Extent and Factors Associated with Adherence to Antidepressant Treatment During Acute and Continuation Phase Depression Treatment Among Older Adults with Dementia and Major Depressive Disorder

Sociodemographics and clinical factors associated with depression treatment outcomes in 65,741 first-time users of selective serotonin reuptake inhibitors: A Danish cohort study in older adults

OBJECTIVE

To investigate a wide range of sociodemographic and clinical factors associated with treatment outcomes in older adults who initiated an SSRI for depression treatment in a real-world setting.

METHODS

This cohort study used Danish registry data covering all older adults (aged ≥65) who initiated SSRIs for depression from 2006 to 2017, first-time (since 1995). We followed the individuals for one year after their SSRI prescription. Six different outcomes were analyzed, including treatment discontinuation, switching, augmentation, psychiatric hospital contacts for depression, psychiatric hospital admission, and suicide attempt/self-harm. Association analyses employed Poisson regression, estimating incidence rate ratios with 95 % confidence intervals.

RESULTS

The study included 65,741 individuals with a mean age of 78.23 years, and 55.6 % were females. During follow-up, 40.1 % discontinued, 4.8 % switched, 20.3 % received augmentation, 3.0 % had psychiatric hospital contacts for depression, 3.2 % had psychiatric admission, and 0.1 % had suicide attempt/self-harm records. Differential treatment outcomes were observed based on sociodemographic and clinical factors. For example, being female, residing predominantly in rural areas, having psychiatric or somatic diagnoses, and using medications acting on blood/blood-forming organs, the cardiovascular system, or musculo-skeletal systems were linked to fewer unfavorable clinical outcomes. Conversely, marital status as being single or separated and the use of nervous system drugs were associated with a higher risk of unfavorable outcomes.

LIMITATIONS

Confounding by indication might remain a problem, and depression severity data was not unavailable.

CONCLUSIONS

Our findings emphasize considering patient characteristics in clinical decisions, as they can influence the clinical course of those undergoing depression treatment.

Depression Treatment Trajectories and Associated Social Determinants: A Three-Year Follow-Up Study in 66,540 Older Adults Undergoing First-Time Depression Treatment in Denmark

OBJECTIVE

This study aimed to describe depression treatment patterns, identify unique trajectory groups using a group-based trajectory approach, and explore associated social determinants in older adults undergoing first-time depression treatment during a 3-year follow-up.

METHODS

This Danish register-based cohort study included all adults aged ≥ 65 who initiated depression treatment by redeeming first-time antidepressant prescriptions (no prescriptions in the last 10 years) between 2006 and 2015. The outcome of interest during the 2-year follow-up was depression treatment, assessed as antidepressant prescriptions redemptions and psychiatric hospital contacts for depression. Latent class growth analyses were applied to model treatment trajectories during 3 years. Multinomial logistic regression analyses were used to analyze adjusted associations between social determinates and trajectory group membership.

RESULTS

Among the 66,540 older adults (55.2% females, mean age: 77.3 years), we identified three distinct groups with unique patterns of depression treatment trajectories: 'brief-treatment' where individuals stopped depression treatment within 6 months (33.7%); 'gradual-withdrawal' (26.5%) where treatment was gradually stopped over 2 years; and 'persistent-treatment' where individuals continued depression treatment for the entire 3 years (39.8%). Females, single-person households, and residents of less-urbanized regions were associated with higher odds of membership in the 'persistent-treatment' group, while older age, widowhood or separation, and non-Danish ethnicities were associated with lower odds.

CONCLUSIONS

Three distinct patterns of depression treatment trajectories were identified in older adults, indicating differential clinical courses of depression-potentially influenced by social determinants, including sex, marital status, urban residence, and ethnicity. Early patient stratification and targeted interventions are crucial in depression care for older adults.

Sociodemographic and clinical predictors of adherence to antidepressants in depressive disorders: a systematic review with a meta-analysis

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].

The role of integrated medical and prescription drug plans in addressing racial and ethnic disparities in medication adherence

Medication nonadherence in the United States contributes to 125,000 deaths and 10% of hospitalizations annually. The pain of preventable deaths and the personal costs of nonadherence are borne disproportionately by Black, Latino, and other minority groups because nonadherence is higher in these groups due to a variety of factors. These factors include socioeconomic challenges, issues with prescription affordability and convenience of filling and refilling them, lack of access to pharmacies and primary care services, difficulty taking advantage of patient engagement opportunities, health literacy limitations, and lack of trust due to historical and structural discrimination outside of and within the medical system. Solutions to address the drivers of lower medication adherence, specifically in minority populations, are needed to improve population outcomes and reduce inequities. While various solutions have shown some traction, these solutions have tended to be challenging to scale for wider impact. We propose that integrated medical and pharmacy plans are well positioned to address racial and ethnic health disparities related to medication adherence. DISCLOSURES: This study was not supported by any funding sources other than employment of all authors by Humana Inc. Humana products and programs are referred to in this article.