ANTIDEPRESSANT ADHERENCE ACROSS DIVERSE POPULATIONS AND HEALTHCARE SETTINGS.
Early adherence is key to successful depression treatment, but nearly 60% of patients discontinue antidepressants within 3 months. Our study aimed to determine factors associated with poor early adherence to antidepressants in a large diverse sample of patients.



Six Mental Health Research Network healthcare systems contributed data for adults with depression and a new antidepressant start, defined by a washout period of at least 270 days, between January 1, 2010 and December 31, 2012. Pharmacy fill and self-reported race/ethnicity data were obtained from the electronic medical record. Patients had early adherence if they had a second antidepressant fill within 180 days of the first. We used logistic regression to investigate the relationship between early adherence and patient characteristics.



A total of 177,469 adult patients had 184,967 new episodes of depression with a filled antidepressant prescription. Patients refilled their antidepressants within 180 days in 71% of episodes. Race/ethnicity was a strong predictor of early adherence, with patients from racial/ethnic minorities other than Native Americans/Alaskan Natives less likely (adjusted odd ratios 0.50-0.59) to refill their antidepressants than non-Hispanic whites. Age, neighborhood education, comorbidity burden, provider type and engagement in psychotherapy were also associated with adherence. Other apparent predictors of early adherence, including neighborhood income, gender, and prior mental health hospitalizations, were no longer significant in the fully adjusted model.



Race/ethnicity was a robust predictor of early antidepressant adherence, with minority groups other than Native Americans/Alaskan Natives less likely to be adherent. Further research is needed to determine whether early nonadherence in specific minority populations is intentional, due to side effects or patient preference, or unintentional and appropriate for targeted interventions to improve adherence.
HealthPartners Institute, Minneapolis, Minnesota.
Rebecca C
RC
Rossom
Group Health Research Institute, Seattle, Washington.
Susan
S
Shortreed
Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, California.
Karen J
KJ
Coleman
Kaiser Permanente Colorado, Institute for Health Research, Denver, Colorado.
Arne
A
Beck
Kaiser Permanente Center for Health Research, Honolulu, Hawaii.
Beth E
BE
Waitzfelder
Group Health Research Institute, Seattle, Washington.
Christine
C
Stewart
Henry Ford Health System, Behavioral Health Services and Center for Health Policy and Health Services Research, Detroit, Michigan.
Brian K
BK
Ahmedani
Baylor Scott & White Health, Center for Applied Health Research, Temple, Texas.|Central Texas Veterans Health Care System, Temple, Texas.
John E
JE
Zeber
Group Health Research Institute, Seattle, Washington.
Greg E
GE
Simon
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000008:administration & dosage*; D003866:Depressive Disorder / Q000188:drug therapy* / Q000208:ethnology*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000208:ethnology*; D008875:Middle Aged; D014481:United States / Q000208:ethnology; D055815:Young Adult
D000928:Antidepressive Agents
antidepressants; medication adherence; patient adherence