title: Duration and compliance with antidepressant treatment in immigrant and native-born populations in Spain: a four year follow-up descriptive study.
abstract: BACKGROUND
  Non-compliance with antidepressant treatment continues to be a complex problem in mental health care. In immigrant populations non-compliance is one of several barriers to adequate management of mental illness; some data suggest greater difficulties in adhering to pharmacological treatment in these groups and an increased risk of therapeutic failure. The aim of this study is to assess differences in the duration and compliance with antidepressant treatment among immigrants and natives in a Spanish health region.
  
  
  METHODS
  Population-based (n = 206,603), retrospective cohort study including all subjects prescribed ADT between 2007 and 2009 and recorded in the national pharmacy claims database. Compliance was considered adequate when the duration was longer than 4 months and when patients withdrew more than 80% of the packs required.
  
  
  RESULTS
  5334 subjects (8.5% of them being immigrants) initiated ADT. Half of the immigrants abandoned treatment during the second month (median for natives = 3 months). Of the immigrants who continued, only 29.5% presented good compliance (compared with 38.8% in natives). The estimated risk of abandoning/ending treatment in the immigrant group compared with the native group, adjusted for age and sex, was 1.28 (95%CI 1.16-1.42).
  
  
  CONCLUSIONS
  In the region under study, immigrants of all origins present higher percentages of early discontinuation of ADT and lower median treatment durations than the native population. Although this is a complex, multifactor situation, the finding of differences between natives and immigrants in the same region suggests the need to investigate the causes in greater depth and to introduce new strategies and interventions in this population group.
authors.affiliation: Primary Care Research Institute IDIAP J Gol, Catalan Institute of Health, Rambla de Ferran 44, 3, 25007 Lleida, Spain. icruzesteve@gmail.com
authors.forename: Inés
authors.initials: I
authors.lastname: Cruz
authors.forename: Catalina
authors.initials: C
authors.lastname: Serna
authors.forename: Montserrat
authors.initials: M
authors.lastname: Rué
authors.forename: Jordi
authors.initials: J
authors.lastname: Real
authors.forename: Jorge
authors.initials: J
authors.lastname: Soler-Gonzalez
authors.forename: Leonardo
authors.initials: L
authors.lastname: Galván
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000208:ethnology; D017677:Age Distribution; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001294:Attitude to Health / Q000208:ethnology*; D002391:Catchment Area, Health; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005061:Europe, Eastern / Q000208:ethnology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007843:Latin America / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000208:ethnology / Q000706:statistics & numerical data*; D010352:Patient Dropouts; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013030:Spain
chemical_list: D000928:Antidepressive Agents