The effects of antidepressant medication adherence as well as psychosocial and clinical factors on depression outcome among older adults.
OBJECTIVE
To examine the contribution of medication adherence to 12-month depression scores in the context of other psychosocial and clinical predictors of depression in a sample of older adults treated for depression.


METHODS
Secondary analysis of a prospective cohort study involving 241 older patients undergoing depression treatment using a standardized algorithm. Depression was measured at baseline and 12-months post-baseline. Baseline predictor variables included antidepressant adherence, barriers to antidepressant adherence, four domains of social support, basic and instrumental activities of daily living (BADLs and IADLs), and clinical factors including past history of depression and medical comorbidities.


RESULTS
Nearly 28% of patients reported being nonadherent with their antidepressant medication. In bivariate analyses, greater antidepressant medication nonadherence, more medication barriers, poorer subjective social support, less non-family interaction, greater BADL and IADL limitations, poor self-rated health, higher baseline depression scores, and not having diabetes were related to higher 12-month depression scores. In multivariable analyses, greater medication nonadherence, not having diabetes, poorer subjective social support, greater BADL limitations, and higher baseline depression scores were related to higher 12-month depression scores.


CONCLUSIONS
Interventions should be directed toward improving antidepressant adherence and modifiable psychosocial variables.
Bosworth
Hayden B
HB
Center for Health Services Research in Primary Care, Durham VAMC, NC 27705, USA. hboswort@acpub.duke.edu
Voils
Corrine I
CI
Potter
Guy G
GG
Steffens
David C
DC
D000203:Activities of Daily Living; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy / Q000523:psychology*; D003920:Diabetes Mellitus / Q000523:psychology; D005260:Female; D015577:Geriatric Assessment; D006304:Health Status; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010349:Patient Compliance; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012931:Social Environment; D012944:Social Support; D016896:Treatment Outcome
D000928:Antidepressive Agents