1123 — Determinants of Antidepressant Adherence among Older Veterans
Kales HC, Zivin K, Kim HM, Bishop T, Kavanagh J, Valenstein M, and Blow FC, COE-Ann Arbor;
Major depression is one of the most significant health concerns facing older adults in the U.S. Geriatric depression is often chronic and/or recurrent, and is associated with substantial suffering, disability, suicide risk, and decreased health-related quality of life. However, many older patients choose not to initiate antidepressant treatment or discontinue their antidepressant treatment prematurely. The purpose of this study was to explore determinants of antidepressant adherence among older Veterans using both qualitative and quantitative methods.
A sequential mixed-methods approach was used. In the qualitative portion, two focus groups were held with older Veterans with depression. Information gleaned from the focus groups was used to refine the quantitative study questionnaire. In the quantitative study, older Veterans with depression newly started on antidepressants by their provider were recruited from three sites (Ann Arbor, Detroit, and Battle Creek MI). Subjects were assessed at baseline and four-month follow-up (acute treatment phase) to examine potential determinants of antidepressant adherence.
Two-hundred seventy nine subjects were recruited into the study. Overall, the rate of four-month antidepressant adherence was 72%. Non-adherent subjects were significantly more likely to be without a spouse or partner and to have a greater amount of medical comorbidity. In addition, it appeared there was a clear impact of race on adherence: while the adherence rate for white subjects was 74%, the adherence rate for African-American subjects was only 48%. We are currently exploring the findings of racial disparities further, including the impact of treatment site and the Primary Care-Mental Health Integration.
Our preliminary findings indicate that significant factors impacting antidepressant adherence in older Veterans with depression include marital status, medical comorbidity, and race. The finding of such a large racial disparity with regard to treatment adherence may point to the need for interventions particularly tailored for older African-American Veterans.
This is the first study to our knowledge to examine adherence behaviors among older Veterans. Given the large number of older Veterans with depression who are prescribed antidepressants, information on adherence behaviors is of critical importance to improving depression care.