Antidepressant nonadherence among older veterans during acute and maintenance treatment phases is strongly associated with African American race and being without a spouse or partner, according to research published in the Journal of Clinical Psychiatry.

This prospective, observational study included 278 veterans (age ≥60 years, 97% male) who had been given a new antidepressant medication at one of 3 Veterans Affairs medical centers in Michigan between 2008 and 2011. At baseline and at 4 and 12 months, investigators assessed medication adherence using the Brief Medication Questionnaire. Participants missing 2 or more daily doses in a week were considered nonadherent, unless their providers recommended medication discontinuation. Investigators used a generalized estimating equation model to determine factors associated with nonadherence at 4 and 12 months.

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Approximately one-third of the participants were nonadherent to antidepressant treatment during both the acute (4 months) and maintenance (12 months) phases. As demonstrated in previous studies, African American race (adjusted odds ratio [AOR], 2.69; 95% CI, 1.30-5.57; P =.01) and being unmarried (AOR, 1.84; 95% CI, 1.16-2.92; P =.009) were both associated with antidepressant nonadherence, and this was shown at both time points. In addition, nonadherence was significantly associated with greater medical comorbidity (AOR, 1.30; 95% CI, 1.13-1.49; P <.001), functional impairment (AOR, 1.34; 95% CI, 1.10-1.63; P =.004), and self-reported side effects (AOR, 2.48; 95% CI, 1.57-3.94; P <.001). Depression and anxiety severity did not predict adherence at either 4 or 12 months.

“[Further] work is needed to develop tailored treatment programs to identify and engage older veterans at higher risk [for] nonadherence early in treatment, including specifically addressing and supporting the needs of racial minorities and those without spouses or partners,” investigators concluded.

Reference

Gerlach LB, Chiang C, Kales HC. The start predicts the finish: factors associated with antidepressant nonadherence among older veterans during the acute and maintenance treatment phases. J Clin Psychiatry. 2019;80(3):18m12476.