Strawn Jeffrey R, Mills Jeffrey A, Neptune Zoe A, Burgei Alyssa, Schroeder Heidi K, Martin Lisa J, Farrow Jenni, Poweleit Ethan A, Ramsey Laura B
Department of Psychiatry & Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
Department of Economics, Lindner College of Business, University of Cincinnati, Cincinnati, Ohio, USA.
J Child Adolesc Psychopharmacol. 2025 Apr;35(3):145-154. doi: 10.1089/cap.2024.0102. Epub 2024 Dec 24.
Antidepressant medication adherence patterns are inconsistent in adolescents with anxiety and related disorders, and the clinical and demographic features predicting adherence are poorly understood. In an ongoing single-site prospective trial involving adolescents (aged 12-17) with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition anxiety disorders treated with escitalopram, adherence was measured for 12 weeks using electronic monitoring caps. Adherence patterns were examined using qualitative and unsupervised clustering approaches, and predictors of adherence were evaluated using logistic regression, with demographic (age, sex, and race) and clinical variables (e.g., anxiety severity [Pediatric Anxiety Rating Scale], irritability [Affective Reactivity Index], depressive symptoms [Children's Depression Rating Scale]). Among adolescents ( = 33) aged 14.5 ± 1.8 years (64% female), four adherence patterns were identified: persistent adherence, intermittent adherence, early adherence-late nonadherence, and nonadherence. In a logistic model of a 5-day moving average measure of adherence, social anxiety disorder ( = -0.68 ± 0.19, = 0.002) and separation anxiety disorder ( = -0.61 ± 0.18, < 0.001) were associated with lower adherence. In contrast, panic disorder, attention-deficit/hyperactivity disorder, generalized anxiety disorder, and depressive symptoms were not associated with adherence. Baseline anxiety severity was linked to lower adherence ( = -0.199 ± 0.05, < 0.001). Older age also reduced adherence ( = -0.342 ± 0.05, < 0.001), with each additional year of age increasing time spent nonadherent by 5% ( < 0.001). Being female ( = 0.451 ± 0.17, = 0.011) and expecting treatment to be efficacious ( = 0.092 ± 0.04, = 0.011) increased adherence, while greater irritability was associated with nonadherence ( = -0.075 ± 0.03, = 0.006). Antidepressant adherence is variable, with distinct patterns, and those with social and separation anxiety disorders were less likely to be adherent. Factors such as older age, severe anxiety, and greater irritability predicted lower adherence, while being female and expecting treatment efficacy were associated with better adherence. Interventions that address specific symptoms or enhance treatment expectations may improve adherence.
在患有焦虑症及相关障碍的青少年中，抗抑郁药物的依从模式并不一致，而且对于预测依从性的临床和人口统计学特征也知之甚少。在一项正在进行的单中心前瞻性试验中，研究对象为年龄在12至17岁、患有《精神疾病诊断与统计手册》第五版焦虑症且正在接受艾司西酞普兰治疗的青少年，使用电子监测帽对其12周的依从性进行测量。采用定性和无监督聚类方法检查依从模式，并使用逻辑回归评估依从性的预测因素，包括人口统计学变量（年龄、性别和种族）和临床变量（例如，焦虑严重程度[儿童焦虑评定量表]、易怒程度[情感反应指数]、抑郁症状[儿童抑郁评定量表]）。在14.5±1.8岁的青少年（n = 33）中，64%为女性，确定了四种依从模式：持续依从、间歇依从、早期依从-后期不依从和不依从。在一个关于依从性的5天移动平均测量的逻辑模型中，社交焦虑障碍（β = -0.68±0.19，P = 0.002）和分离焦虑障碍（β = -0.61±0.18，P < 0.001）与较低的依从性相关。相比之下，惊恐障碍、注意力缺陷/多动障碍、广泛性焦虑障碍和抑郁症状与依从性无关。基线焦虑严重程度与较低的依从性相关（β = -0.199±0.05，P < 0.001）。年龄较大也会降低依从性（β = -0.342±0.05，P < 0.001），每增加一岁，不依从的时间就增加5%（P < 0.001）。女性（β = 0.451±0.17，P = 0.011）以及预期治疗有效（β = 0.092±0.04，P = 0.011）会增加依从性，而易怒程度较高与不依从相关（β = -0.075±0.03，P = 0.006）。抗抑郁药物的依从性存在差异，有不同的模式，患有社交焦虑障碍和分离焦虑障碍的青少年依从性较低的可能性更大。年龄较大、焦虑严重和易怒程度较高等因素预示着较低的依从性，而女性和预期治疗有效则与较好的依从性相关。针对特定症状或提高治疗预期的干预措施可能会改善依从性。
