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Cited by 87Medication Adherence and ComplianceMental Health Treatment and AccessPsychotherapy Techniques and Applications

Adherence to Depression Treatment in Primary Care: A Randomized Clinical Trial

Open access
Sirey, Jo Anne, Banerjee, Samprit, Marino, Patricia, Bruce, Martha L., Halkett, Ashley, Turnwald, Molly, Chiang, Claire, Liles, Brian +3 more·2017·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2017.3047PMC PMC5710215
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Abstract

Importance: Nonadherence to antidepressant medication is common and leads to poor outcomes. Early nonadherence is especially problematic. Objective: To test the effectiveness of a psychosocial intervention to improve early adherence among older patients whose primary care physician newly initiated an antidepressant for depression. Design, Setting, and Participants: The Treatment Initiation and Participation Program (TIP) was offered in a 2-site randomized clinical effectiveness study between January 2011 and December 2014 at primary care practices in New York, New York, and Ann Arbor, Michigan. Analyses began in February 2016. All participants were middle-aged and older adults (aged ≥55 years) who received newly initiated depression treatment by their primary care physician and recruited within 10 days of their prescription. Analyses were intention-to-treat. Interventions: Participants were randomly assigned to the intervention (TIP) or treatment as usual. Participants in the TIP group identified and addressed barriers to adherence, including stigma, misconceptions, and fears about treatment, before developing a personalized adherence strategy. The Treatment Initiation and Participation Program was delivered in three 30-minute contacts scheduled during a 6-week period just after the antidepressant was prescribed. Main Outcomes and Measures: The primary outcome was self-reported adherence on the Brief Medication Questionnaire, with adequate early adherence defined as taking 80% or more of the prescribed doses at 6 and 12 weeks. The secondary outcome was depression severity. Results: In total, 231 middle-aged and older adults (167 women [72.3%] and 64 men [27.7%]) without significant cognitive impairment were randomly assigned to the TIP intervention (n = 115) or treatment as usual (n = 116). Participants had a mean (SD) age of 67.3 (8.4) years. Participants in the TIP group were 5 times more likely to be adherent at 6 weeks (odds ratio, 5.54; 95% CI, 2.57 to 11.96; χ21 = 19.05; P < .001) and 3 times more likely to be adherent at both 6 and 12 weeks (odds ratio, 3.27; 95% CI, 1.73 to 6.17; χ21 = 13.34; P < .001). Participants in the TIP group showed a significant earlier reduction (24.9%) in depressive symptoms (95% CI, 13.9 to 35.9; t337 = 4.46; adjusted P < .001). In both groups, participants who were 80% adherent at weeks 6 and 12 had a 15% greater improvement in depressive symptoms from baseline over the course of treatment (95% CI, -0.2 to -30; t369 = 1.93; P = .051). Conclusions and Relevance: The Treatment Initiation and Participation Program is an effective intervention to improve early adherence to pharmacotherapy. Improved adherence can promote improvement in depression. Trial Registration: clinicaltrials.gov Identifier: NCT01301859.

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Research works printed but not linked: 2

  1. Datto CJ, Thompson R, Horowitz D, Disbot M, Bogner H, Katz IR. Do clinician and patient adherence predict outcome in a depression disease management program? J Clin Outcomes Manage. 2003;10(2):79-85.
  2. Spitzer RL, Gibbon M, Williams JB. Structured Clinical Interview for Axis I DSM-IV Disorders (SCID). Washington, DC: American Psychiatric Association Press, Inc; 1995.

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Authors
Sirey, J. A., Banerjee, S., Marino, P., Bruce, M. L., Halkett, A., Turnwald, M., Chiang, C., Liles, B., Artis, A., Blow, F., & Kales, H. C.
Affiliations
  • Weill Cornell Medicine (US)
  • Dartmouth College (US)
  • University of Michigan (US)
  • Department of Psychiatry, University of Michigan, Ann Arbor
Corresponding author
Sirey, Jo Anne
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2017-11-01
Volume
74
Issue
11
Pages
1129
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2017.3047
PMC
PMC5710215
OpenAlex
W2760352907
Cited by
87
References
48
Citations by year
2026: 10 · 2025: 8 · 2024: 9 · 2023: 9 · 2022: 15 · 2021: 5 · 2020: 13 · 2019: 5 · 2018: 11 · 2017: 2
FWCI
8.82
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Mental Health (P50MH113838, R01MH087562)
Topics
  • Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
medication adherence, antidepressants, depression, older adults, psychosocial interventions, primary care, barriers to adherence, stigma, depression severity, Brief Medication Questionnaire, middle-aged and older adults, cost-effectiveness, quality of life
MeSH terms
Aged, Antidepressive Agents, Depression, Female, Humans, Male, Middle Aged, Primary Health Care, Psychotherapy, Psychotherapy, Brief, Medication Adherence

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