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Kariis HM, Kasela S, Jürgenson T, Saar A, Lass J, Krebs K, Võsa U, Haan E, Milani L, Lehto K. The role of depression and antidepressant treatment in antihypertensive medication adherence and persistence: Utilising electronic health record data. J Psychiatr Res 2023; 168:269-278. [PMID: 37924579 DOI: 10.1016/j.jpsychires.2023.10.018] [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: 03/12/2023] [Revised: 08/16/2023] [Accepted: 10/13/2023] [Indexed: 11/06/2023]
Abstract
Higher blood pressure levels in patients with depression may be associated with lower adherence to antihypertensive medications (AHMs). Here, we use electronic health record (EHR) data from the Estonian Biobank (EstBB) to investigate the role of lifetime depression in AHM adherence and persistence. We also explore the relationship between antidepressant initiation and intraindividual change in AHM adherence among hypertension (HTN) patients with newly diagnosed depression. Diagnosis and pharmacy refill data were obtained from the National Health Insurance database. Adherence and persistence to AHMs were determined for hypertension (HTN) patients initiating treatment between 2009 and 2017 with a three-year follow-up period. Multivariable regression was used to explore the associations between depression and AHM adherence or persistence, adjusting for sociodemographic, genetic, and health-related factors. A linear mixed-effects model was used to estimate the effect of antidepressant treatment initiation on antihypertensive medication adherence, adjusting for age and sex. We identified 20,724 individuals with newly diagnosed HTN (6294 depression cases and 14,430 controls). Depression was associated with 6% lower probability of AHM adherence (OR = 0.943, 95%CI = 0.909-0.979) and 12% lower odds of AHM persistence (OR = 0.876, 95%CI = 0.821-0.936). Adjusting for sociodemographic, genetic, and health-related factors did not significantly influence these associations. AHM adherence increased 8% six months after initiating antidepressant therapy (N = 132; β = 0.078; 95%CI = 0.025-0.131). Based on the EHR data on EstBB participants, depression is associated with lower AHM adherence and persistence. Additionally, antidepressant therapy may help improve AHM adherence in patients with depression.
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Affiliation(s)
- Hanna Maria Kariis
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Riia 23B, Tartu, 51010, Tartumaa, Estonia
| | - Silva Kasela
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Riia 23B, Tartu, 51010, Tartumaa, Estonia
| | - Tuuli Jürgenson
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Riia 23B, Tartu, 51010, Tartumaa, Estonia
| | - Aet Saar
- North Estonia Medical Centre, J. Sütiste Street 19, Tallinn, 13419, Harjumaa, Estonia
| | - Jana Lass
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Riia 23B, Tartu, 51010, Tartumaa, Estonia; Tartu University Hospital, L. Puusepa 8, Tartu, 50406, Tartumaa, Estonia
| | - Kristi Krebs
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Riia 23B, Tartu, 51010, Tartumaa, Estonia
| | - Urmo Võsa
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Riia 23B, Tartu, 51010, Tartumaa, Estonia
| | - Elis Haan
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Riia 23B, Tartu, 51010, Tartumaa, Estonia
| | - Lili Milani
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Riia 23B, Tartu, 51010, Tartumaa, Estonia
| | - Kelli Lehto
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Riia 23B, Tartu, 51010, Tartumaa, Estonia.
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Ekanem US, Dan EI, Etukudo GG, Ndon II, Etebom EE, Nkobo KB. An Assessment of Antihypertensive Medication Adherence among Hypertensive Patients Attending the Outpatient Clinics in the University of Uyo Teaching Hospital, Uyo. Niger Med J 2020; 61:120-125. [PMID: 33100461 PMCID: PMC7547759 DOI: 10.4103/nmj.nmj_95_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/22/2019] [Accepted: 03/29/2020] [Indexed: 11/05/2022] Open
Abstract
Context: Hypertension is a global cause of significant morbidity, ranking top as a cause of increased disability-adjusted life years. Patients who do not take their prescribed medication show almost a fourfold increase in the risk of dying from stroke by the second year after being prescribed treatment and a nearly threefold increased risk in the 10th year when compared to patients who take their prescribed medication. Medication adherence is a key factor in the control of high blood pressure. Objective: The objective of the study was to assess the antihypertensive medication adherence rate of patients attending the outpatient clinics at the University of Uyo Teaching Hospital (UUTH) and to explore factors that affect their adherence to the medications. Materials and Methods: This was a descriptive cross-sectional study of adult hypertensive patients attending the outpatient clinics at UUTH, from May to July 2018, who had been placed on antihypertensive medication(s) for at least 6 months. A standardized Morisky Medication Adherence 8 Questionnaire for assessing medication adherence was modified and used for the data collection. The questionnaires were administered by trained interviewers. Data were analyzed using SPSS 20.0. Results: A total of 379 hypertensive patients took part in the study; 85.2% were adherent to antihypertensive medication(s), but only 14.2% showed good adherence. Four of the five dimensions considered in the Morisky Assessment greatly affected antihypertensive medication adherence. The mean age of the study participants was 60.8 ± 1.8 years, and 75% were male. Conclusion: Good adherence to antihypertensive medication was quite low in this study population, and it was affected by all dimensions of the Morisky Assessment; health-care providers should pay more attention to their patient's drug adherence, educate them on medication adherence, and get them involved in their care.
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Affiliation(s)
| | - Emem Ime Dan
- Department of Obstetrics and Gyneacology, Emmanuel General Hospital, Eket, Akwa Ibom State, Nigeria
| | - George George Etukudo
- Department of Internal Medicine, Emmanuel General Hospital, Eket, Akwa Ibom State, Nigeria
| | | | - Ekemini Essien Etebom
- Department of Obstetrics and Gyneacology, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria
| | - Kingsley Bassey Nkobo
- Department of Surgery, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria
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Jin Y, He P. Antihypertensive treatment and depressive symptoms in Chinese middle-aged and older hypertensive adults: A population-based longitudinal study. Int J Geriatr Psychiatry 2020; 35:312-320. [PMID: 31833587 DOI: 10.1002/gps.5250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 12/07/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Hypertension is a risk factor for depressive disorders. Although the benefits of lowering blood pressure on the subsequent depressive disorders are supported by biological interpretation, the effect of antihypertensive therapies on depressive disorders is not clear. This study aimed to assess whether blood-pressure-lowering treatment have a protective effect on subsequent depressive symptoms in China. METHODS We used data from the nationally representative survey, including 2428 hypertensive participants free from depressive symptoms at baseline in 2011 to 2012. We assessed the depressive symptoms based on the 10-item Center for Epidemiological Studies Depression scale. We conducted Cox proportional hazards regression models to examine the effect of antihypertensive treatment on the incidence of depressive symptoms in 2011 to 2015. RESULTS In the total sample, all the models resulted in nonsignificant results and an estimated 8% reduction in risk (95% CI, 0·76-1·12) in the model adjusted for all covariates for the antihypertensive treatment takers with blood pressure controlled. In the group of urban residents, the antihypertensive treatment takers with blood pressure controlled had lower odds (HR: 0.68; 95% CI, 0·49-0·96) of depressive disorders. CONCLUSION The protective effect of the antihypertensive therapies might be relative to not only lowering blood pressure per se but also the management of hypertension. We proposed the early intervention to achieve the long-term protective effect of being antihypertensive and the supply of effective and collaborative care of hypertension and depression.
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Affiliation(s)
- Yinzi Jin
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Ping He
- China Center for Health Development Studies, Peking University, Beijing, China
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Martínez P, Castro A, Alonso D, Vöhringer PA, Rojas G. Effectiveness of the management of major depressive episodes/disorder in adults with comorbid chronic physical diseases: a protocol for a systematic review and meta-analysis. BMJ Open 2017; 7:e011249. [PMID: 28729304 PMCID: PMC5541516 DOI: 10.1136/bmjopen-2016-011249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Depression is a global-scale public health problem, and a significant association has been established between depression and chronic physical diseases. This growing comorbidity poses a challenge to healthcare systems. We aim to assess the effectiveness of the management of major depressive episodes/disorder in adults with comorbid chronic physical diseases. METHODS AND ANALYSIS We will conduct a systematic review and meta-analysis of randomised clinical trials. Two databases MEDLINE and Cochrane Library (Cochrane Database for Systematic Reviews and CENTRAL), as well as the reference lists of the included articles, will be searched for studies either in English or Spanish with published results within the 2005-2015 period. Studies must fulfil the following conditions: (1) participants aged 18 years or older, diagnosed as having a major depressive episodes/disorder according to standardised criteria and chronic physical diseases; (2)interventions (be it pharmacological, psychological, psychosocial or a combination) must be compared with control conditions (other 'active' intervention, treatment as usual, waiting list or placebo); (3)and must report reduction in depressive symptoms after treatment, response to treatment, remission of major depressive episodes/disorder and significant improvement in quality of life. Data extraction, risk of bias evaluation, results summarisation and quality of the evidence (GRADE) will be performed as recommended by the Cochrane Collaboration. A qualitative synthesis and a random effects meta-analysis will be carried out. Effect sizes will be calculated (relative risk and Cohen's d), I2 and Q statistics will be employed to study heterogeneity and publication bias analysis will be performed. Subgroup analyses and meta-regression will be carried out. ETHICS AND DISSEMINATION Results are expected to be published in specialised peer-reviewed journals (preferred topics: Mental Health, Psychology, Psychiatry and/or Systematic Reviews) and dissemination activities will be targeted to all the healthcare providers. TRIAL REGISTRATION NUMBER International Prospective Register of Systematic Reviews (CRD42016029166) submitted on 11 January 2016.
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Affiliation(s)
- Pablo Martínez
- Department of Psychiatry and Mental Health, Clinical Hospital, Universidad de Chile, Santiago de Chile, Chile
- Information Technology Innovation Centre for Social Applications (CITIAPS), Universidad de Santiago de Chile, Santiago, Chile
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
- School of Psychology, Faculty of Humanities, Universidad de Santiago de Chile, Santiago, Chile
| | - Ariel Castro
- School of Medicine, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Diego Alonso
- School of Medicine, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Paul A Vöhringer
- Department of Psychiatry and Mental Health, Clinical Hospital, Universidad de Chile, Santiago de Chile, Chile
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
- Mood Disorders Program, Tufts Medical Center, Tufts University, Boston, Massachusetts, USA
| | - Graciela Rojas
- Department of Psychiatry and Mental Health, Clinical Hospital, Universidad de Chile, Santiago de Chile, Chile
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
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Bauer AM, Parker MM, Moffet HH, Schillinger D, Adler NE, Adams AS, Schmittdiel JA, Katon WJ, Karter AJ. Depressive symptoms and adherence to cardiometabolic therapies across phases of treatment among adults with diabetes: the Diabetes Study of Northern California (DISTANCE). Patient Prefer Adherence 2017; 11:643-652. [PMID: 28392679 PMCID: PMC5373834 DOI: 10.2147/ppa.s124181] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Among adults with diabetes, depression is associated with poorer adherence to cardiometabolic medications in ongoing users; however, it is unknown whether this extends to early adherence among patients newly prescribed these medications. This study examined whether depressive symptoms among adults with diabetes newly prescribed cardiometabolic medications are associated with early and long-term nonadherence. PATIENTS AND METHODS An observational follow-up of 4,018 adults with type 2 diabetes who completed a survey in 2006 and were newly prescribed oral antihyperglycemic, antihypertensive, or lipid-lowering agents within the following year at Kaiser Permanente Northern California was conducted. Depressive symptoms were examined based on Patient Health Questionnaire-8 scores. Pharmacy utilization data were used to identify nonadherence by using validated methods: early nonadherence (medication never dispensed or dispensed once and never refilled) and long-term nonadherence (new prescription medication gap [NPMG]: percentage of time without medication supply). These analyses were conducted in 2016. RESULTS Patients with moderate-to-severe depressive symptoms had poorer adherence than nondepressed patients (8.3% more patients with early nonadherence, P=0.01; 4.9% patients with longer NPMG, P=0.002; 7.8% more patients with overall nonadherence [medication gap >20%], P=0.03). After adjustment for confounders, the models remained statistically significant for new NPMG (3.7% difference, P=0.02). There was a graded association between greater depression severity and nonadherence for all the models (test of trend, P<0.05). CONCLUSION Depressive symptoms were associated with modest differences in early and long-term adherence to newly prescribed cardiometabolic medications in diabetes patients. Interventions targeting adherence among adults with diabetes and depression need to address both initiation and maintenance of medication use.
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Affiliation(s)
- Amy M Bauer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
- Correspondence: Amy M Bauer, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, USA, Tel +1 206 221 8385, Fax +1 206 543 9520, Email
| | | | | | - Dean Schillinger
- Division of General Internal Medicine, University of California, San Francisco
- Center for Vulnerable Populations, San Francisco General Hospital and Trauma Center
| | - Nancy E Adler
- Department of Psychiatry and Pediatrics, Center for Health and Community, University of California, San Francisco, CA, USA
| | | | | | - Wayne J Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
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Boima V, Ademola AD, Odusola AO, Agyekum F, Nwafor CE, Cole H, Salako BL, Ogedegbe G, Tayo BO. Factors Associated with Medication Nonadherence among Hypertensives in Ghana and Nigeria. Int J Hypertens 2015; 2015:205716. [PMID: 26509081 PMCID: PMC4610060 DOI: 10.1155/2015/205716] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 03/25/2015] [Indexed: 11/18/2022] Open
Abstract
Background. Blood pressure (BP) control is poor among hypertensives in many parts of sub-Saharan Africa. A potentially modifiable factor for control of BP is medication nonadherence (MNA); our study therefore aimed to determine factors associated with MNA among hypertensives in Ghana and Nigeria. Methodology. We conducted a multicenter cross-sectional study. Patients were recruited from Korle-Bu Hospital (n = 120), Ghana; and University of Port Harcourt Teaching Hospital, (n = 73) Apapa General Hospital Lagos (n = 79) and University College Hospital Ibadan (n = 85), Nigeria. Results. 357 hypertensive patients (42.6% males) participated. MNA was found in 66.7%. Adherence showed correlation with depression (r = -0.208, P < 0.001), concern about medications (r = -0.0347, P = 0.002), and knowledge of hypertension (r = 0.14, P = 0.006). MNA was associated with formal education (P = 0.001) and use of herbal preparation (P = 0.014). MNA was found in 61.7% of uninsured participants versus 73.1% of insured participants (P = 0.032). Poor BP control was observed in 69.7% and there was significant association between MNA and poor BP control (P = 0.006). Conclusion. MNA is high among hypertensives in Ghana and Nigeria and is associated with depression, concern about hypertensive medications, formal education, and use of herbal preparations. The negative association between health insurance and MNA suggests interplay of other factors and needs further investigation.
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Affiliation(s)
- Vincent Boima
- School of Medicine and Dentistry, University of Ghana, P.O. Box 4236, Accra, Ghana
- Department of Medicine, Korle Bu Teaching Hospital, P.O. Box 77, Accra, Ghana
| | - Adebowale Dele Ademola
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan PMB 5017, Oyo State, Nigeria
- Department of Paediatrics, University College Hospital, Ibadan PMB 5116, Oyo State, Nigeria
| | - Aina Olufemi Odusola
- Department of Medicine, General Hospital, Randle Avenue, Apapa PMB 1014, Lagos, Nigeria
| | - Francis Agyekum
- Department of Medicine, Korle Bu Teaching Hospital, P.O. Box 77, Accra, Ghana
| | - Chibuike Eze Nwafor
- Cardiology Division, Department of Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt PMB 6173, Rivers State, Nigeria
| | - Helen Cole
- Department of Population Health, NYU School of Medicine, 227 E. 30th Street, 6th Floor, New York, NY 10016, USA
| | - Babatunde L. Salako
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan PMB 5017, Oyo State, Nigeria
- Department of Medicine, University College Hospital, Ibadan PMB 5116, Oyo State, Nigeria
| | - Gbenga Ogedegbe
- Department of Population Health, NYU School of Medicine, 227 E. 30th Street, 6th Floor, New York, NY 10016, USA
- Global Institute of Public Health, New York University, New York, NY 10003, USA
| | - Bamidele O. Tayo
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, 2160 South First Avenue, Maywood, IL 60153, USA
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