|
BACKGROUND/RATIONALE:
Geriatric depression is often chronic, recurrent, and associated with significant suffering, disability, suicide risk and decreased quality of life. Most geriatric depression is treated in primary care where a substantial treatment gap exists. Research examining this treatment gap has focused on provider and system factors. Despite the success of collaborative care models to treat late-life depression, patient-level factors including poor participation and non-adherence limit the extent to which older patients realize the benefits of efficacious depression treatments. Older patients often fail to take antidepressants as prescribed; as many as 40% discontinue antidepressants prematurely. To develop interventions to increase depression treatments’ effectiveness, it is critical to understand late-life adherence behaviors. In particular, we must examine factors for which future interventions would have impact. One factor that appears to put depressed older patients at substantial risk for non-adherence is comorbid anxiety. Other important factors likely impact late-life antidepressant adherence, but little research has investigated this area.
OBJECTIVE(S):
The primary aims of this study are to: 1) assess the impact of clinically significant anxiety on antidepressant adherence in older veterans with depression, 2) use qualitative and quantitative methods to examine other potentially modifiable determinants of adherence (e.g. beliefs, attitudes, social support, etc.) and 3) test the relative impact of anxiety in older patients with depression compared to other patient, provider, and system factors on antidepressant non-adherence. Secondary exploratory aims are to: 1) assess the effect of acute phase antidepressant non-adherence on longer-term healthcare utilization and outcomes, and 2) gain a better understanding of the mechanisms of impact of comorbid anxiety and other modifiable factors on adherence among depressed older veterans.
METHODS:
This study will use a sequential mixed-methods approach to identify and examine factors that impede late-life antidepressant adherence. Qualitative methods (focus groups) will be used to guide the development of a subsequent prospective quantitative structured interview in the following ways: 1) suggesting other domains not yet considered or studied; 2) revealing potential mechanisms for the impact of these factors on adherence; and 3) informing the structured interview questions. Based on the qualitative results, we will refine a structured interview instrument that assesses comorbid anxiety and other key constructs potentially determining adherence. Participants in both portions of the study will be identified via an IRM algorithm using VistA/Cache. For the quantitative portion, 289 patients aged 60 years or older diagnosed with depression and given a new outpatient antidepressant prescription will be recruited from three VISN 11 study sites (Ann Arbor, Battle Creek, and Detroit). Participants will have a baseline interview and follow-up interviews at 4- and 12-months. The primary analysis will examine the effect of comorbid anxiety on acute phase (first 4 months) antidepressant adherence. Secondary exploratory analyses will assess the role of other factors on acute phase adherence as well as examine the impact of non-adherence on 12-month health care outcomes.
FINDINGS/RESULTS:
No results at this time.
IMPACT:
This research will provide us with the insight and understanding of late-life depression adherence behaviors essential for developing and testing interventions that increase the effectiveness of existing depression treatments and collaborative care models, improving depression outcomes for a substantial number of older veterans.
PUBLICATIONS:
None at this time.
DRA:
Aging and Age-Related Changes, Mental Illness
DRE:
Quality of Care, Treatment
Keywords:
Access, Depression
MeSH Terms:
none
|
