Effectiveness of interventions to improve adherence to antidepressant medication in patients with depressive disorders: a cluster randomized controlled trial.

Aim: To assess the effectiveness of two interventions of knowledge transfer and behavior modification to improve medication adherence in patients with depressive disorders. Methods: An open, multicenter, three-arm clinical trial with random allocation by cluster to usual care or to one of the two interventions. The intervention for psychiatrists (PsI) included an educational program based on a patient-centered care model. The intervention for patients and relatives (PtI) included a collaborative care program plus a reminder system that works using an already available medication reminder application. The primary outcome was patient adherence to antidepressant treatment assessed through the Sidorkiewicz Adherence Instrument. Secondary measures were depression severity, comorbid anxiety and health-related quality of life. Mixed regression models with repeated measures were used for data analysis. Results: Ten psychiatrists and 150 patients diagnosed with depressive disorder from eight Community Mental Health Units in the Canary Islands (Spain) were included. Compared with usual care, no differences in long-term adherence were observed in either group PsI or PtI. The PsI group had significantly improved depression symptoms (B = -0.39; 95%CI: -0.65, -0.12; p = 0.004) during the follow-up period. The PtI group presented improved depression symptoms (B = -0.63; 95%CI: -0.96, -0.30; p < 0.001) and mental quality of life (B = 0.08; 95%CI: 0.004, 0.15; p = 0.039) during the follow-up period. Conclusion: The assessed interventions to improve adherence in patients with depressive disorder were effective for depression symptoms and mental quality of life, even over the long term. However, no effect on antidepressant adherence was observed.

Sociodemographic and clinical predictors of adherence to antidepressants in depressive disorders: a systematic review with a meta-analysis.

Introduction: Current evidence reveals concerning rates of non-adherence to antidepressant treatment, possibly influenced by various relevant determinants such as sociodemographic factors or those related to the health system and their professionals. The aim of this paper is to review the scientific evidence on sociodemographic and clinical predictors of adherence to pharmacological treatment in patients diagnosed with a depressive disorder. Methods: a systematic review (SR) was conducted. The search for a previous SR was updated and de novo searches were performed in Medline, EMBASE, Web of Science (WoS) and PsycInfo (last 10 years). The risk of bias was assessed using the Cochrane tool for non-randomized studies-of Exposure (ROBINS-E). Meta-analyses were conducted. Results: Thirty-nine studies (n = 2,778,313) were included, 24 of them in the meta-analyses. In the initiation phase, no association of adherence was found with any of the predictors studied. In the implementation and discontinuation phases, middle-aged and older patients had better adherence rates and lower discontinuation rates than younger ones. White patients adhered to treatment better than African-American patients. Discussion: Age and ethnicity are presented as the predictive factors of pharmacological adherence. However, more research is needed in this field to obtain more conclusive results on other possible factors. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023414059], identifier [CRD42023414059].

Barriers and Facilitating Factors of Adherence to Antidepressant Treatments: An Exploratory Qualitative Study with Patients and Psychiatrists.

This study examines the experiences and expectations of patients with depressive disorders regarding the disease and different antidepressants, as well as examining the barriers and facilitating factors that could affect their adherence to medications. An exploratory qualitative study was carried out. The study involved two focus groups made up of patients and caregivers and six semi-structured interviews with psychiatrists. In both cases, the participants were selected by intentional theoretical sampling, seeking maximum significance variation of social types. Prejudice about the side effects of medication was relevant. The importance of patients being well informed about the disease/treatments was noteworthy. The stigmatization of antidepressants by patients was identified as a barrier to medication adherence. The involvement of family members and the motivation of patients to be actively involved in the process to recover from the disease were identified as facilitating factors. The work carried out suggests the need for patients to have rigorous information about the disease/treatment to reduce the possible prejudices generated by beliefs. Maintaining greater contact and monitoring of patients/caregivers to help therapeutic adherence in patients with depressive disorders was also identified as being of great importance.

Effectiveness and cost-effectiveness of a multicomponent intervention to improve medication adherence in people with depressive disorders - MAPDep: a study protocol for a cluster randomized controlled trial.

PURPOSE: Depression is a widespread mental disorder which can be treated effectively. However, low adherence to antidepressants is very common. The study of medication adherence in depression (MAPDep study) assesses the effectiveness and cost-effectiveness of a multicomponent strategy to enhance adherence toward medications in patients with depression. INTERVENTION: The intervention is a multicomponent one consisting of an educational program for psychiatrists and/or a collaborative care program for patients and relatives, plus a reminder system that works through the use of an already available high-quality medication reminder application. STUDY DESIGN: MAPDep study is an open, multicenter, four-arm cluster randomized controlled trial. The clusters are mental health units where psychiatrists are invited to participate. The clusters are randomly allocated to one of the three interventions or to usual care (control arm). Patients (18-65 years of age) diagnosed with depressive disorder, those taking antidepressant medication for an existing diagnosis of depression, and mobile phone users are selected. In group 1, only patients and relatives receive intervention; in group 2, only psychiatrists receive intervention; and in group 3, patients/relatives and psychiatrists receive intervention. The primary outcome is adherence to the antidepressant drug. The calculated sample size is 400 patients. To examine changes across time, generalized linear mixed model with repeated measures will be used. A cost-effectiveness analysis will be conducted. The effectiveness measure is quality-adjusted life years. Deterministic sensitivity analyses are planned. CONCLUSION: MAPDep study aims to assess a multicomponent strategy to improve adherence toward medications in patients with depression, based not only on clinical effectiveness but also on cost-effectiveness. This methodology will enhance the transferability of the expected results beyond mental health services (patients and psychiatrists) to health care policy decision making. CLINICAL TRIAL IDENTIFIER: NCT03668457.

[Reporting on Suicide. WHO recommendations for the Media.] / Noticias sobre suicidio en los medios de comunicación.Recomendaciones de la OMS.

Inappropriate reporting on suicide in the media may lead to a contagious effect or "Werther effect", while appropriate characteristics may have a protective effect or "Papageno effect". Therefore, the media can contribute to the prevention of suicide. For this reason, the WHO has developed three documents with recommendations for media professionals about how to report on suicide. However, only the first one has been translated into Spanish, they have overlaps and have a different structure. Therefore, Spanish-speaking media professionals in general, and Spanish ones in particular, can hardly have access to these WHO recommendations displayed in a clear and concise manner. The objective of this work was the elaboration and provision of a single and concise text that includes the recommendations of these documents. A formal and structured procedure was followed, combining scientific and linguistic criteria. The final text contains the recommendations grouped into three categories: "what to do", "what not to do" and "other recommendations". This document can be very useful for media professionals, for training activities to disseminate such recommendations for preventive purposes, and for research.

La exposición inadecuada en los medios de comunicación sobre suicidios puede producir un efecto contagio o efecto Werther, mientras que determinadas características adecuadas pueden tener un efecto protector o efecto Papageno. Por tanto, los medios de comunicación pueden contribuir a la prevención del suicidio. Por ello, la OMS ha elaborado tres documentos con una serie de recomendaciones dirigidas a los profesionales de los medios de comunicación, para el tratamiento de las noticias relacionadas con el suicidio. Sin embargo, solo se ha traducido al español el primero, ambos tienen solapamientos y poseen una estructura diferente. Esto supone que los profesionales de los medios de comunicación de habla hispana en general, y de España en particular, difícilmente pueden tener un acceso a estas recomendaciones de la OMS de una forma clara y concisa. El objetivo de este trabajo fue la elaboración y provisión de un texto único y sintético que recogiera las recomendaciones de estos documentos. Para su creación se siguió un procedimiento formal y estructurado, que aunó criterios científicos y lingüísticos. El texto final contiene las recomendaciones agrupadas en tres categorías: "qué hacer", "qué no hacer" y "otras recomendaciones". Este documento puede ser de gran utilidad para los profesionales de los medios de comunicación, para actividades formativas de difusión de tales recomendaciones con finalidad preventiva y para la investigación.

Noticias sobre suicidio en los medios de comunicación. Recomendaciones de la OMS / Reporting on suicide. WHO recommendations for the Media

La exposición inadecuada en los medios de comunicación sobre suicidios puede producir un efecto contagio o efecto Werther, mientras que determinadas características adecuadas pueden tener un efecto protector o efecto Papageno. Por tanto, los medios de comunicación pueden contribuir a la prevención del suicidio. Por ello, la OMS ha elaborado tres documentos con una serie de recomendaciones dirigidas a los profesionales de los medios de comunicación, para el tratamiento de las noticias relacionadas con el suicidio. Sin embargo, solo se ha traducido al español el primero, ambos tienen solapamientos y poseen una estructura diferente. Esto supone que los profesionales de los medios de comunicación de habla hispana en general, y de España en particular, difícilmente pueden tener un acceso a estas recomendaciones de la OMS de una forma clara y concisa. El objetivo de este trabajo fue la elaboración y provisión de un texto único y sintético que recogiera las recomendaciones de estos documentos. Para su creación se siguió un procedimiento formal y estructurado, que aunó criterios científicos y lingüísticos. El texto final contiene las recomendaciones agrupadas en tres categorías: "qué hacer", "qué no hacer" y "otras recomendaciones". Este documento puede ser de gran utilidad para los profesionales de los medios de comunicación, para actividades formativas de difusión de tales recomendaciones con finalidad preventiva y para la investigación (AU)

Inappropriate reporting on suicide in the media may lead to a contagious effect or "Werther effect", while appropriate characteristics may have a protective effect or "Papageno effect". Therefore, the media can contribute to the prevention of suicide. For this reason, the WHO has developed three documents with recommendations for media professionals about how to report on suicide. However, only the first one has been translated into Spanish, they have overlaps and have a different structure. Therefore, Spanish-speaking media professionals in general, and Spanish ones in particular, can hardly have access to these WHO recommendations displayed in a clear and concise manner. The objective of this work was the elaboration and provision of a single and concise text that includes the recommendations of these documents. A formal and structured procedure was followed, combining scientific and linguistic criteria. The final text contains the recommendations grouped into three categories: "what to do", "what not to do" and "other recommendations". This document can be very useful for media professionals, for training activities to disseminate such recommendations for preventive purposes, and for research (AU)

De 'medicina basada en la evidencia' a 'medicina sustentada en hallazgos': una propuesta razonada de traducción / From 'Evidence Based Medicine' to 'medicina sustentada en hallazgos': A Reasoned Translation Proposal

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