September 28, 2016
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Poor medication adherence related to depressive symptoms in congenital hypogonadotropic hypogonadism

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In men undergoing long-term treatment for congenital hypogonadotropic hypogonadism, lapses in medication adherence are common and may be associated with depressive symptoms, study data show.

Andrew A. Dwyer, PhD, FNP-BC, of the Institute of Higher Education and Research in Healthcare at the University of Lausanne in Switzerland, and colleagues evaluated data from 101 men (mean age, 37 years) with congenital hypogonadotropic hypogonadism prescribed hormonal therapies for at least 1 year to determine adherence to treatment, depressive symptoms and illness perceptions.

Andrew Dwyer
Andrew A. Dwyer

Participants completed an online survey to report information on medication adherence using the Morisky medication adherence scale, depressive symptoms using the Zung self-rating depression scale, and patient perception of congenital hypogonadotropic hypogonadism using the revised illness perceptions questionnaire. Depressive symptom scores were compared with published results from a reference group of healthy, similarly aged community-dwelling men and a group of men seeking assisted fertility; illness perception scores were compared with those from several published reference groups. Following the surveys, 26 study participants also attended focus group discussions to explore factors relating to treatment adherence.

Researchers found that 57% of participants reported low medication adherence, 21% reported moderate adherence and 22% reported high adherence; 38% of participants reported discontinuing treatment for more than 1 year.

“As testosterone replacement has strong effects on mood, libido and sexual function, we presumed that treatment pauses would result in a potent trigger for [congenital hypogonadotropic hypogonadism] men to resume treatment — yet surprisingly, this was seemingly not the case,” the researchers wrote.

Compared with the similarly aged reference group, participants with congenital hypogonadotropic hypogonadism had higher rates of mild (27%), moderate (17%) and severe (20%) depressive symptoms (P < .001 for all). Presence of depressive symptoms was also greater in participants with congenital hypogonadotropic hypogonadism (64%) compared with the combined reference group seeking assisted fertility treatment (7.1%; P < .001).

Participants with congenital hypogonadotropic hypogonadism with biological or adopted children had fewer depressive symptoms compared with those without children (P < .001). Poorer medication adherence was moderately associated with more severe depressive symptoms (P < .001). Researchers noted that the association may be bidirectional: Chronic disease may contribute to depressive symptoms, causing poor medication adherence, and withdrawal of testosterone can trigger depressive symptoms.

Participants with congenital hypogonadotropic hypogonadism perceived their illness as being more chronic compared with each of the three reference groups (P < .001 for all).

After analysis of the focus group discussions, the most commonly reported facilitators for adherence were a strong personal preference for a particular treatment type, supportive family members and peers, and continuity of care. Commonly reported barriers to adherence included depression, increased fatigue when off treatment, and poor understanding of congenital hypogonadotropic hypogonadism.

“The main finding of this paper is that many patients with congenital hypogonadotropic hypogonadism have difficulty adhering to long term treatment, have increased depressive symptoms and often struggle with the psychosocial impact of the condition,” Dwyer told Endocrine Today. “In terms of clinical care, there is a need for more systematic evaluation of adherence as well as depression screening in these patients. More research is needed to determine if online interventions and peer-to-peer support can help support effective coping for the dispersed rare disease patients.” – by Amber Cox

For more information:

Andrew A. Dwyer, PhD, FNP-BC, can be reached at University of Lausanne, Institute of Higher Education and Research in Healthcare, Biopole 2 – Route de la Corniche 10, Lausanne, 1010, Switzerland; email: Andrew.dwyer@chuv.ch.

Disclosure: The researchers report no relevant financial disclosures.