title: Socio-economic determinants of early discontinuation of anti-depressant treatment in young adults.
abstract: BACKGROUND
  Early discontinuation of anti-depressant treatment is common. This study analysed whether socio-economic factors influence early discontinuation among new anti-depressant users aged 20-34 years.
  
  
  METHODS
  Our study population included all Swedes aged 20-34 years who purchased anti-depressants in 2006 and had not purchased such drugs in the preceding 6 months (n = 25,003). We obtained prescription data from the Swedish Prescribed Drug Register. Information about demographic and socio-economic factors (country of birth, marital status, household size, education level, occupation, income and social assistance) was collected from Statistics Sweden by record linkage. We defined early discontinuation as filling only one anti-depressant prescription within a 6-month period. We used multiple logistic regression analysis to analyse the socio-economic factors associated with early discontinuation.
  
  
  RESULTS
  We identified 6536 individuals (26.1%) as early discontinuers. Early discontinuation was less common among women [odds ratio (OR) = 0.82; 95% confidence intervals (CI) 0.75-0.87] and in those with at least two years of higher education (OR = 0.71; 95% CI 0.61-0.83), whereas it was more common among those born outside Sweden (OR = 1.76; 95% CI 1.48-2.10) and those who received social assistance (OR = 1.26; 95% CI 1.11-1.44). Compared with selective serotonin re-uptake inhibitors, SSRI, early discontinuation was more common among individuals who started treatment with a tri-cyclic anti-depressant, TCA, (OR = 2.58; 95% CI 2.24-2.98) or an anti-depressant other than SSRIs, TCAs or selective serotonin-norepinephrine re-uptake inhibitors/norepinephrine (noradrenaline) re-uptake inhibitors (OR = 2.90; 95% CI 2.05-4.10).
  
  
  CONCLUSIONS
  Early discontinuation occurred more commonly among social assistance recipients and those with immigrant background, suggesting that those groups might require greater support when initiating anti-depressant therapy.
authors.affiliation: Nordic School of Public Health, Gothenburg, Sweden. karolina.a.sundell@nhv.se
authors.forename: Karolina Andersson
authors.initials: KA
authors.lastname: Sundell
authors.forename: Margda
authors.initials: M
authors.lastname: Waern
authors.forename: Max
authors.initials: M
authors.lastname: Petzold
authors.forename: Mika
authors.initials: M
authors.lastname: Gissler
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D004522:Educational Status; D054242:Emigrants and Immigrants / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy*; D016017:Odds Ratio; D010349:Patient Compliance / Q000523:psychology*; D012044:Regression Analysis; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D012737:Sex Factors; D012959:Socioeconomic Factors; D013548:Sweden; D013997:Time Factors; D016312:Treatment Refusal / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors