safety of electroacupuncture plus moxibustion for MDD. TRIAL REGISTRATION The protocol was registered at Korean Clinical Trial Registry (CRIS-KCT0001810).
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Affiliation(s)
- Mikyung Kim
- Department of Internal Medicine, College of Korean Medicine, Sangji University, Wonju, Republic of Korea
| | - Eun-Ji Choi
- Haneum Neuropsychiatry Clinic of Korean Medicine, Cheonan, Republic of Korea
| | - O-Jin Kwon
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Deajeon, Republic of Korea
| | - Hyo-Ju Park
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Deajeon, Republic of Korea
| | - Ae-Ran Kim
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Deajeon, Republic of Korea
| | - Bok-Nam Seo
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Deajeon, Republic of Korea
| | - Sun-Yong Chung
- Department of Neuropsychiatry, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jun-Hwan Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Deajeon, Republic of Korea
- Korean Medicine Life Science, University of Science & Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Joo-Hee Kim
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Sangji University, Wonju, Republic of Korea
- Research institute of Korean medicine, Sangji University, Wonju, Republic of Korea
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Picco CJ, Domínguez-Robles J, Utomo E, Paredes AJ, Volpe-Zanutto F, Malinova D, Donnelly RF, Larrañeta E. 3D-printed implantable devices with biodegradable rate-controlling membrane for sustained delivery of hydrophobic drugs. Drug Deliv 2022; 29:1038-1048. [PMID: 35363100 PMCID: PMC8979538 DOI: 10.1080/10717544.2022.2057620] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Implantable drug delivery systems offer an alternative for the treatments of long-term conditions (i.e. schizophrenia, HIV, or Parkinson’s disease among many others). The objective of the present work was to formulate implantable devices loaded with the model hydrophobic drug olanzapine (OLZ) using robocasting 3D-printing combined with a pre-formed rate controlling membrane. OLZ was selected as a model molecule due to its hydrophobic nature and because is a good example of a molecule used to treat a chronic condition schizophrenia. The resulting implants consisted of a poly(ethylene oxide) (PEO) implant coated with a poly(caprolactone) (PCL)-based membrane. The implants were loaded with 50 and 80% (w/w) of OLZ. They were prepared using an extrusion-based 3D-printer from aqueous pastes containing 36–38% (w/w) of water. The printing process was carried out at room temperature. The resulting implants were characterized by using infrared spectroscopy, scanning electron microscopy, thermal analysis, and X-ray diffraction. Crystals of OLZ were present in the implant after the printing process. In vitro release studies showed that implants containing 50% and 80% (w/w) of OLZ were capable of providing drug release for up to 190 days. On the other hand, implants containing 80% (w/w) of OLZ presented a slower release kinetics. After 190 days, total drug release was ca. 77% and ca. 64% for implants containing 50% and 80% (w/w) of OLZ, respectively. The higher PEO content within implants containing 50% (w/w) of OLZ allows a faster release as this polymer acts as a co-solvent of the drug.
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Affiliation(s)
- Camila J Picco
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | | | - Emilia Utomo
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | | | | | - Dessislava Malinova
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
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Ruetsch C, Liberman J, Davis T, Sajatovic M, Velligan D, Forma F. The Effect of Objectively Collected Medication Adherence Information on Bipolar I and Major Depressive Disorder Treatment Decisions: A Randomized Case Vignette Study of Psychiatric Clinicians. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Riveros ME, Ávila A, Schruers K, Ezquer F. Antioxidant Biomolecules and Their Potential for the Treatment of Difficult-to-Treat Depression and Conventional Treatment-Resistant Depression. Antioxidants (Basel) 2022; 11:540. [PMID: 35326190 PMCID: PMC8944633 DOI: 10.3390/antiox11030540] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 11/23/2022] Open
Abstract
Major depression is a devastating disease affecting an increasing number of people from a young age worldwide, a situation that is expected to be worsened by the COVID-19 pandemic. New approaches for the treatment of this disease are urgently needed since available treatments are not effective for all patients, take a long time to produce an effect, and are not well-tolerated in many cases; moreover, they are not safe for all patients. There is solid evidence showing that the antioxidant capacity is lower and the oxidative damage is higher in the brains of depressed patients as compared with healthy controls. Mitochondrial disfunction is associated with depression and other neuropsychiatric disorders, and this dysfunction can be an important source of oxidative damage. Additionally, neuroinflammation that is commonly present in the brain of depressive patients highly contributes to the generation of reactive oxygen species (ROS). There is evidence showing that pro-inflammatory diets can increase depression risk; on the contrary, an anti-inflammatory diet such as the Mediterranean diet can decrease it. Therefore, it is interesting to evaluate the possible role of plant-derived antioxidants in depression treatment and prevention as well as other biomolecules with high antioxidant and anti-inflammatory potential such as the molecules paracrinely secreted by mesenchymal stem cells. In this review, we evaluated the preclinical and clinical evidence showing the potential effects of different antioxidant and anti-inflammatory biomolecules as antidepressants, with a focus on difficult-to-treat depression and conventional treatment-resistant depression.
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Affiliation(s)
- María Eugenia Riveros
- Centro de Fisiología Celular e Integrativa, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago 7710162, Chile
| | - Alba Ávila
- Centro de Medicina Regenerativa, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago 7710162, Chile;
| | - Koen Schruers
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, 6229 Maastricht, The Netherlands;
| | - Fernando Ezquer
- Centro de Medicina Regenerativa, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago 7710162, Chile;
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Liu R, Xu X, Zou S, Li Y, Wang H, Yan X, Du X, Zhang L, Zhang Q, Li W, Cheung T, Ungvari GS, Ng CH, Xiang YT. Prevalence of Suicidality and its Association with Quality of Life in Older Patients with Clinically Stable Psychiatric Disorders in China During the COVID-19 Pandemic. J Geriatr Psychiatry Neurol 2022; 35:237-244. [PMID: 35246000 PMCID: PMC8899831 DOI: 10.1177/08919887221078557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIMS The pattern of suicidality in older patients with psychiatric disorders during the COVID-19 pandemic is not clear. This study examined the prevalence of suicidality and its association with quality of life (QOL) among older clinically stable patients with psychiatric disorders during the COVID-19 pandemic. METHODS A multicenter, cross-sectional study was conducted from May 22 to July 15, 2020, among four major tertiary psychiatric hospitals in China. Suicidality was assessed by asking 3 standardized questions. Depressive symptoms, pain, and QOL were assessed with the 9-item Patient Health Questionnaire (PHQ-9), the numeric pain rating scale (NPRS), and the World Health Organization Quality of Life Questionnaire-brief version, respectively. RESULTS A total of 1063 clinically stable patients participated and completed the assessment. The prevalence of suicidality was 11.8% (95% CI: 9.9%-13.7%) during the COVID-19 pandemic. Multiple logistic regression analysis revealed that poor treatment adherence (P = .009, OR = 1.86, 95% CI: 1.17-2.96) and perceived illness worsening during the COVID-19 outbreak (P = .02, OR = 2.07, 95% CI: 1.15-3.73), being diagnosed with major depressive disorder (P < .001, OR = 2.79, 95% CI: 1.68-4.64), PHQ-9 total score (P < .001, OR = 1.20, 95% CI: 1.15-1.24) and NPRS total score (P = .002, OR = 1.17, 95% CI: 1.06-1.29) were associated with higher risk of suicidality. After controlling for covariates, older psychiatric patients with suicidality had lower QOL compared to those without (F(1, 1063) =16.5, P<.001). CONCLUSIONS Suicidality was common in older patients with clinically stable psychiatric disorders during the COVID-19 pandemic. Considering its negative impact on QOL and personal suffering, routine screening and preventive suicide measures should be implemented for older psychiatric patients.
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Affiliation(s)
- Rui Liu
- Unit of Psychiatry, Department of
Public Health and Medicinal Administration, Institute of Translational Medicine,
Faculty of Health Sciences, University of
Macau, Macao SAR, China
- Centre for Cognitive and Brain
Sciences, University
of Macau, Macao SAR, China
- Institute of Advanced Studies in
Humanities and Social Sciences, University of
Macau, Macao SAR, China
- The National Clinical Research
Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders
Beijing Anding Hospital & the Advanced Innovation Center for Human Brain
Protection, School of Mental Health, Capital Medical
University, Beijing, China
| | - Xiuying Xu
- Department of Psychiatry,
Xiamen
Xianyue Hospital, Xiamen, China
| | - Siyun Zou
- Medical College of Soochow
University, Jiangsu province,
China
- Guangji Hospital Affiliated to Soochow
University, Jiangsu province,
China
| | - Yulong Li
- Department of Psychiatry,
Lanzhou
University Second Hospital, Gansu
province, China
| | - Huan Wang
- Department of Psychiatry,
Lanzhou
University Second Hospital, Gansu
province, China
| | - Xiaona Yan
- Department of Psychiatry,
Xiamen
Xianyue Hospital, Xiamen, China
| | - Xiangdong Du
- Medical College of Soochow
University, Jiangsu province,
China
- Guangji Hospital Affiliated to Soochow
University, Jiangsu province,
China
| | - Lan Zhang
- Department of Psychiatry,
Lanzhou
University Second Hospital, Gansu
province, China
| | - Qinge Zhang
- The National Clinical Research
Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders
Beijing Anding Hospital & the Advanced Innovation Center for Human Brain
Protection, School of Mental Health, Capital Medical
University, Beijing, China
| | - Wen Li
- Unit of Psychiatry, Department of
Public Health and Medicinal Administration, Institute of Translational Medicine,
Faculty of Health Sciences, University of
Macau, Macao SAR, China
- Centre for Cognitive and Brain
Sciences, University
of Macau, Macao SAR, China
- Institute of Advanced Studies in
Humanities and Social Sciences, University of
Macau, Macao SAR, China
| | - Teris Cheung
- School of Nursing,
Hong Kong
Polytechnic University, Hong Kong SAR,
China
| | - Gabor S. Ungvari
- Division of Psychiatry, School of
Medicine, University of Western Australia,
Perth, NSW, Australia
- University of Notre Dame
Australia, Fremantle, WA,
Australia
| | - Chee H. Ng
- Department of Psychiatry, The
Melbourne Clinic and St Vincent’s Hospital, University of
Melbourne, Richmond, VIC, Australia
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of
Public Health and Medicinal Administration, Institute of Translational Medicine,
Faculty of Health Sciences, University of
Macau, Macao SAR, China
- Centre for Cognitive and Brain
Sciences, University
of Macau, Macao SAR, China
- Institute of Advanced Studies in
Humanities and Social Sciences, University of
Macau, Macao SAR, China
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Touya M, Lawrence DF, Kangethe A, Chrones L, Evangelatos T, Polson M. Incremental burden of relapse in patients with major depressive disorder: a real-world, retrospective cohort study using claims data. BMC Psychiatry 2022; 22:152. [PMID: 35232411 PMCID: PMC8886836 DOI: 10.1186/s12888-022-03793-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Relapse is common in major depressive disorder (MDD). In this study, we evaluated the incremental health care burden of relapse in patients with MDD. METHODS This real-world retrospective cohort study used administrative medical and pharmacy claims data to identify commercially insured adult patients in the United States diagnosed with MDD who initiated a new antidepressant between January 1, 2012, and September 30, 2017. All-cause health care resource utilization, total costs, and medication adherence were evaluated in two cohorts: patients with and patients without relapse. Relapse was defined as suicide attempts, psychiatric hospitalization, mental health-related emergency department (ED) visit, use of electroconvulsive therapy, or reinitiation of treatment after a gap ≥6 months. RESULTS The study population included 14,186 patients (7093 baseline-matched patients per cohort). The mean follow-up period was 27.5 and 26.0 months for patients with and patients without relapse, respectively. Patients with relapse had significantly higher rates of hospitalization (16.6% vs 8.5%; p < .0001) and ED visits (54.8% vs 34.7%; p < .0001) than patients without relapse. The total costs for patients with relapse were significantly higher ($12,594 vs $10,445; p < .0001). Patients with relapse were also less adherent to antidepressants (mean proportion of days covered, 0.43 vs 0.49; p < .0001). CONCLUSIONS Relapse of MDD was associated with increased total costs and health care utilization and lower adherence to antidepressants. Reducing the risk of relapse may result in a reduction of the associated health care burden; however, findings may only be generalizable to patients with commercial insurance.
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Affiliation(s)
- Maëlys Touya
- Lundbeck LLC, 6 Parkway North, Deerfield, IL, 60015, USA.
| | - Debra F. Lawrence
- grid.419849.90000 0004 0447 7762Takeda Pharmaceuticals U.S.A., Inc, Lexington, MA USA
| | | | - Lambros Chrones
- grid.419849.90000 0004 0447 7762Takeda Pharmaceuticals U.S.A., Inc, Lexington, MA USA
| | - Themmi Evangelatos
- grid.419849.90000 0004 0447 7762Takeda Pharmaceuticals U.S.A., Inc, Lexington, MA USA
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A Delphi-method-based consensus guideline for definition of treatment-resistant depression for clinical trials. Mol Psychiatry 2022; 27:1286-1299. [PMID: 34907394 PMCID: PMC9095475 DOI: 10.1038/s41380-021-01381-x] [Citation(s) in RCA: 73] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/11/2021] [Accepted: 10/26/2021] [Indexed: 12/22/2022]
Abstract
Criteria for treatment-resistant depression (TRD) and partially responsive depression (PRD) as subtypes of major depressive disorder (MDD) are not unequivocally defined. In the present document we used a Delphi-method-based consensus approach to define TRD and PRD and to serve as operational criteria for future clinical studies, especially if conducted for regulatory purposes. We reviewed the literature and brought together a group of international experts (including clinicians, academics, researchers, employees of pharmaceutical companies, regulatory bodies representatives, and one person with lived experience) to evaluate the state-of-the-art and main controversies regarding the current classification. We then provided recommendations on how to design clinical trials, and on how to guide research in unmet needs and knowledge gaps. This report will feed into one of the main objectives of the EUropean Patient-cEntric clinicAl tRial pLatforms, Innovative Medicines Initiative (EU-PEARL, IMI) MDD project, to design a protocol for platform trials of new medications for TRD/PRD.
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"Supporting Wellness": A depression and bipolar support alliance mixed-methods investigation of lived experience perspectives and priorities for mood disorder treatment. J Affect Disord 2022; 299:575-584. [PMID: 34942220 DOI: 10.1016/j.jad.2021.12.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/08/2021] [Accepted: 12/12/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The lived experience of people with mood disorders may be leveraged to inform priorities for research, define key treatment outcomes, and support decision-making in clinical care. The aim of this mixed-methods project was to provide insight into how people with depression and bipolar disorder experience the impact of symptoms, their treatment preferences, and their definitions of wellness. METHODS The project was implemented in two phases. In Phase 1, community-based participatory research was used to develop a web-based survey enquiring about living with a mood disorder, treatment experiences, and wellness priorities. In Phase 2, a series of focus groups were conducted to explore aspects of wellness in greater detail. RESULTS Respondents (n= 6153) described the symptoms of mood disorders as having a significant, chronic impact on their lives. A holistic approach to treatment was desired by participants, but not necessarily experienced. Qualitative findings were used to further describe four highly ranked wellness priorities identified in the survey: ability to act independently or according to my own will; purpose in life; getting through the day; and contentment. LIMITATIONS Experience of a mood disorder was self-reported, and no formal confirmation of diagnosis occurred. Although the survey could not incorporate all possible wellness definitions, this was supplemented by qualitative focus groups. CONCLUSION The present findings provide important insights from the perspectives of individuals with lived experience of mood disorders. Implications of this for research and clinical practice are discussed, particularly with regards to measurement-based care and use of wellness-oriented clinical outcome assessments.
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Yonatan-Leus R, Abargil M, Cooper-Kazaz R. The combined effect of psychodynamic psychotherapy and pharmacotherapy on healthcare cost. Psychother Res 2022; 32:874-885. [PMID: 35118912 DOI: 10.1080/10503307.2022.2032861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Previous studies have established a connection between therapy and healthcare cost: an increase in cost prior to therapy and a maintained decrease post therapy. There is, however, a lack of studies examining the combined effects of psychotherapy and pharmacotherapy on healthcare cost. METHOD Healthcare cost was examined quarterly in 1,213 patients (28,776 observations) in a naturalistic longitudinal design. Psychotherapy only was compared to combined treatment and to an addition of psychotherapy to preexisting pharmacotherapy. The comparisons were conducted with a multilevel piecewise model (LMLM) computed for three phases: pre-, during-, and post-therapy. RESULTS Significant interactions were found between the contrast comparing preexisting pharmacotherapy to the during-psychotherapy and no-pharmacotherapy groups and the three piecewise variables. The pre-therapy increase was larger for the preexisting-pharmacotherapy group than for the other groups. The during-therapy decrease was larger for the preexisting-pharmacotherapy group than for the other groups. In the post-therapy period, the increase was significant only for the prior-psychiatric-medication group. CONCLUSIONS Preexisting psychotropic treatment along with an increase in healthcare expenditure may serve as an indication of the need for additional psychotherapy treatment.
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Affiliation(s)
- Refael Yonatan-Leus
- Department of Psychology the College of Management Academic Studies- Rishon Lezion, Israel.,Clalit Health Services - Jerusalem, Israel
| | - Maayan Abargil
- Department of Psychology, Hebrew University of Jerusalem, Israel
| | - Rena Cooper-Kazaz
- Clalit Health Services -Jerusalem. Affiliated with The Faculty of Medicine at The Hebrew University Jerusalem, Israel
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Breeden M, Gillis A, Salas J, Scherrer JF. Antidepressant treatment and blood pressure control in patients with comorbid depression and treatment resistant hypertension. J Psychosom Res 2022; 153:110692. [PMID: 34906849 DOI: 10.1016/j.jpsychores.2021.110692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/12/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Though inconsistent, the majority of studies support an association between depression and incident hypertension and poor blood pressure control. However, none have investigated whether antidepressant medication (ADM) therapy is associated with blood pressure control in patients with comorbid depression and treatment resistant hypertension. METHODS Optum® de-identified Electronic Health Record data (2010-2018) were used to create a retrospective cohort of patients (≥18 years of age) with comorbid depression and treatment resistant hypertension. Patients were categorized into adequate ADM, inadequate ADM and no ADM treatment. A modified Poisson regression approach with robust error variance was used to estimate the association between ADM status and blood pressure control before and after adjusting for covariates. RESULTS Patients were, on average, 55.7 (SD ± 9.9) years of age, 63.9% were female, 76.2% were white and 19.2% Black race. In crude models, inadequate ADM (RR = 1.06; 95%CI:1.01-1.11) and adequate ADM (RR = 1.08; 95%CI:1.03-1.14), compared to no ADM treatment, were associated with blood pressure control. After adjusting for covariates this relationship was attenuated and no longer significant. CONCLUSIONS The modest association between ADM therapy and blood pressure control in patients with treatment resistant hypertension is largely explained by traditional risk factors for hypertension such as obesity and older age. Treating depression is not a robust factor in blood pressure control among those with treatment resistant hypertension.
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Affiliation(s)
- Matthew Breeden
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA.
| | - Auston Gillis
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA; Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA; Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA
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Pharmacists and community health workers improve medication-related process outcomes among Cambodian Americans with depression and risk for diabetes. J Am Pharm Assoc (2003) 2022; 62:496-504.e1. [PMID: 34838475 PMCID: PMC8934259 DOI: 10.1016/j.japh.2021.10.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/14/2021] [Accepted: 10/27/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cambodian Americans have high rates of cardiometabolic and psychiatric disorders and disadvantaged social determinants of health (SDOH). These factors can make it challenging to resolve drug therapy problems (DTPs) and improve medication-related outcomes. This manuscript reports planned analyses from a randomized controlled trial in which participants were randomized to one of 3 treatment arms: (1) community health worker (CHW)-delivered lifestyle intervention called Eat, Walk, sleep (EWS), (2) EWS plus pharmacist/CHW-delivered medication therapy management (EWS + MTM), or (3) social services (SS: control). OBJECTIVES We compared the 3 arms on changes in self-reported medication adherence, barriers, and beliefs. Within the EWS + MTM arm only, we assessed the impact of EWS + MTM on DTP resolution and examined predictors of DTP resolution. METHODS Cambodian Americans at the age of 35-75 years at high risk of developing diabetes and meeting the criteria for likely depression (N = 188) were randomized (EWS, n = 67; EWS + MTM, n = 63; SS, n = 50; control). For all participants, self-reported surveys were collected at baseline, 12 months, and 15 months. DTPs were assessed on the same schedule but only for participants in the EWS + MTM. RESULTS All 3 groups reported a significant decrease in barriers to taking medications. Compared with the other arms, the EWS + MTM arm reported a decrease in forgetting to take medications at 15 months. In the EWS + MTM arm, mean DTPs per patient was 6.57 and 84% of DTPs were resolved. SDOH predictors of DTP resolution included years of education (odds ratio [OR] 0.94, P = 0.016), ability to write English (OR 0.73, P = 0.015), difficulty communicating with provider (OR 1.39, P < 0.001), private insurance (OR 1.99, P = 0.030), disability (OR 0.51, P = 0.008), and years living under Pol Pot (OR 0.66, P = 0.045). Medication barriers at baseline predicted DTP resolution (OR 0.79, P = 0.019) such that each additional barrier was associated with a 21% reduction (1-0.79) in the odds of having a resolution. CONCLUSION CHWs can reduce medications barriers and help pharmacists reduce DTPs in disadvantaged populations.
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Gruber J, Lordan G, Pilling S, Propper C, Saunders R. The impact of mental health support for the chronically ill on hospital utilisation: Evidence from the UK. Soc Sci Med 2021; 294:114675. [PMID: 35032745 DOI: 10.1016/j.socscimed.2021.114675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/12/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
Individuals with common mental disorders (CMDs) such as depression and anxiety frequently have co-occurring long-term physical health conditions (LTCs) and this co-occurrence is associated with higher hospital utilisation. Psychological treatment for CMDs may reduce healthcare utilisation through better management of the LTC, but there is little previous research. We examined the impact of psychological treatment delivered under the nationwide Improving Access to Psychological Therapies (IAPT) programme in England on hospital utilisation 12-months after the end of IAPT treatment. We examined three types of hospital utilisation: Inpatient treatment, Outpatient treatment and Emergency Room attendance. We examined individuals with Chronic Obstructive Pulmonary Disease (COPD) (n = 816), Diabetes (n = 2813) or Cardiovascular Disease (CVD) (n = 4115) who received psychological treatment between April 2014 and March 2016. IAPT episode data was linked to hospital utilisation data which went up to March 2017. Changes in the probability of hospital utilisation were compared to a matched control sample for each LTC. Individuals in the control sample received IAPT treatment between April 2017 and March 2018. Compared to the control sample, the treated sample had significant reductions in the probability of all three types of hospital utilisation, for all three LTCs 12-months after the end of IAPT treatment. Reductions in utilisation of Emergency Room, Outpatient and non-elective Inpatient treatment were also observed immediately following the end of psychological treatment, and 6-months after, for individuals with diabetes and CVD, compared to the matched sample. These findings suggest that psychological interventions for CMDs delivered to individuals with co-occurring long-term chronic conditions may reduce the probability of utilisation of hospital services. Our results support the roll-out of psychological treatment aimed at individuals who have co-occurring CMDs and long-term chronic conditions.
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Affiliation(s)
- Jonathan Gruber
- Department of Economics, MIT and NBER, The Morris and Sophie Chang Building, 50 Memorial Drive, Bldg E52-434, Cambridge, MA 02139, USA
| | - Grace Lordan
- Department of Psychological and Behavioural Science, The London School of Economics and Political Science, Queens House, 55/56 Lincoln's Inn Fields, London WC2A 3LJ, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Carol Propper
- Imperial College Business School, South Kensington Campus, London SW7 2AZ, UK; The Institute for Fiscal Studies, 7 Ridgemount Street, London, WC1E 7AE, UK; Centre for Economic Policy Research (CEPR), 33 Great Sutton Street, London, EC1V 0DX, UK
| | - Rob Saunders
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK; Imperial College Business School, South Kensington Campus, London SW7 2AZ, UK.
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Alnijadi AA, Yuan J, Wu J, Li M, Lu ZK. Cost-Related Medication Nonadherence (CRN) on Healthcare Utilization and Patient-Reported Outcomes: Considerations in Managing Medicare Beneficiaries on Antidepressants. Front Pharmacol 2021; 12:764697. [PMID: 34950029 PMCID: PMC8688804 DOI: 10.3389/fphar.2021.764697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/05/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Many patients face a financial burden due to their medications, which may lead to poor health outcomes. The behaviors of non-adherence due to financial difficulties, known as cost-related medication non-adherence (CRN), include taking smaller doses of drugs, skipping doses to make prescriptions last longer, or delaying prescriptions. To date, the prevalence of CRN remains unknown, and there are few studies about the association of CRN on self-reported healthcare utilization (Emergency room (ER) visits and outpatient visits) and self-reported health outcomes (health status and disability status) among older adults taking antidepressants. Objectives: The objectives were to 1) examine the CRN prevalence, and 2) determine the association of CRN on self-reported healthcare utilization and self-reported health outcomes. Methods: This study was a cross-sectional study of a sample of older adults from the Medicare Current Beneficiary Survey (MCBS) who reported having used antidepressants in 2017. Four logistic regressions were implemented to evaluate the association of CRN, and self-reported healthcare utilization and self-reported health outcomes. Results: The study identified 602 participants who were Medicare beneficiaries on antidepressants. The prevalence of CRN among antidepressant users was (16.61%). After controlling for covariates, CRN was associated with poorer self-reported outcomes but not statistically significant: general health status [odds ratio (OR): 0.67; 95% confidence interval (CI): 0.39-1.16] and disability status (OR: 1.34; 95% CI: 0.83-2.14). In addition, CRN was associated with increased outpatient visits (OR: 1.89; 95% CI: 1.19-3.02), but not associated with ER visits (OR: 1.10; 95% CI: 0.69-1.76). Conclusion: For Medicare beneficiaries on antidepressants, CRN prevalence was high and contributed to more outpatient visits. The healthcare provider needs to define the reasoning for CRN and provide solutions to reduce the financial burden on the affected patient. Also, health care providers need to consider the factors that may enhance patient health status and healthcare efficiency.
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Affiliation(s)
- Abdulrahman A. Alnijadi
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia, SC, United States
- Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Jing Yuan
- Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, Fudan University, Shanghai, China
| | - Jun Wu
- Department of Pharmaceutical and Administrative Sciences, Presbyterian College, Clinton, SC, United States
| | - Minghui Li
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Z. Kevin Lu
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia, SC, United States
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Moulton CD, Rokakis AS, Pickup JC, Young AH, Stahl D, Ismail K. SITAgliptin for Depressive Symptoms in Type 2 Diabetes: A Feasibility Randomized Controlled Trial. Psychosom Med 2021; 83:913-923. [PMID: 34292203 DOI: 10.1097/psy.0000000000000985] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We tested the feasibility of using sitagliptin-a dipeptidyl peptidase-IV inhibitor-for depressive symptoms in type 2 diabetes (T2D). METHODS In a feasibility, double-blind, randomized controlled trial, we recruited people aged 18 to 75 years with T2D (glycated hemoglobin A1c levels ≥53 and ≤86 mmol/mol prescribed oral hypoglycemic therapy) and comorbid depressive symptoms (Patient Health Questionnaire-9 score ≥10) from family practices in South London. Eligible patients were randomized to sitagliptin 100 mg per day or matched placebo for 12 weeks. The primary feasibility outcomes were participation rates, attrition rates, and adverse events. The primary clinical outcomes were depressive symptoms (Patient Health Questionnaire-9 and 16-item Quick Inventory of Depressive Symptomatology scores) at 12 weeks as assessed using analyses of covariance. Ranges of treatment effects were estimated using Cohen d and associated 95% confidence intervals, where negative values favored sitagliptin over placebo. RESULTS Of 153 people screened across 32 practices, 44 were randomized (22 to each arm). The mean (standard deviation) age was 58.8 (8.3) years, 46% were female, and 52% were of non-white ethnicity. Of those treated, 1 patient (4.5%) in each arm withdrew, and there were no group differences in adverse events. Despite improving 12-week glycated hemoglobin A1c (d = -1.19 [95% confidence interval = -1.90 to -0.48), improvement in 12-week Quick Inventory of Depressive Symptomatology score with sitagliptin was inferior to placebo across the range of estimated treatment effects (d = 0.71 [0.13 to 1.30]). Effects of sitagliptin on inflammation were inconsistent (d = -0.32 [-0.81 to 0.17] for high-sensitivity C-reactive protein). CONCLUSIONS Repositioning of oral hypoglycemic therapy for depressive symptoms in T2D is feasible. However, in this unpowered feasibility study, we did not detect evidence of superiority of sitagliptin over placebo. The results are cautioned by the small sample size and limited treatment duration.Trial Registration: EudraCT: 2015-004527-32.
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Affiliation(s)
- Calum D Moulton
- From the Departments of Psychological Medicine (Moulton, Young, Rokakis, Ismail) Institute of Psychiatry, Psychology and Neuroscience; Division of Diabetes and Nutritional Sciences (Pickup), Faculty of Life Sciences and Medicine; and Department of Biostatistics (Stahl), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Pardiñas AF, Owen MJ, Walters JTR. Pharmacogenomics: A road ahead for precision medicine in psychiatry. Neuron 2021; 109:3914-3929. [PMID: 34619094 DOI: 10.1016/j.neuron.2021.09.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/05/2021] [Accepted: 09/09/2021] [Indexed: 12/11/2022]
Abstract
Psychiatric genomics is providing insights into the nature of psychiatric conditions that in time should identify new drug targets and improve patient care. Less attention has been paid to psychiatric pharmacogenomics research, despite its potential to deliver more rapid change in clinical practice and patient outcomes. The pharmacogenomics of treatment response encapsulates both pharmacokinetic ("what the body does to a drug") and pharmacodynamic ("what the drug does to the body") effects. Despite early optimism and substantial research in both these areas, they have to date made little impact on clinical management in psychiatry. A number of bottlenecks have hampered progress, including a lack of large-scale replication studies, inconsistencies in defining valid treatment outcomes across experiments, a failure to routinely incorporate adverse drug reactions and serum metabolite monitoring in study designs, and inadequate investment in the longitudinal data collections required to demonstrate clinical utility. Nonetheless, advances in genomics and health informatics present distinct opportunities for psychiatric pharmacogenomics to enter a new and productive phase of research discovery and translation.
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Affiliation(s)
- Antonio F Pardiñas
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
| | - Michael J Owen
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK.
| | - James T R Walters
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
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Baseline beliefs about medication are associated with outcomes of antidepressants in inpatients with first-diagnosed depression under supervised therapeutic compliance. Aging (Albany NY) 2021; 13:21400-21407. [PMID: 34473643 PMCID: PMC8457603 DOI: 10.18632/aging.203477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 08/14/2021] [Indexed: 12/23/2022]
Abstract
The aim of the present study was to explore the effect of baseline beliefs about medication on therapeutic outcomes of antidepressants in inpatients with first-diagnosed depression under supervised therapeutic compliance. Ninety-seven inpatients with first-diagnosed depression were included to collect their baseline demographic data to evaluate the Hamilton depression rating scale (HAMD) scores and the beliefs about medicine questionnaire-specific (BMQ-S) scores at baseline and the end of the eight-week treatment. Additionally, we explored the relationship between inpatients’ medication beliefs and therapeutic effect of antidepressants. The inpatients were divided into remitted depression and unremitted depression groups according to outcomes at the end of the eight-week treatment. There was no significant difference in the baseline HAMD between the two groups (P > 0.050). The scores on the BMQ-S of the unremitted group were significantly lower than those of the remitted group (P < 0.001). The HAMD scores were significantly reduced in both groups after the eight-week treatment (P < 0.001). There was no significant difference in the BMQ-S scores before and after the treatment (P > 0.050). The medication beliefs of the unremitted inpatients after the treatment were still lower than those of the remitted inpatients (P < 0.001). Logistic-regression analysis showed that low BMQ-S scores at the baseline were an independent risk factor for antidepressant efficacy. Beliefs about medication at baseline may be correlated with the therapeutic efficacy in inpatients with first-diagnosed depression under supervised therapeutic compliance.
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Kim M, Choi EJ, Kwon OJ, Park HJ, Kim AR, Seo BN, Chung SY, Lee JH, Kim JH. Electroacupuncture plus moxibustion for major depressive disorder: A randomized, sham-controlled, pilot clinical trial. Integr Med Res 2021; 10:100727. [PMID: 34307020 PMCID: PMC8296085 DOI: 10.1016/j.imr.2021.100727] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The first treatment option for major depressive disorder (MDD) is antidepressants, however, there is substantial demand for alternative therapies due to its low compliance and remission rates. This study was aimed to explore the effectiveness, safety, and feasibility of electroacupuncture plus moxibustion therapy for MDD. METHODS Thirty adults with MDD were randomly assigned to the treatment group (TG) or control group (CG). The TG was treated with electroacupuncture plus moxibustion, and the CG received sham interventions at non-acupoints for 8 weeks. The primary outcome measure was the intergroup difference of the mean change of total score of the Hamilton rating scale for depression (HRSD) between baseline and week 9. Secondary outcome measures were Beck's depression inventory, insomnia severity index, the state-trait anxiety inventory, the EuroQol-5 dimension index, the measure yourself medical outcome profile version 2, and frontal alpha asymmetry measured by electroencephalography. Adverse events (AEs) were monitored for safety assessment. RESULTS The primary outcome measure was not significantly different between the two groups (p=0.2641), although the scores of HRSD in both groups improved significantly after treatment. No significant difference was identified between groups in secondary outcome measures. The incidence of AE was not significantly different between the two groups (p=0.1067). CONCLUSION A clinical trial using electroacupuncture plus moxibustion for MDD seems feasible. However, further studies with the larger size, adopting ideal controls are warranted to provide a confirmative conclusion to the efficacy and safety of electroacupuncture plus moxibustion for MDD.
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Affiliation(s)
- Mikyung Kim
- Department of Internal Medicine, College of Korean Medicine, Sangji University, Wonju, Republic of Korea
| | - Eun-Ji Choi
- Haneum Neuropsychiatry Clinic of Korean Medicine, Cheonan, Republic of Korea
| | - O-Jin Kwon
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Hyo-Ju Park
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Ae-Ran Kim
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Bok-Nam Seo
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Sun-Yong Chung
- Department of Neuropsychiatry, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jun-Hwan Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
- Korean Medicine Life Science, University of Science & Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Joo-Hee Kim
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Sangji University, Wonju, Republic of Korea
- Research institute of Korean medicine, Sangji University, Wonju, Republic of Korea
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49
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Powell SK, Gibson CL, Okoroafor I, Hernandez-Antonio J, Nabel EM, Meah YS, Katz CL. On-Site Prescription Dispensing Improves Antidepressant Adherence among Uninsured Depressed Patients. Psychiatr Q 2021; 92:1093-1107. [PMID: 33587260 DOI: 10.1007/s11126-021-09885-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Samuel K Powell
- Medical Scientist Training Program, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
| | - Claire L Gibson
- Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | | | | | - Elisa M Nabel
- Medical Scientist Training Program, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Yasmin S Meah
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Geriatric and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Craig L Katz
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Global Health Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
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50
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Lawrence DF, Manjelievskaia J, Chrones L, McCue M, Touya M. Adherence and persistence among patients with major depressive disorder enrolled in the vortioxetine tAccess Patient Support Program. Curr Med Res Opin 2021; 37:1385-1392. [PMID: 33904815 DOI: 10.1080/03007995.2021.1918072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
OBJECTIVE The tAccess Patient Support Program (PSP) is a personalized support program for patients prescribed vortioxetine therapy. We assessed the impact of the tAccess PSP on adherence to and persistence with vortioxetine among adult patients with major depressive disorder (MDD). METHODS A retrospective observational cohort study was conducted in patients with MDD receiving vortioxetine who were enrolled in the tAccess PSP. Eligible patients were 18 to 64 years of age and had ≥1 vortioxetine claim and ≥1 inpatient/outpatient medical MDD claim during the 12 months preceding or on the index date, defined as the date of the earliest vortioxetine claim. Study outcomes included medication adherence (proportion of days covered [PDC], adherent ≥80%) and persistence (the total number of days on therapy without a ≥30-day gap) at 90, 180, and 365 days. Additionally, persistence was reported for a subset of patients meeting the standardized Healthcare Effectiveness Data and Information Set (HEDIS) Antidepressant Medication Management (AMM) criteria (the percentage of adults aged 18-64 years who remained on an antidepressant for ≥84 days or ≥180 days), as defined by the National Committee for Quality Assurance. These data were reviewed alongside current HEDIS AMM data for commercially insured patients meeting the standardized metric. RESULTS The study identified a total of 2635 patients with an MDD diagnosis and ≥90 days of follow-up time and a subset of 2238 patients meeting HEDIS AMM criteria. Mean PDC among all patients with MDD was 0.78, with 58.3% of patients achieving PDC ≥80%. During the 90-day follow-up, 62.1% of patients with MDD were persistent on vortioxetine. Among the subset of patients who met HEDIS AMM criteria, persistence was 83.4% and 69.9% at 84 and 180 days, respectively. In comparison, in 2017, HEDIS AMM criteria for antidepressant persistence were met by 67.8% of commercially insured patients at 84 days and 51.8% at 180 days. CONCLUSIONS These initial results, reviewed alongside recent available HEDIS AMM data, suggest that the tAccess PSP may be beneficial in addressing treatment adherence and persistence in patients with MDD.
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Affiliation(s)
| | | | | | - Maggie McCue
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, USA
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