Program for Positive Aging, University of Michigan-Department of Psychiatry, 4250 Plymouth Rd, Ann Arbor, MI 48109.
Program for Positive Aging, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA.
J Clin Psychiatry. 2019 Mar 26;80(3):18m12476. doi: 10.4088/JCP.18m12476.
To best prevent depression relapse and reduce recurrence, an understanding of the factors associated with continued maintenance treatment is needed. This study compared factors associated with antidepressant nonadherence during the acute (ie, during the first 4 months) and maintenance (ie, during 12 months) treatment phase among older veterans with depression.
In this prospective, observational study of 278 older veterans with depression (Patient Health Questionnaire-9 score ≥ 5), patients had been given a new antidepressant prescription between 2008 and 2011. Participants completed initial and follow-up interviews at 4 and 12 months. Medication adherence was assessed by the Brief Medication Questionnaire. A generalized estimating equation was used to determine patient factors associated with nonadherence at each time point.
Nearly a third of veterans were nonadherent at 4- and 12-month follow-up. In adjusted analyses, nonadherence was significantly associated with African American race (adjusted odds ratio [AOR] = 2.69, 95% CI, 1.30-5.57; P = .01), being unmarried (AOR = 1.84; 95% CI, 1.16-2.92; P = .049), greater medical comorbidity (AOR = 1.30; 95% CI, 1.13-1.49; P < .001), functional impairment (AOR = 1.34; 95% CI, 1.10-1.63; P = .01), and self-reported side effects (AOR = 2.48; 95% CI, 1.57-3.94; P < .001) at both 4 and 12 months. Depression or anxiety severity did not predict antidepressant adherence at either time point.
Rates of and factors associated with antidepressant nonadherence were similar at 4 and 12 months. Further work is needed to develop tailored treatment programs to engage older veterans at higher risk of nonadherence in the early treatment period, which may ultimately help to both achieve remission and reduce relapse and recurrence.
为了最好地预防抑郁症复发和减少复发，需要了解与继续维持治疗相关的因素。本研究比较了老年抑郁症患者在急性期（即前 4 个月）和维持期（即 12 个月）治疗期间与抗抑郁药依从性相关的因素。
在这项对 278 名老年抑郁症患者（患者健康问卷-9 得分≥5）的前瞻性、观察性研究中，患者在 2008 年至 2011 年间接受了新的抗抑郁药处方。参与者在 4 个月和 12 个月时完成了初始和随访访谈。药物依从性通过简短药物问卷进行评估。使用广义估计方程确定每个时间点与不依从相关的患者因素。
近三分之一的退伍军人在 4 个月和 12 个月的随访中不依从。在调整后的分析中，不依从与非裔美国人种族显著相关（调整后的优势比 [AOR] = 2.69，95%置信区间，1.30-5.57；P =.01），未婚（AOR = 1.84；95%置信区间，1.16-2.92；P =.049），更多的合并症（AOR = 1.30；95%置信区间，1.13-1.49；P <.001），功能障碍（AOR = 1.34；95%置信区间，1.10-1.63；P =.01）和自我报告的副作用（AOR = 2.48；95%置信区间，1.57-3.94；P <.001）在 4 个月和 12 个月时均有发生。抑郁或焦虑严重程度在任何时间点都不能预测抗抑郁药的依从性。
在 4 个月和 12 个月时，抗抑郁药不依从的发生率和相关因素相似。需要进一步努力制定量身定制的治疗方案，以让处于较高不依从风险的老年退伍军人在早期治疗期间参与其中，这可能最终有助于实现缓解并减少复发和复发。
