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. While racial differences in depression treatment preferences have been reported, little is known about racial differences in antidepressant medication adherence among older patients. Design Prospective, observational study comparing antidepressant adherence for older African-American and white primary care patients. Participants One hundred and eighty-eight subjects aged 60 and older, diagnosed with clinically significant depression with a new recommendation for antidepressant treatment by their primary care physician. Measurement Study participants were assessed at study entry and at four-month follow-up (encompassing the acute treatment phase). Depression medication adherence was based on a well-validated self-report measure. Results At four-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 four-month antidepressant adherence than white subjects (n=106). African-American females had the lowest adherence rates (44.4%) followed by African-American males (56.8%), white males (65.3%) and white females (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 four-month antidepressant adherence (OR 3.58, 95% CI 1.27-10.07, Wald Chi-square =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 the older adults should take into account the potential impact of race and gender on adherence to prescribed medications.

Cost‐Effectiveness of a Community‐Integrated Home‐Based Depression Intervention in Older African Americans

“…Previous research and our focus group work conducted to inform intervention development suggested that older African Americans prefer nonpharmacological strategies as first-line treatment and also tend to use active coping mechanisms such as engaging in activities to handle daily life stressors. 24,25,26 Further, previous research suggests that depressive symptoms in this group may reflect a confluence of external contextual factors such as poor self-management of chronic disease or financial strain that warrant consideration and modification as part of a depression treatment program.…”

The Association Between Benzodiazepine Use and Depression Outcomes in Older Veterans

“…The consent form then had to be mailed back by the participant prior to conducting the initial interview. Consistent with prior work by Kales, Nease Jr, Sirey, Zivin, Kim, Kavanagh, Lynn, Chiang, Neighbors, Valenstein, Blow 17 , participants were subsequently excluded if they were found to have cognitive impairment using the Six-Item Screener 18 and/or if their depression was not viewed to be clinically significant (i.e. having a Patient Health Questionnaire [PHQ-9] score of less than 5) 19 .…”

Race-related Differences in Depression Onset and Recovery in Older Persons Over Time: The Health, Aging, and Body Composition Study

“…For example, low educational attainment and female sex have been found to be associated with depression onset (24-26) but not remission (27). Relatedly, female sex has been found to be associated with more severe depressive symptoms (28) and a higher likelihood of receiving treatment for depression (29), while black race is associated with a lower likelihood of initiation and adherence to depression treatment(30). Consequently, whether there are race-related differences in the onset of and recovery from depression in older persons, or whether race is similarly associated with these outcomes in men and women, remains unknown.…”