LOS ANGELES – Perceived social support plays an important role in antidepressant medication adherence among older African American adults, particularly women, according to findings from a study of more than 450 patients.
Among the total study population of adults aged over 60 years with significant depression, no significant relationship was seen between perceived social support and 4-month medication adherence (odds ratio, 0.92), but after stratification of results by race, a significant relationship emerged between race, social support and treatment adherence, Dr. Lauren B. Gerlach reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.
Adherence rates for those with impaired social support were 40% for African American women, 78% for white women, 51% for African American men, and 74% for white men. Adherence rates for those with adequate social support were 52%, 69%, 56%, and 72% for the groups, respectively, according to Dr. Gerlach of the University of Michigan, Ann Arbor.
After adjustment for demographic, illness, site of care, and functional status variables, the differences in adherence between African American women with impaired social support and white women and men with impaired social support remained statistically significant (odds ratios for adherence for white women and men, compared with African American women, 4.82 and 3.50, respectively).
The study comprised 183 subjects recruited from 13 primary care clinics at the University of Michigan, and 269 subjects recruited from primary care or psychiatry outpatient clinics at four Veterans Affairs medical centers in Michigan. They had a mean age of 66 years, and all had a score of at least 5 on the Geriatric Depression Scale and had been given a new antidepressant prescription by their primary care provider or a psychiatrist. Nearly half (46%) had impaired social support on a subscale of the Duke Social Support Index.
Adherence to medication was assessed via the Brief Medication Questionnaire.
"African Americans with impaired social support had the lowest levels of antidepressant medical adherence and may represent a vulnerable population in regards to medication treatment adherence. Factors such as racial perspectives towards mental health care, views on antidepressant medication efficacy, and access to care may be underlying our findings," Dr. Gerlach wrote.
The findings suggest a need for racially sensitive targeted interventions to improve treatment compliance in individuals with low levels of social support, she concluded, noting that such interventions may include social skills training, assessment of quality and quantity of relationships, and encouragement of participation in community and patient advocacy groups.
This study was supported by grants from the National Institute of Mental Health and the VA Health Services Research and Development Service.