Sociodemographic Determinants of Nonadherence to Depression and Anxiety Medication among Individuals Experiencing Homelessness

Abstract

Psychiatric medication nonadherence continues to be a leading cause of poor health outcomes for individuals experiencing homelessness. Identifying the sociodemographic factors that contribute to medication nonadherence may help guide strategies to care for and support this group. This study examined 200 adults with depression diagnoses and active anti-depressant prescriptions (Mage = 43.98 ± 12.08, 59.4% Caucasian, 58.5% male, 70% uninsured, 89.5% unemployed) and 181 adults with anxiety diagnoses and active anti-anxiety prescriptions (Mage = 43.45 ± 11.02, 54.4% Caucasian, 57.5% male, 66.3% uninsured, 88.9% unemployed) recruited from six homeless-serving agencies in Oklahoma City. Self-reported sociodemographic variables included: age, sex, race/ethnicity, education, monthly income, employment status, and health insurance status. Adjusted logistic regression analyses revealed that employed (OR = 4.022, CI0.95: 1.244–13.004) and insured (OR = 2.923, CI0.95: 1.225–6.973) participants had greater odds of depression medication nonadherence. For anxiety, being employed (OR = 3.573, CI0.95: 1.160–11.010) was associated with greater odds of anxiety medication nonadherence, whereas having depression and anxiety diagnostic comorbidity (OR = 0.333, CI0.95: 0.137–0.810) was associated with lower odds of anxiety medication nonadherence. Interventions aimed at facilitating accessible prescription acquisition or otherwise reducing barriers to prescription medications for employed adults, including those with health insurance, may benefit adherence, but more research is needed. Future studies would benefit from using a qualitative approach to better delineate nuanced barriers to psychiatric medication adherence.

Analysis of older adult blood pressure readings and hypertension treatment rates among the unsheltered population of Miami‐Dade County

“…PEH have increased rates of behaviors known to increase hypertension risk, including higher smoking rates, poor diet, and high levels of sodium in average daily nutritional intake 35–38 . Studies on health care use in PEH populations have reported cost to be a significant barrier to medication access, likely impacting adherence to antihypertensives 35–40 . PEH also navigate an environment that poses logistical and practical barriers to lifestyle changes necessary for blood pressure control and maintenance, including barriers to obtaining fresh produce and reduced access to blood pressure monitoring equipment 34,35,37–39,41 .…”

“…and Crimmins et al. have called into question the age at which older adult care should begin for low SES and housing‐insecure patients, and recommend defining older adults in at‐risk populations earlier in the life course to better match onset of age‐associated diseases 32–44 . Doing so would have clinical relevance for primary care physicians who are tasked to manage chronic diseases, such as hypertension, in vulnerable patient populations.…”

“…Receiving a diagnosis of hypertension, even if the patient is asymptomatic, is important as there are proven effective strategies to control blood pressure, 37 including medications 38 and lifestyle changes that prevent the progression of the disease 39 . Hypertension is a common chronic disease in older adult populations, and when untreated, hypertension contributes to older adult frailty due to multisystem vulnerability, comorbidities, and increased risk of adverse events 40,41 . Unfortunately, few of these strategies have been critically analyzed within the context of older PEUH care.…”

“…39 Hypertension is a common chronic disease in older adult populations, and when untreated, hypertension contributes to older adult frailty due to multisystem vulnerability, comorbidities, and increased risk of adverse events. 40,41 Unfortunately, few of these…”

Understanding and Tackling the Complex Challenges of Homelessness and Health

“…The health impacts of homelessness presented by Eshtehardi [ 5 ] examine prescription management in supporting a comorbid diagnosis of depression, Carroll [ 6 ] reports an absence of access to rehabilitation services, Vallesi [ 7 ] identifies tri- and multi-morbidity, identifying the pervasiveness of preventable health conditions that exist for this population and limited access to screening programmes, and Salem [ 8 ] examines the increased risk of latent tuberculosis infection. Broderick [ 9 ] presents the outcomes of a review of physical health screening tests and confirms the challenge in using unsuitable standard tests which add to increased pain and discomfort.…”