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Javier SJ, Risbud R, Rossi FS, Slightam C, Aikens J, Guetterman T, Piette JD, Trivedi R. Improving depression management with support from close others: A thematic analysis of individuals with depression and their partners in care. Chronic Illn 2024; 20:283-295. [PMID: 37904531 DOI: 10.1177/17423953231175690] [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: 11/01/2023]
Abstract
OBJECTIVES With support from others, individuals with depression can build skills and implement lifestyle changes that help them manage their illness. The objective of the current study was to understand how the CarePartners for Depression Program, a randomized clinical trial aimed at enhancing the role of caregivers in the management of depression, improved communication and shared understandings of depression among individuals with depression and their close others. METHODS We conducted in-depth, semi-structured interviews with individuals with depression and their caregivers who participated in the CarePartners program. Interviews were qualitatively coded using a thematic analytic framework. RESULTS We conducted individual interviews with 39 participants in the CarePartners program, including 18 individuals with depression, 14 out-of-home care partners, and 7 informal caregivers. Three central themes were derived from analyses: (a) The quality of interpersonal relationships influenced the management of depression; (2) having clearly defined roles for CarePartners improved communication between CarePartners and individuals with depression; and (3) shared understanding of depression improved management of depression. DISCUSSION Our findings established the conditions under which the management of depression was influenced in a dyadic intervention. Dyadic interventions may make it easier for individuals to support patients with depression by fostering communication and collaboration.
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Affiliation(s)
- Sarah J Javier
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
- Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA, USA
| | - Rashmi Risbud
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Fernanda S Rossi
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
- Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA, USA
| | - Cindie Slightam
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
- Department of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - James Aikens
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Tim Guetterman
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - John D Piette
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Ranak Trivedi
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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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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Stahl ST, Kincman J, Karp JF, Anne Gebara M. Psychosocial interventions to improve adherence in depressed and anxious older adults prescribed antidepressant pharmacotherapy: a scoping review. Ther Adv Psychopharmacol 2023; 13:20451253231212322. [PMID: 38022838 PMCID: PMC10664420 DOI: 10.1177/20451253231212322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Medication nonadherence in depressed and anxious older adults is prevalent and associated with non-response to antidepressant pharmacotherapy. Evidence-based options to improve medication adherence are limited in this population. To review the state of the literature on the types and efficacy of psychosocial interventions for improving antidepressant pharmacotherapy adherence in depressed and anxious older adults. We conducted a scoping review according to PRISMA-ScR guidelines. PubMed/Medline and article references starting in 1980 up to 28 February 2023 were reviewed. Of the 710 records screened, 4 psychosocial interventions were included in the review. All studies included depressed older adults, and none included anxious older adults. Samples included racial and ethnic minorities and were primarily women. The psychosocial interventions consisted mainly of psychoeducation with usual care as the control comparison. Measures of antidepressant adherence included self-reported adherence or pill counting. Three of the four randomized controlled trials improved medication adherence rates and reduced depression symptom burden. Effective interventions exist for improving antidepressant medication adherence in depressed older adults. Improved adherence can reduce depression symptom burden. The lack of interventions for anxious older adults highlights the need to develop and deliver interventions for anxious older adults prescribed antidepressant pharmacotherapy.
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Affiliation(s)
- Sarah T. Stahl
- Department of Psychiatry, University of Pittsburgh, 3811 O’Hara Street, Pittsburgh, PA, 15213, USA
| | - Joelle Kincman
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jordan F. Karp
- Department of Psychiatry, University of Arizona, Tucson AZ, USA
| | - Marie Anne Gebara
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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Garber BB, Chen J, Beliveau A, Farwell DG, Bewley AF, Birkeland AC, Abouyared M. Using the Patient Health Questionnaire-2 to improve depression screening in head and neck cancer patients. Am J Otolaryngol 2023; 44:103724. [PMID: 36493469 DOI: 10.1016/j.amjoto.2022.103724] [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: 09/26/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE The purpose of this study is to examine the use of the Patient Health Questionnaire-2 (PHQ-2) to screen for depression in patients undergoing treatment for head and neck cancer and to evaluate potential patient-specific risk factors that may contribute to depression. MATERIALS AND METHODS This is a retrospective study at a tertiary-level hospital of outpatient adult patients with head and neck cancer who completed the PHQ-2/9 from 2019 to 2020. Patients were given a PHQ-2 during a surveillance visit. A positive PHQ-2 screen (score ≥ 3) prompted further evaluation with a PHQ-9. Patients were stratified into either low risk (PHQ-2 score < 3) or high risk (PHQ-2 score ≥ 3) for depression. Univariate regression was performed on all variables, and a multivariate logistic regression was performed on statistically significant variables (P < 0.05). RESULTS In total, 110 patients were included in this study. Fifteen (14 %) patients had a positive PHQ-2 screen with a score ≥ 3 and underwent evaluation with a PHQ-9. The median PHQ-9 score was 15 (6-26). The PHQ-2 ≥ 3 group were significantly younger (59 years vs. 67 years; P = 0.03) and had a greater number of patients with a psychiatric history (33 % vs. 8 %; P < 0.01). CONCLUSIONS There is a strong association between a PHQ-2 score ≥ 3 and detection of depressive symptoms among patients with head and neck cancer. Younger age and pretreatment mental illness are significant risk factors for developing depression following treatment. Early screening and treatment should be considered for all patients to mitigate the burden of depression and suicide in this patient population. Further research is warranted to investigate utilization of the PHQ-2/9 to detect depression and barriers that exist for timely screening and interventions.
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Affiliation(s)
- Beverly B Garber
- University of California, Davis, Department of Otolaryngology-Head and Neck Surgery, Sacramento, CA, United States of America
| | - Joy Chen
- University of California, Davis, Department of Otolaryngology-Head and Neck Surgery, Sacramento, CA, United States of America
| | - Angela Beliveau
- University of California, Davis, Department of Otolaryngology-Head and Neck Surgery, Sacramento, CA, United States of America
| | - D Gregory Farwell
- University of Pennsylvania, Department of Otorhinolaryngology-Head and Neck Surgery, Philadelphia, PA, United States of America
| | - Arnaud F Bewley
- University of California, Davis, Department of Otolaryngology-Head and Neck Surgery, Sacramento, CA, United States of America
| | - Andrew C Birkeland
- University of California, Davis, Department of Otolaryngology-Head and Neck Surgery, Sacramento, CA, United States of America
| | - Marianne Abouyared
- University of California, Davis, Department of Otolaryngology-Head and Neck Surgery, Sacramento, CA, United States of America.
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Fausto BA, Azimipour S, Charles L, Yarborough C, Grullon K, Hokett E, Duberstein PR, Gluck MA. Cardio-Dance Exercise to Improve Cognition and Mood in Older African Americans: A Propensity-Matched Cohort Study. J Appl Gerontol 2022; 41:496-505. [PMID: 33938312 PMCID: PMC8563498 DOI: 10.1177/07334648211010580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The current study sought to determine the influence of initial sleep quality and body mass index on the cognitive and mood outcomes of a community-based cardio-dance exercise program. Thirty-two older African Americans who participated in a 5-month cardio-dance exercise program were propensity-matched to 32 no-contact controls. Participants completed neuropsychological tests of attention, executive function, and memory and a self-reported depression measure at baseline and post-test. Among exercise participants, we observed significant improvements in depression (baseline = 6.16 ± 5.54, post-test = 4.66 ± 4.89, η p 2 = . 12 , p = .009) and attention (baseline = 40.53 ± 14.01, post-test = 36.63 ± 13.29, η p 2 = . 12 , p = .009) relative to controls. Improvements in executive function and attention were most pronounced among exercise participants with poor sleep quality (baseline = 7.71 ± 1.25, post-test = 8.29 ± 2.06, η p 2 = . 41 , p = .04) and with obesity (baseline = 38.05 ± 12.78, post-test = 35.67 ± 13.82, η p 2 = . 30 , p = .001), respectively. This study provides novel evidence that exercise has the potential to improve depression in older African Americans. For those with poor sleep quality or obesity, exercise can also improve some cognitive outcomes.
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Cuffee YL, Rosal M, Hargraves JL, Briesacher BA, Akuley S, Altwatban N, Hullett S, Allison JJ. Does Home Remedy Use Contribute to Medication Nonadherence Among Blacks with Hypertension? Ethn Dis 2020; 30:451-458. [PMID: 32742150 DOI: 10.18865/ed.30.3.451] [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] [Indexed: 11/18/2022] Open
Abstract
Background Home remedies (HRs) are described as foods, herbs, and other household products used to manage chronic conditions. The objective of this study was to examine home remedy (HR) use among Blacks with hypertension and to determine if home remedy use is correlated with blood pressure and medication adherence. Methods Data for this cross-sectional study were obtained from the TRUST study conducted between 2006-2008. Medication adherence was measured using the Morisky Medication Adherence Scale, and HR use was self-reported. Multivariable associations were quantified using ordinal logistic regression. Results The study sample consisted of 788 Blacks with hypertension living in the southern region of the United States. HR use was associated with higher systolic (HR users 152.79, nonusers 149.53; P=.004) and diastolic blood pressure (HR users 84.10, nonusers 82.14 P=.005). Use of two or more HRs was associated with low adherence (OR: .55, CI: .36-.83, P= .004). Conclusion The use of HR and the number of HRs used may be associated with medication nonadherence, and higher systolic and diastolic blood pressure among Blacks with hypertension. Medication nonadherence is of critical importance for individuals with hypertension, and it is essential that health care providers be aware of health behaviors that may serve as barriers to medication adherence, such as use of home remedies.
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Affiliation(s)
- Yendelela L Cuffee
- Department of Public Health Sciences, Division of Epidemiology, Penn State College of Medicine, Hershey, PA
| | - Milagros Rosal
- Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - J Lee Hargraves
- Center for Survey Research, University of Massachusetts Boston, Boston, MA
| | | | - Suzanne Akuley
- Department of Public Health Sciences, Division of Epidemiology, Penn State College of Medicine, Hershey, PA
| | - Noof Altwatban
- George Washington University, Milken Institute School of Public Health, Washington, DC
| | | | - Jeroan J Allison
- Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
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Depressive role impairment and subthreshold depression in older black and white women: race differences in the clinical significance criterion. Int Psychogeriatr 2020; 32:393-405. [PMID: 31455459 PMCID: PMC7047602 DOI: 10.1017/s1041610219001133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We examined race differences in the DSM-IV clinical significance criterion (CSC), an indicator of depressive role impairment, and its impact on assessment outcomes in older white and black women with diagnosed and subthreshold depression. DESIGN We conducted a secondary analysis of a community-based interview study, using group comparisons and logistic regression. SETTING Lower-income neighborhoods in a Midwestern city. PARTICIPANTS 411 community-dwelling depressed and non-depressed women ≥ 65 years (45.3% Black; mean age = 75.2, SD = 7.2) recruited through census tract-based telephone screening. MEASUREMENTS SCID interview for DSM-IV to assess major depression and dysthymia; Center for Epidemiologic Studies-Depression Scale to define subthreshold depression (≥16 points); Mini-Mental State Examination, count of medical conditions, activities of daily living, and mental health treatment to assess health factors. RESULTS Black participants were less likely than Whites to endorse the CSC (11.8% vs. 24.1%; p = .002). There were few race differences in depressive symptom type, severity, or count. Blacks with subthreshold depression endorsed more symptoms, though this comparison was not significant after adjustments. Health factors did not account for race differences in CSC endorsement. Disregarding the CSC-eliminated differences in diagnosis rate, race was a significant predictor of CSC endorsement in a logistic regression. CONCLUSIONS Race differences in CSC endorsement are not due to depressive symptom presentations or health factors. The use of the CSC may lead to underdiagnosis of depression among black older adults. Subthreshold depression among Blacks may be more severe compared to Whites, thus requiring tailored assessment and treatment approaches.
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Sirey JA, Banerjee S, Marino P, Bruce ML, Halkett A, Turnwald M, Chiang C, Liles B, Artis A, Blow F, Kales HC. Adherence to Depression Treatment in Primary Care: A Randomized Clinical Trial. JAMA Psychiatry 2017; 74:1129-1135. [PMID: 28973066 PMCID: PMC5710215 DOI: 10.1001/jamapsychiatry.2017.3047] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/06/2017] [Indexed: 11/14/2022]
Abstract
Importance Nonadherence to antidepressant medication is common and leads to poor outcomes. Early nonadherence is especially problematic. Objective To test the effectiveness of a psychosocial intervention to improve early adherence among older patients whose primary care physician newly initiated an antidepressant for depression. Design, Setting, and Participants The Treatment Initiation and Participation Program (TIP) was offered in a 2-site randomized clinical effectiveness study between January 2011 and December 2014 at primary care practices in New York, New York, and Ann Arbor, Michigan. Analyses began in February 2016. All participants were middle-aged and older adults (aged ≥55 years) who received newly initiated depression treatment by their primary care physician and recruited within 10 days of their prescription. Analyses were intention-to-treat. Interventions Participants were randomly assigned to the intervention (TIP) or treatment as usual. Participants in the TIP group identified and addressed barriers to adherence, including stigma, misconceptions, and fears about treatment, before developing a personalized adherence strategy. The Treatment Initiation and Participation Program was delivered in three 30-minute contacts scheduled during a 6-week period just after the antidepressant was prescribed. Main Outcomes and Measures The primary outcome was self-reported adherence on the Brief Medication Questionnaire, with adequate early adherence defined as taking 80% or more of the prescribed doses at 6 and 12 weeks. The secondary outcome was depression severity. Results In total, 231 middle-aged and older adults (167 women [72.3%] and 64 men [27.7%]) without significant cognitive impairment were randomly assigned to the TIP intervention (n = 115) or treatment as usual (n = 116). Participants had a mean (SD) age of 67.3 (8.4) years. Participants in the TIP group were 5 times more likely to be adherent at 6 weeks (odds ratio, 5.54; 95% CI, 2.57 to 11.96; χ21 = 19.05; P < .001) and 3 times more likely to be adherent at both 6 and 12 weeks (odds ratio, 3.27; 95% CI, 1.73 to 6.17; χ21 = 13.34; P < .001). Participants in the TIP group showed a significant earlier reduction (24.9%) in depressive symptoms (95% CI, 13.9 to 35.9; t337 = 4.46; adjusted P < .001). In both groups, participants who were 80% adherent at weeks 6 and 12 had a 15% greater improvement in depressive symptoms from baseline over the course of treatment (95% CI, -0.2 to -30; t369 = 1.93; P = .051). Conclusions and Relevance The Treatment Initiation and Participation Program is an effective intervention to improve early adherence to pharmacotherapy. Improved adherence can promote improvement in depression. Trial Registration clinicaltrials.gov Identifier: NCT01301859.
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Affiliation(s)
- Jo Anne Sirey
- Department of Psychiatry, Weill Cornell Medicine, White Plains, New York
| | - Samprit Banerjee
- Department of Healthcare Policy & Research, Weill Cornell Medicine, White Plains, New York
| | - Patricia Marino
- Department of Psychiatry, Weill Cornell Medicine, White Plains, New York
| | - Martha L. Bruce
- Department of Psychiatry and The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Ashley Halkett
- Department of Psychiatry, Weill Cornell Medicine, White Plains, New York
| | - Molly Turnwald
- Department of Psychiatry, University of Michigan, Ann Arbor
| | - Claire Chiang
- Department of Psychiatry, University of Michigan, Ann Arbor
| | - Brian Liles
- Department of Psychiatry, Weill Cornell Medicine, White Plains, New York
| | - Amanda Artis
- Department of Healthcare Policy & Research, Weill Cornell Medicine, White Plains, New York
| | - Fred Blow
- Department of Psychiatry, University of Michigan, Ann Arbor
| | - Helen C. Kales
- Department of Psychiatry, University of Michigan, Ann Arbor
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With a little help from my friends?: racial and gender differences in the role of social support in later-life depression medication adherence. Int Psychogeriatr 2017; 29:1485-1493. [PMID: 28528594 DOI: 10.1017/s104161021700076x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Social support has been shown to be an important factor in improving depression symptom outcomes, yet less is known regarding its impact on antidepressant medication adherence. This study sought to evaluate the role of perceived social support on adherence to new antidepressant medication prescriptions in later-life depression. METHODS Data from two prospective observational studies of participants ≥60 years old, diagnosed with depression, and recently prescribed a new antidepressant (N = 452). Perceived social support was measured using a subscale of the Duke Social Support Index and medication adherence was assessed using a validated self-report measure. RESULTS At four-month follow up, 68% of patients reported that they were adherent to antidepressant medication. Examining the overall sample, logistic regression analysis demonstrated no significant relationship between perceived social support and medication adherence. However, when stratifying the sample by social support, race, and gender, adherence significantly differed by race and gender in those with inadequate social support: Among those with low social support, African-American females were significantly less likely to adhere to depression treatment than white females (OR = 4.82, 95% CI = 1.14-20.28, p = 0.032) and white males (OR = 3.50, 95% CI = 1.03-11.92, p = 0.045). CONCLUSIONS There is a significant difference in antidepressant medication adherence by race and gender in those with inadequate social support. Tailored treatment interventions for low social support should be sensitive to racial and gender differences.
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Mårdby AC, Schiöler L, Sundell KA, Bjerkeli P, Lesén E, Jönsson AK. Adherence to antidepressants among women and men described with trajectory models: a Swedish longitudinal study. Eur J Clin Pharmacol 2016; 72:1381-1389. [PMID: 27488388 DOI: 10.1007/s00228-016-2106-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 07/19/2016] [Indexed: 01/28/2023]
Abstract
PURPOSE The purpose of this study are to analyse adherence to antidepressant treatment over 2 years in Sweden among women and men who initiated treatment with citalopram and to identify groups at risk of non-adherence using trajectory models. METHODS The study population, including individuals 18-85 years who initiated citalopram use between 1 July 2006 and 30 June 2007, was identified in the Swedish Prescribed Drug Register and followed for 2 years. Adherence was estimated with continuous measure of medication acquisition (CMA) and group-based trajectory modelling, a method which describes adherence patterns over time by estimating trajectories of adherence and the individual's probability of belonging to a specific trajectory. RESULTS The study population included 54,248 individuals, 64 % women. Mean CMA was 52 % among women and 50 % among men (p < 0.001). Five different adherence patterns (Trajectories) were identified. Similar proportion of women and men belonged to each Trajectory. Around 29 % of the women and 27 % of the men belonged to the Trajectory which showed full adherence throughout the 2-year study period. The other four Trajectories showed adherence that declined to different degrees and at different stages in time. Having low socioeconomic status was more common among individuals in Trajectories showing declining adherence than in the adherent Trajectory. CONCLUSIONS Using trajectory modelling, five Trajectories describing different patterns of adherence to citalopram treatment over time were identified. A large proportion discontinued treatment early and having low socioeconomic status increased the risk of being non-adherent.
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Affiliation(s)
- Ann-Charlotte Mårdby
- Research and Development, Sahlgrenska University Hospital, Röda Stråket 8, 413 45, Gothenburg, Sweden.
- Section of Epidemiology and Social Medicine, Department of Public Health and Community Medicine at Institute of Medicine, University of Gothenburg, Box 453, 405 30, Gothenburg, Sweden.
- Novo Nordisk A/S, Box 50587, SE-202 15, Malmö, Sweden.
| | - Linus Schiöler
- Section of Occupational and Environmental Medicine, Department of Public Health and Community Medicine at Institute of Medicine, University of Gothenburg, Box 100, 405 30, Gothenburg, Sweden
| | - Karolina Andersson Sundell
- Section of Epidemiology and Social Medicine, Department of Public Health and Community Medicine at Institute of Medicine, University of Gothenburg, Box 453, 405 30, Gothenburg, Sweden
- Medical Evidence and Observational Research, AstraZeneca, Pepparedsleden 1, 431 83, Mölndal, Sweden
| | - Pernilla Bjerkeli
- Nordic School of Public Health, PO Box 421, 42140, Gothenburg, Sweden
- Department for Biomedicine and Public Health Research, University of Skövde, PO Box 408, SE 541 28, Skövde, Sweden
| | - Eva Lesén
- Nordic Health Economics AB, Medicinaregatan 8B, 413 90, Gothenburg, Sweden
| | - Anna K Jönsson
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, 581 85, Linköping, Sweden
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Shao Z, Richie WD, Bailey RK. Racial and Ethnic Disparity in Major Depressive Disorder. J Racial Ethn Health Disparities 2015; 3:692-705. [DOI: 10.1007/s40615-015-0188-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/08/2015] [Accepted: 11/12/2015] [Indexed: 12/15/2022]
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Leggett A, Kavanagh J, Zivin K, Chiang C, Kim HM, Kales HC. The Association Between Benzodiazepine Use and Depression Outcomes in Older Veterans. J Geriatr Psychiatry Neurol 2015; 28:281-7. [PMID: 26269493 PMCID: PMC4927262 DOI: 10.1177/0891988715598227] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Benzodiazepines (BZDs) are commonly prescribed to older adults with depression, but it is unknown whether they improve antidepressant (AD) adherence or depressive symptoms. We followed 297 older veterans diagnosed with depression and provided a new AD medication prospectively for 4 months. Data include validated self-report measures and VA pharmacy records. At initial assessment, 20.5% of participants were prescribed a BZD. Those with a BZD prescription at baseline were significantly more likely than those without to have a personality disorder, schizophrenia spectrum disorder, or other anxiety disorder, and higher depressive symptom and anxiety symptom scale scores on average. In adjusted regressions, BZD use was not significantly associated with AD adherence, any improvement in depressive symptoms, or a 50% reduction in depressive symptoms. Our results suggest BZD use concurrent with AD treatment does not significantly improve depressive outcomes in older veterans.
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Affiliation(s)
- Amanda Leggett
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Janet Kavanagh
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - Kara Zivin
- Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI,Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI,Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI,Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Claire Chiang
- Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI,Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - Hyungjin Myra Kim
- Center for Statistical Consultation & Research, University of Michigan, Ann Arbor, MI,Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Helen C. Kales
- Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI,Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
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13
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Areán PA, Raue PJ, McCulloch C, Kanellopoulos D, Seirup JK, Banerjee S, Kiosses DN, Dwyer E, Alexopoulos GS. Effects of Problem-Solving Therapy and Clinical Case Management on Disability in Low-Income Older Adults. Am J Geriatr Psychiatry 2015; 23:1307-1314. [PMID: 26628206 PMCID: PMC6033321 DOI: 10.1016/j.jagp.2015.04.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 04/12/2015] [Accepted: 04/16/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To test the following hypotheses: (1) Clinical case management integrated with problem-solving therapy (CM-PST) is more effective than clinical case management alone (CM) in improving functional outcomes in disabled, impoverished patients and (2) improvement in depression, self-efficacy, and problem-solving skills mediates improvement of disability. METHODS Using a randomized controlled trial with a parallel design, 271 individuals were screened and 171 were randomized to 12 weekly sessions of either CM or CM-PST at 1:1 ratio. Raters were blind to patients' assignments. Participants were at least age 60 years with major depression, had at least one disability, were eligible for home-based meals services, and had income no more than 30% of their counties' median. The WHO Disability Assessment Scale was used. RESULTS Both interventions resulted in improved functioning by 12 weeks (t = 4.28, df = 554, p = 0.001), which was maintained until 24 weeks. Contrary to hypothesis, CM was noninferior to CM-PST (one-sided p = 0.0003, t = -3.5, df = 558). Change in disability was not affected by baseline depression severity, cognitive function, or number of unmet social service needs. Improvements in self efficacy (t = -2.45, df = 672, p = 0.021), problem-solving skill (t = -2.44, df = 546, p = 0.015), and depression symptoms (t = 2.25, df = 672, p = .025) by week 9 predicted improvement in function across groups by week 12. CONCLUSION CM is noninferior to CM-PST for late-life depression in low-income populations. The effect of these interventions occur early, with benefits in functional status maintained as long as 24 weeks after treatment initiation (clinicaltrials.gov; NCT00540865).
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Affiliation(s)
- Patricia A Areán
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.
| | - Patrick J Raue
- Department of Public Health, Weill Cornell Medical College, New York, NY
| | - Charles McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Dora Kanellopoulos
- Department of Public Health, Weill Cornell Medical College, New York, NY
| | - Joanna K Seirup
- Department of Public Health, Weill Cornell Medical College, New York, NY
| | - Samprit Banerjee
- Department of Public Health, Weill Cornell Medical College, New York, NY
| | - Dimitris N Kiosses
- Department of Public Health, Weill Cornell Medical College, New York, NY
| | - Eleanor Dwyer
- San Mateo Department of Public Health, San Mateo, CA
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14
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Davidson TM, McGillicuddy J, Mueller M, Brunner-Jackson B, Favella A, Anderson A, Torres M, Ruggiero KJ, Treiber FA. Evaluation of an mHealth Medication Regimen Self-Management Program for African American and Hispanic Uncontrolled Hypertensives. J Pers Med 2015; 5:389-405. [PMID: 26593951 PMCID: PMC4695862 DOI: 10.3390/jpm5040389] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/03/2015] [Accepted: 11/06/2015] [Indexed: 12/18/2022] Open
Abstract
African Americans and Hispanics have disproportionate rates of uncontrolled essential hypertension (EH) compared to Non-Hispanic Whites. Medication non-adherence (MNA) is the leading modifiable behavior to improved blood pressure (BP) control. The Smartphone Medication Adherence Stops Hypertension (SMASH) program was developed using a patient-centered, theory-guided, iterative design process. Electronic medication trays provided reminder signals, and Short Message Service [SMS] messaging reminded subjects to monitor BP with Bluetooth-enabled monitors. Motivational and reinforcement text messages were sent to participants based upon levels of adherence. Thirty-eight African-American (18) and Hispanic (20) uncontrolled hypertensives completed clinic-based anthropometric and resting BP evaluations prior to randomization, and again at months 1, 3 and 6. Generalized linear mixed modeling (GLMM) revealed statistically significant time-by-treatment interactions (p < 0.0001) indicating significant reductions in resting systolic blood pressure (SBP) and diastolic blood pressure (DBP) for the SMASH group vs. the standard care (SC) control group across all time points. 70.6% of SMASH subjects vs. 15.8% of the SC group reached BP control (< 140/90 mmH) at month 1 (p < 0.001). At month 6, 94.4% of the SMASH vs. 41.2% of the SC group exhibited controlled BP (p < 0.003). Our findings provide encouraging evidence that efficacious mHealth, chronic disease, medical regimen, self-management programs can be developed following principles of patient-centered, theory-guided design.
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Affiliation(s)
- Tatiana M. Davidson
- College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA; E-Mails: (J.M.); (F.A.T.)
- College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA; E-Mails: (M.M.); (B.B.-J.); (A.F.); (A.A.); (M.T.); (K.J.R.)
| | - John McGillicuddy
- College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA; E-Mails: (J.M.); (F.A.T.)
| | - Martina Mueller
- College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA; E-Mails: (M.M.); (B.B.-J.); (A.F.); (A.A.); (M.T.); (K.J.R.)
| | - Brenda Brunner-Jackson
- College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA; E-Mails: (M.M.); (B.B.-J.); (A.F.); (A.A.); (M.T.); (K.J.R.)
| | - April Favella
- College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA; E-Mails: (M.M.); (B.B.-J.); (A.F.); (A.A.); (M.T.); (K.J.R.)
| | - Ashley Anderson
- College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA; E-Mails: (M.M.); (B.B.-J.); (A.F.); (A.A.); (M.T.); (K.J.R.)
| | - Magaly Torres
- College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA; E-Mails: (M.M.); (B.B.-J.); (A.F.); (A.A.); (M.T.); (K.J.R.)
| | - Kenneth J. Ruggiero
- College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA; E-Mails: (M.M.); (B.B.-J.); (A.F.); (A.A.); (M.T.); (K.J.R.)
| | - Frank A. Treiber
- College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA; E-Mails: (J.M.); (F.A.T.)
- College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA; E-Mails: (M.M.); (B.B.-J.); (A.F.); (A.A.); (M.T.); (K.J.R.)
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15
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Spoont MR, Nelson DB, Murdoch M, Sayer NA, Nugent S, Rector T, Westermeyer J. Are there racial/ethnic disparities in VA PTSD treatment retention? Depress Anxiety 2015; 32:415-25. [PMID: 25421265 DOI: 10.1002/da.22295] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 06/17/2014] [Accepted: 06/27/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Chronic posttraumatic stress disorder (PTSD) can result in significant social and physical impairments. Despite the Department of Veterans Affairs' (VA) expansion of mental health services into primary care clinics to reach larger numbers of Veterans with PTSD, many do not receive sufficient treatment to clinically benefit. This study explored whether the odds of premature mental health treatment termination varies by patient race/ethnicity and, if so, whether such variation is associated with differential access to services or beliefs about mental health treatments. METHODS Prospective national cohort study of VA patients who were recently diagnosed with PTSD (n = 6,788). Self-administered surveys and electronic VA databases were utilized to examine mental health treatment retention across racial/ethnic groups in the 6 months following the PTSD diagnosis controlling for treatment need, access factors, age, gender, treatment beliefs, and facility factors. RESULTS African American and Latino Veterans were less likely to receive a minimal trial of pharmacotherapy and African American Veterans were less likely to receive a minimal trial of any treatment in the 6 months after being diagnosed with PTSD. Controlling for beliefs about mental health treatments diminished the lower odds of pharmacotherapy retention among Latino but not African American Veterans. Access factors did not contribute to treatment retention disparities. CONCLUSIONS Even in safety-net healthcare systems like VA, racial and ethnic disparities in mental health treatment occur. To improve treatment equity, clinicians may need to more directly address patients' treatment beliefs. More understanding is needed to address the treatment disparity for African American Veterans.
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Affiliation(s)
- Michele R Spoont
- National Center for PTSD, US Department of Veterans Affairs.,Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Healthcare System, University of Minnesota Medical School, Minneapolis, Minnesota
| | - David B Nelson
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Healthcare System, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Maureen Murdoch
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Healthcare System, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Nina A Sayer
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Healthcare System, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Sean Nugent
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Healthcare System, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Thomas Rector
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Healthcare System, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Joseph Westermeyer
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Healthcare System, University of Minnesota Medical School, Minneapolis, Minnesota
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16
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Pizzi LT, Jutkowitz E, Frick KD, Suh DC, Prioli KM, Gitlin LN. Cost-Effectiveness of a Community-Integrated Home-Based Depression Intervention in Older African Americans. J Am Geriatr Soc 2014; 62:2288-95. [DOI: 10.1111/jgs.13146] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Laura T. Pizzi
- Jefferson School of Pharmacy; Thomas Jefferson University; Philadelphia Pennsylvania
| | - Eric Jutkowitz
- Division of Health Policy and Management; University of Minnesota; Minneapolis Minnesota
| | - Kevin D. Frick
- The Johns Hopkins Carey Business School; Johns Hopkins University; Baltimore Maryland
| | - Dong-Churl Suh
- College of Pharmacy; Chung-Ang University; Seoul South Korea
| | - Katherine M. Prioli
- Jefferson School of Pharmacy; Thomas Jefferson University; Philadelphia Pennsylvania
| | - Laura N. Gitlin
- Department of Community Public Health; School of Nursing; Johns Hopkins University; Baltimore Maryland
- Division of Geriatrics and Gerontology; Department of Psychiatry; School of Medicine; Johns Hopkins University; Baltimore Maryland
- Center for Innovative Care in Aging; Johns Hopkins University; Baltimore Maryland
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17
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Gitlin LN, Roth DL, Huang J. Mediators of the impact of a home-based intervention (beat the blues) on depressive symptoms among older African Americans. Psychol Aging 2014; 29:601-11. [PMID: 25244479 DOI: 10.1037/a0036784] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Older African Americans (N = 208) with depressive symptoms were randomly assigned to a home-based nonpharmacologic intervention (Beat the Blues, or BTB) or wait-list control group. BTB was delivered by licensed social workers and involved up to 10 home visits focused on care management, referral and linkage, depression knowledge and efficacy in symptom recognition, instruction in stress reduction techniques, and behavioral activation through identification of personal goals and action plans for achieving them. Structured interviews by assessors masked to study assignment were used to assess changes in depressive symptoms (main trial endpoint), behavioral activation, depression knowledge, formal care service utilization, and anxiety (mediators) at baseline and 4 months. At 4 months, the intervention had a positive effect on depressive symptoms and all mediators except formal care service utilization. Structural equation models indicated that increased activation, enhanced depression knowledge, and decreased anxiety each independently mediated a significant proportion of the intervention's impact on depressive symptoms as assessed with 2 different measures (PHQ-9 and CES-D). These 3 factors also jointly explained over 60% of the intervention's total effect on both indicators of depressive symptoms. Our findings suggest that most of the impact of BTB on depressive symptoms is driven by enhancing activation or becoming active, reducing anxiety, and improving depression knowledge/efficacy. The intervention components appear to work in concert and may be mutually necessary for maximal benefits from treatment to occur. Implications for designing tailored interventions to address depressive symptoms among older African Americans are discussed.
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Affiliation(s)
- Laura N Gitlin
- School of Nursing Center for Innovative Care in Aging, Johns Hopkins University
| | - David L Roth
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University
| | - Jin Huang
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University
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18
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Abstract
PURPOSE OF REVIEW Poor adherence and discontinuation of treatment are the major challenges of pharmacotherapy among patients with depression. This article reviews the factors predicting adherence to and persistence of antidepressant treatment identified in recent years. RECENT FINDINGS Study populations have been extended to subgroups of patients with depression or depressive patients with comorbid medical conditions. Some studies have investigated the issues by analysing medical claims databases. Socio-demographic variables, clinical features of depression, comorbidities, pharmacological factors, attitudes towards antidepressants, previous experiences of antidepressant treatment, patient-professional relationship and genes were found to be common factors. An older age, positive attitudes to antidepressants and previous experiences and vicarious experiences of depression or treatment were found to be factors predicting better adherence or persistence. Conversely, patients in minority groups, those with a low family income, pregnancy, experience of side effects, dissatisfaction with treatment and a poor patient-professional relationship were found to be associated with poorer adherence or persistence. SUMMARY The factors predicting adherence and persistence are complex and interactive. Different methods of studies have limitations in terms of exploring all these factors. Future studies should integrate these factors simultaneously and explore specific factors predicting adherence and persistence among subgroups of patients with depression.
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19
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Arean PA, Niu G. Choosing treatment for depression in older adults and evaluating response. Clin Geriatr Med 2014; 30:535-51. [PMID: 25037294 DOI: 10.1016/j.cger.2014.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
An update is provided on the current information regarding late life depression with regard to assessment, clinical implications, and treatment recommendations. Several treatments are considered evidence-based, but when deployed into field trials, the efficacy of these treatments falls short. It is thought that the lower impact in community trials is due in large part to patient, clinical, environmental, socio-economic, and cognitive correlates that influence treatment response. The aim is to assist providers in making decisions about what type of treatment to recommend based on a sound assessment of these clinical correlates.
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Affiliation(s)
- Patricia A Arean
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Grace Niu
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA
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20
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Barry LC, Thorpe RJ, Penninx BW, Yaffe K, Wakefield D, Ayonayon HN, Satterfield S, Newman AB, Simonsick EM. Race-related differences in depression onset and recovery in older persons over time: the health, aging, and body composition study. Am J Geriatr Psychiatry 2014; 22:682-91. [PMID: 24125816 PMCID: PMC3984378 DOI: 10.1016/j.jagp.2013.09.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 09/03/2013] [Accepted: 09/03/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate race-related differences in depression onset and recovery in older persons, overall and by sex, and examine race-related differences in mortality according to depression. DESIGN Prospective cohort study. SETTING General community in pre-designated zip code areas in Memphis, Tennessee, and Pittsburgh, Pennsylvania. PARTICIPANTS 3,075 persons aged 70-79 years at baseline in the Health, Aging, and Body Composition study. MEASUREMENTS Depression was assessed at eight time points over 10 years using the 10-item Center for Epidemiologic Studies-Depression scale; patients were categorized as nondepressed (score less than 8) or depressed (score of 8 or higher). We created variables for transitions across each 18-month time interval, namely, from nondepressed or depressed to nondepressed, depressed, or death, and determined the association between race and the average likelihood of these transitions over time. RESULTS A higher percentage of blacks than whites were depressed at nearly all time points. Adjusting for demographics, common chronic conditions, and body mass index, blacks had a higher likelihood of experiencing depression onset than whites (odds ratio [OR]: 1.22; 95% confidence interval [CI]: 1.03-1.43); among men, blacks were more likely to experience depression onset than whites (OR: 1.44; 95% CI: 1.24-2.89). Blacks also had a higher likelihood of transitioning from nondepressed to death (OR: 1.79; 95% CI: 1.30-2.46). Overall and in sex-stratified analyses, race was not associated with recovery from depression or with the transition from depression to death. CONCLUSION Our findings highlight race differences in depression in older persons and encourage further research on the course of depression in older black patients.
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Affiliation(s)
- Lisa C. Barry
- Center on Aging, University of Connecticut, Farmington, Connecticut 06030-5215, US
| | - Roland J. Thorpe
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, US
| | - Brenda W.J.H. Penninx
- Department of Psychiatry, VU University Medical Center in Amsterdam, The Netherlands
| | - Kristine Yaffe
- Department of Psychiatry, University of California, San Francisco, California, US
| | - Dorothy Wakefield
- Center on Aging, University of Connecticut, Farmington, Connecticut, US
| | - Hilsa N. Ayonayon
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, US
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, US
| | - Anne B. Newman
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, US
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21
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Choi NG, Sirey JA, Bruce ML. Depression in Homebound Older Adults: Recent Advances in Screening and Psychosocial Interventions. CURRENT TRANSLATIONAL GERIATRICS AND EXPERIMENTAL GERONTOLOGY REPORTS 2013; 2:16-23. [PMID: 23459163 PMCID: PMC3582679 DOI: 10.1007/s13670-012-0032-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Homebound older adults are more likely than their ambulatory peers to suffer from depression. Unfortunately, the effectiveness of antidepressant medications alone in such cases is limited. Greater benefits might be realized if patients received both pharmacotherapy and psychotherapy to enhance their skills to cope with their multiple chronic medical conditions, isolation, and mobility impairment; however, referrals to specialty mental health services seldom succeed due to inaccessibility, shortage of geriatric mental health providers, and cost. Since a large proportion of homebound older adults receive case management and other services from aging services network agencies, the integration of mental health services into these agencies is likely to be cost-efficient and effective. This review summarizes recent advances in home-based assessment and psychosocial treatment of depression in homebound recipients of aging services.
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Affiliation(s)
- Namkee G. Choi
- The University of Texas at Austin School of Social Work, 1925 San Jacinto Blvd, Austin, TX 78712; ; 512-232-9590; 512-471-9600 (fax)
| | - Jo Anne Sirey
- Department of Psychiatry, Westchester Division, Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY 10605; ; 914-997-4333; 914-682-6979 (fax)
| | - Martha L. Bruce
- Department of Psychiatry, Westchester Division, Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY 10605; ; 914-997-5977
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