Zivin K (Ann Arbor COE ), Ganoczy D
(Ann Arbor COE), Pfeiffer P
(Ann Arbor COE ), Miller E
(Ann Arbor COE ), Valenstein M
(Ann Arbor COE )
Patients with depression discharged from a psychiatric hospitalization face increased risks for adverse outcomes including suicide. While adherence to antidepressants may be particularly important at this time, rates of adherence during this high-risk period are not known. We assessed overall levels of antidepressant adherence in the first three and six months following psychiatric hospitalization and the patient factors associated with poorer adherence.
We identified VA patients who: 1) received at least two depression diagnoses or one diagnosis followed by an antidepressant fill between April 1, 1999 and September 30, 2003; 2) were hospitalized for psychiatric reasons during that time; 3) received an antidepressant fill at time of discharge (up to three days before to two days after discharge); 4) had an outpatient visit within the three or six-month post-discharge follow-up period; and 5) lived at least 90 days following discharge. We examined whether patients had high levels of adherence (medication possession ratios or MPRs > 0.8) or poor adherence (MPRs < 0.8) in the three and six months post-discharge, and identified predictors of poor adherence.
Of the initial sample of 37,103 patients who received an antidepressant fill at time of psychiatric discharge, 25,139 (68%) patients met criteria for three-month MPR calculations and 33,893 (91%) met criteria for six-month MPR calculations. The mean MPR at three months was 0.82 (0.38); 46% had poor adherence over the three month period. The mean MPR at six months was 0.72 (0.40); 54% of patients had poor adherence over the six month period. Patients with poorer adherence were younger, non-white, Hispanic, and had substance use disorder, but were less likely to have PTSD or other anxiety disorders.
Implications: This study provides new information regarding antidepressant adherence post-hospitalization among depressed veterans, and indicates that poor adherence during this critical treatment period is common.
Depressed patients who have been recently hospitalized are at high risk for adverse outcomes and suicide, and are often poorly adherent to antidepressant medication in the months following hospitalization. Efforts are needed to increase antidepressant adherence during this vulnerable treatment period.