title: Racial differences in adherence to antidepressant treatment in later life.
abstract: OBJECTIVE
  Although antidepressants are an effective treatment for later-life depression, older patients often choose not to initiate or to discontinue medication treatment prematurely. Although racial differences in depression treatment preferences have been reported, little is known about racial differences in antidepressant medication adherence among older patients.
  
  
  METHODS
  Prospective, observational study comparing antidepressant adherence for older African American and white primary care patients.
  
  
  METHODS
  A total of 188 subjects age 60 and older, diagnosed with clinically significant depression with a new recommendation for antidepressant treatment by their primary care physician.
  
  
  METHODS
  Study participants were assessed at study entry and at the 4-month follow-up (encompassing the acute treatment phase). Depression medication adherence was based on a well-validated self-report measure.
  
  
  RESULTS
  At the 4-month follow-up, 61.2% of subjects reported that they were adherent to their antidepressant medication. In unadjusted and two of the three adjusted analyses, African American subjects (n = 82) had significantly lower rates of 4-month antidepressant adherence than white subjects (n = 106). African American women had the lowest adherence rates (44.4%) followed by African American men (56.8%), white men (65.3%), and white women (73.7%). In logistic regression models controlling for demographic, illness, and functional status variables, significant differences persisted between African American women and white women in reported 4-month antidepressant adherence (OR: 3.58, 95% CI: 1.27-10.07, Wald χ(2) = 2.42, df = 1, p <0.02).
  
  
  CONCLUSIONS
  The results demonstrate racial and gender differences in antidepressant adherence in older adults. Depression treatment interventions for older adults should take into account the potential impact of race and gender on adherence to prescribed medications.
authors.affiliation: Department of Psychiatry, University of Michigan, Ann Arbor, MI; Department of Veterans Affairs, HSR&D Center for Clinical Management Research (CCMR), and Serious Mental Illness Treatment, Resource and Evaluation Center (SMITREC), Ann Arbor, MI. Electronic address: kales@umich.edu.
authors.forename: Helen C
authors.initials: HC
authors.lastname: Kales
authors.forename: Donald E
authors.initials: DE
authors.lastname: Nease
authors.forename: Jo Anne
authors.initials: JA
authors.lastname: Sirey
authors.forename: Kara
authors.initials: K
authors.lastname: Zivin
authors.forename: Hyungjin Myra
authors.initials: HM
authors.lastname: Kim
authors.forename: Janet
authors.initials: J
authors.lastname: Kavanagh
authors.forename: Shana
authors.initials: S
authors.lastname: Lynn
authors.forename: Claire
authors.initials: C
authors.lastname: Chiang
authors.forename: Harold W
authors.initials: HW
authors.lastname: Neighbors
authors.forename: Marcia
authors.initials: M
authors.lastname: Valenstein
authors.forename: Frederic C
authors.initials: FC
authors.lastname: Blow
mesh_terms: D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D011320:Primary Health Care; D011446:Prospective Studies; D057566:Self Report; D012737:Sex Factors; D044465:White People / Q000523:psychology* / Q000706:statistics & numerical data; D016903:Drug Monitoring
chemical_list: D000928:Antidepressive Agents
keywords: Depression care; disparities; treatment adherence