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Primary care intervention improves depression treatment adherence

A psychosocial intervention conducted in primary care treatment significantly improved antidepressant treatment adherence among older adults.

“Nonadherence to antidepressant therapy remains a major challenge to quality depression care,” Jo Anne Sirey, PhD, of the department of psychiatry, Weill Cornell Medicine, White Plains, N.Y., and colleagues wrote in their study published in JAMA Psychiatry. “Rates of nonadherence among older adults range from 29% to 40% in the United States. Most depression management is provided in primary care, and higher rates of antidepressant nonadherence are documented in primary care compared with psychiatry sites.”

To assess efficacy of a psychosocial intervention for early adherence to depression treatment among older adults in primary care, researchers conducted a randomized clinical trial among 231 middle-aged and older adults (aged 55 years) who recently began depression treatment. Study participants were randomly assigned to the Treatment Initiation and Participation Program (TIP; n = 115) or treatment as usual (n = 116) at two primary care practices.

Participants in the TIP group identified and addressed barriers to adherence, including stigma, misconceptions and fears regarding treatment before developing a personalized adherence strategy. TIP was delivered via three 30-minute contacts across a 6-week period following antidepressant prescription.

Mean participant age was 67.3 years.

At 6 weeks, TIP participants were five times as likely to adhere to antidepressant treatment (OR = 5.54; 95% CI, 2.57-11.96).

At both 6 and 12 weeks, TIP participants were three times as likely to adhere to antidepressant medication (OR = 3.27; 95% CI, 1.73-6.17).

Participants in the TIP group exhibited significant earlier reduction in depressive symptoms (24.9%; 95% CI, 13.9-35.9), whereas those in the usual care arm demonstrated only a nonsignificant improvement (10.7%; 95% CI, 0.01 to 21.4).

Among both treatment groups, participants who were 80% adherent at 6 and 12 weeks had a 15% greater improvement in depressive symptoms from baseline to treatment end (95% CI, –0.2 to –30).

“Given the high rates of depression, nonadherence and use of primary care as a mental health service, wide-scale implementation of a targeted adherence intervention, such as TIP, could have a meaningful impact on public health,” the researchers wrote. “In addition, future work can extend TIP to other patient groups with depression (eg, patients with treatment for refractory depression from an earlier antidepressant trial) or patients with comorbid clinical conditions (eg, cognitive impairment).” – by Amanda Oldt

Disclosures: The authors report no relevant financial disclosures.