title: Identifying opportunities to improve management of autoimmune hepatitis: evaluation of drug adherence and psychosocial factors.
abstract: OBJECTIVE
  Recognizing the importance of adherence to therapy in autoimmune hepatitis (AIH) is critical for patient care and avoidance of unnecessary intervention. The influence of psychosocial factors on treatment adherence needs better understanding and prominence. We sought to determine the association between anxiety, depressive symptoms, and avoidant relationship style on self-reported immunosuppressant medication adherence and treatment response in patients with AIH.
  
  
  METHODS
  Fifty two patients with AIH were assessed using the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Experiences in Close Relationship Scale (ECR) and a visual analogue scale to measure self-reported adherence. Laboratory markers of adherence and immunosuppressant treatment response were recorded. Chi-square Fisher's exact or Wilcox rank sum tests were used for comparison between groups.
  
  
  RESULTS
  Treatment responders compared to non-responders were older (p=0.035), had normal or mild score ranges for anxiety and depression (p=0.025) and were significantly more likely to report >80% treatment adherence (p=0.007). Non-responders had higher anxiety symptoms (p=0.025), and significantly higher ECR-avoidance scores (p=0.023), suggestive of a tendency towards a more avoidant relationship style.
  
  
  CONCLUSIONS
  We formally document that patients with AIH who have higher depressive and anxiety symptoms and avoidant relationship styles are more likely to be non-adherent to AIH therapy. We reiterate the need for early recognition and treatment of anxiety and depression in patients with AIH, stress the need for treatment adherence and highlight the need for formal evaluation of these factors in trials of therapy targeting apparent treatment non-responders.
authors.affiliation: University Health Network, Program in Medical Psychiatry, Canada. sanjeev.sockalingam@uhn.on.ca
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sockalingam
authors.forename: Diana
authors.initials: D
authors.lastname: Blank
authors.forename: Nour
authors.initials: N
authors.lastname: Abdelhamid
authors.forename: Susan E
authors.initials: SE
authors.lastname: Abbey
authors.forename: Gideon M
authors.initials: GM
authors.lastname: Hirschfield
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology; D003863:Depression / Q000523:psychology; D005260:Female; D019693:Hepatitis, Autoimmune / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged
chemical_list: D007166:Immunosuppressive Agents