Racial Differences in Geriatric Antidepressant Adherence

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DESCRIPTION (provided by applicant): Geriatric depression is often chronic or recurrent, and is associated with substantial suffering, disability, suicide risk and decreased health-related quality of life. Although antidepressants and psychotherapy are clearly effective, older patients often fail to take them as prescribed or recommended and as many as 40% discontinues medication use prematurely. Even with successful health system changes such as collaborative care models in primary care, treatment gaps remain, and thus, poor treatment adherence may limit the extent to which many geriatric patients realize the benefits of these efficacious treatments. While there are racial differences in clinical diagnostic rates of depression, substantially less is known about racial differences in depression treatment adherence rates or the key determinants of adherence among older patients. Limited data from mixed-age samples suggests that African-American patients may be even less willing to engage in psychotherapy or accept antidepressant treatment than white patients. This study will use a mixed methods approach in order to identify the key modifiable determinants of depression treatment adherence among older African-American and white patients. A baseline survey including both quantitative and qualitative components will assess key constructs potentially determining adherence, with particular attention to possible factors (spirituality and stigma) that may differ across racial groups. In addition, four focus groups held with a subset of patients (n=6-8 for each group) will allow us to obtain more in-depth qualitative information and inform the addition of new domains to the follow-up survey. African-American (n=103) and white (n=103) patients 60 years old or over with the recent diagnosis of clinically significant depression in five participating primary care clinic sites will be eligible. Using the baseline and a four-month follow-up survey, we will compare rates of adherence between African-American and white patients and identify the determinants most significantly associated with non-adherence in the acute phase following a new diagnosis of depression. By identifying the key modifiable determinants of depression treatment adherence among both African-American and white elders, clinicians and researchers will be much more effective in identifying at-risk individuals and developing tailored interventions that may improve their treatment adherence and depression outcomes.