Adherence to Depression Treatment in Primary Care

Sirey, Jo Anne; Banerjee, Samprit; Marino, Patricia; Bruce, Martha L.; Halkett, Ashley; Turnwald, Molly; Chiang, Claire; Liles, Brian; Artis, Amanda; Blow, Fred; Kales, Helen C.

doi:10.1001/jamapsychiatry.2017.3047

Cited by 69 publications

(67 citation statements)

References 47 publications

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“…On the contrary, an optimal medication adherence has been linked to positive clinical outcomes regardless of the antidepressant type (Thompson, Peveler, Stephenson, & McKendrick, ). Thus, favoring medication adherence is a real challenge for professionals involved in MD cares (Sirey et al., ).…”

Section: Introductionmentioning

confidence: 99%

Determinants of suboptimal medication adherence in patients with a major depressive episode

et al. 2018

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Background Major Depression (MD) is often a chronic condition requiring a long‐term pharmacologic treatment. Despite the efficacy of antidepressants, the medication adherence in those affected is usually very poor. In this scenario, further research concerning drivers of suboptimal adherence is needed. We aimed to explore medication adherence in patients with a MD episode, and to identify sociodemographic, clinical (psychiatric antecedents, comorbidities, medication, pain, and medication side effects), and psychosocial factors (negative life events, childhood trauma, and attitudes to medication) related to adherence status. Method The Medication Adherence Rating Scale (MARS) was completed by 370 patients at hospital admission. Participants were divided into groups of optimal and suboptimal adherence based on the medication adherence behavior score (MARS's factor 1), and were compared with respect to the study variables. Results Twenty‐nine percent of participants (n = 107) were found to be optimally adherents to their medication (score = 4/4). Compared to optimally adherents, suboptimally adherents (71%) presented a significantly higher depression severity, more psychiatric hospitalizations, suicidal ideation, physical pain, negative medication side effects, and antecedents of emotional maltreatment. Suboptimally adherents also had less favorable attitudes toward medication and were less in a relationship than optimally adherents. Multivariate analyses showed that depression severity, suicidal ideation, and physical pain increase the probability of belonging to the suboptimal adherent group. Conclusion These results suggest a vicious circle in which more vulnerable patients are less adherent to medication, which could worsen the clinical picture maintaining, in turn, low adherence. More efforts are needed to develop interventions aiming to improve medication adherence in MD patients.

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Section: Introductionmentioning

confidence: 99%

Determinants of suboptimal medication adherence in patients with a major depressive episode

et al. 2018

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“…Studies of the prevalence of depression and anxiety in older adults do not offer insight into the explanatory models of illness (i.e., how they describe their experience, causes of depression and anxiety, and what to do about it) [9]. Interventions that take into account one's understanding of illness could lead to improved engagement and better health outcomes [10]. Approaches with a narrow focus or use of a bio-medical model may overlook important social, contextual, and cultural factors [11].…”

Section: Introductionmentioning

confidence: 99%

“We can’t carry the weight of the whole world”: illness experiences among Peruvian older adults with symptoms of depression and anxiety

Flores-Flores

Zevallos-Morales

Carrión

et al. 2020

Int J Ment Health Syst

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Background Despite the high levels of depression and anxiety symptoms in old age, the use of mental health services in this population is low. Help-seeking behaviors are shaped by how an individual perceives and experiences their illness. The objective of this study was to characterize the illness experiences of Peruvian older adults with depression and anxiety symptoms in order to lay the foundation for tailored community-based mental health interventions. Methods In this qualitative study, we conducted in-depth interviews with a purposively selected sample of older adults (≥ 60 years) from peri-urban areas of Lima, Peru. We included individuals with only depressive symptoms (Patient Health Questionnaire-9 ≥ 10), only anxiety symptoms (Beck Anxiety Inventory ≥ 16), with depressive and anxiety symptoms, and older adults who mentioned they had received mental health treatment/care. The interview guide included the following topics: perceptions and experiences about depression and anxiety; perceptions about the relationship between physical chronic diseases and mental health; experiences with mental health professionals and treatments, and coping mechanisms. Data collection was conducted between October 2018 and February 2019. Results We interviewed 38 participants (23 women, 15 men) with a mean age of 67.9 years. Participants’ ideas and perceptions of depression and anxiety showed considerable overlap. Participants attributed depression and anxiety mainly to familial and financial problems, loneliness, loss of independence and past traumatic experiences. Coping strategies used by older adults included ‘self-reflection and adaptation’ to circumstances, ‘do your part’, and seeking ‘emotional support’ mainly from non-professionals (relatives, friends, acquaintances, and religion). Conclusions Illness experiences of depression and anxiety set the pathway for tailored community-based mental health interventions for older adults. Overlapping narratives and perceptions of depression and anxiety suggest that these conditions should be addressed together. Mental health interventions should incorporate addressing areas related to depression and anxiety such as prevention of loss of independence, trauma, and loneliness. Good acceptability of receiving emotional support for non-professionals might offer an opportunity to incorporate them when delivering mental health care to older adults.

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“…However, depression response and remission and medication Apply evidence-based practices in a population health perspective, use a data-driven approach to assess and improve practice performance, and regularly evaluate outcomes, adverse events, and patients' perspectives to advance services use and adherence did not differ by group. Sirey and colleagues [17] showed that patients who engaged in a psychosocial intervention targeting antidepressant medication adherence were more likely to be adherent at 6 and 12 weeks than those receiving usual care. Although the intervention group exhibited a larger initial reduction in depressive symptom severity, symptom improvement was similar across groups at 24 weeks.…”

Section: Components Of Depression Treatment In the Pcmhmentioning

confidence: 99%

The Role of the Patient-Centered Medical Home in Treating Depression

Bogucki

Williams

Solberg

et al. 2020

Curr Psychiatry Rep

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Purpose of Review This review discusses the role of the patient-centered medical home (PCMH) in treating depression, focusing on findings from primary care-based studies and their implications for the PCMH. Recent Findings Pharmacotherapy, psychotherapy, and collaborative care are evidence-based treatments for depression that can be delivered in primary care and extended to diverse populations. Recent research aligns with the core components of the PCMH model. Summary The core components of the PCMH are critical elements of depression treatment. Comprehensive care within the PCMH addresses medical and behavioral health concerns, including depression. Psychiatric and psychological care must be flexibly delivered so services remain accessible yet patient-centered. To ensure the quality and safety of treatment, depression symptoms must be consistently monitored. Coordination within and occasionally outside of the PCMH is needed to ensure patients receive the appropriate level of care. More research is needed to empirically evaluate depression treatment within the PCMH.

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Adherence to Depression Treatment in Primary Care

Abstract: clinicaltrials.gov Identifier: NCT01301859.

Cited by 69 publications

References 47 publications

Determinants of suboptimal medication adherence in patients with a major depressive episode

Determinants of suboptimal medication adherence in patients with a major depressive episode

“We can’t carry the weight of the whole world”: illness experiences among Peruvian older adults with symptoms of depression and anxiety

The Role of the Patient-Centered Medical Home in Treating Depression

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