The Impact of Socioeconomic Status, Race/Ethnicity, and Patient Perceptions on Medication Adherence in Depression Treatment.

OBJECTIVE: Nonadherence to pharmacotherapy for psychiatric conditions is associated with poor outcomes, including increased risk of relapse, increased health care costs, and reduced quality of life. The objective of this study was to investigate the strength of association between socioeconomic factors, race/ethnicity, and patient perceptions with medication adherence in individuals with depression. METHODS: Baseline surveys were sent out in 2012 to 4,216 adult patients within a large health system who presented with a clinical diagnosis of major depressive disorder (ICD-9), recorded at least twice in the electronic medical record in the year 2011. A total of 1,573 patients responded to the baseline survey. Of those, 1,209 patients who completed the survey and had used antidepressants in the last 12 months were recruited for the study. Perception of medication risk was assessed using the Beliefs About Medicines Questionnaire, and adherence to medications was assessed using the Morisky Medication Adherence Scale. Logistic regression was used to investigate the relationship between perception of medicine risk and treatment adherence. RESULTS: For non-Hispanic white individuals, medication adherence was higher among those who were least concerned about the risk of medications (64%; 95% CI, 58-70) compared to those who were most concerned (34%; 95% CI, 26-43). In the logistic regression model, less concern about medications and their side effects was associated with higher medication adherence (odds ratio = 2.6; 95% CI, 1.77-3.84; P < .0001). This association remained significant after adjustment for age, race, education level, and extramedical use of other medications or substances. Moreover, patients with older age and lower education level as well as those who were non-Hispanic white and had no extramedical use of other medications/substances were more likely to be adherent to medications. CONCLUSIONS: This study contributes quantitative data on factors that impact treatment adherence. Identifying patients at increased risk of nonadherence, having discussions with patients early in the treatment process to understand their concerns regarding treatment options, being sensitive to cultural beliefs, and patiently proceeding with the decision-making process could help ensure better outcomes.

Suicide thoughts and attempts and psychiatric treatment utilization: informing prevention strategies.

OBJECTIVES: The aim of this study was to investigate the characteristics of nonreceipt of specialty psychiatric treatment among those who experienced suicidal thoughts or who attempted suicide. METHODS: Data were from the 2008-2009 National Survey on Drug Use and Health and included responses from adults 18 years and older who answered mental health and suicide-related questions (N=75,690). RESULTS: Overall, 3.7% of the respondents experienced suicidal thoughts and .5% attempted suicide. Lack of psychiatric treatment was common among these individuals. Men, 18- to 25-year-olds, persons without insurance, and racial-ethnic groups other than white non-Hispanics were least likely to receive treatment. CONCLUSIONS: Prevention and treatment efforts have targeted seekers of specialty treatment at high risk of suicide, but fewer interventions have focused on individuals with suicidal thoughts or attempters who do not seek treatment. More targeted prevention strategies are needed to mitigate suicide in the United States.