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Antidepressant Adherence After Psychiatric Hospitalization Among VA Patients with Depression

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Abstract

Depressed patients discharged from psychiatric hospitalizations face increased risks for adverse outcomes including suicide, yet antidepressant adherence rates during this high-risk period are unknown. Using Veterans Affairs (VA) data, we assessed antidepressant adherence and predictors of poor adherence among depressed veterans following psychiatric hospitalization. We identified VA patients nationwide with depressive disorders who had a psychiatric hospitalization between April 1, 1999 and September 30, 2003, received antidepressant medication, and had an outpatient appointment following discharge. We calculated medication possession ratios (MPRs), a measure of medication adherence, within 3 and 6 months following discharge. We assessed patient factors associated with having lower levels of adherence (MPRs < 0.8) after discharge. The criteria for 3- and 6-month MPRs were met by 20,931 and 23,182 patients respectively. The mean 3 month MPR was 0.79 (SD = 0.37). The mean 6 month MPR was 0.66 (SD = 0.40). Patients with poorer adherence were male, younger, non-white, and had a substance abuse disorder, but were less likely to have PTSD or other anxiety disorders. Poor antidepressant adherence is common among depressed patients after psychiatric hospitalization. Efforts to improve adherence at this time may be critical in improving the outcomes of these high-risk patients.

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Acknowledgements

This study was funded in part by the Department of Veterans Affairs, Health Services Research and Development Service, IIR 04-211-1 (MV), CD2 07-206-1 (KZ), the National Institute of Mental Health, R01-MH078698-01 (MV), and by the Depression Health Services Research Evaluation and Management (DREAM) program in the Comprehensive Depression Center at the University of Michigan.

Author information

Authors and Affiliations

  1. Department of Veterans Affairs, Health Services Research and Development (HSR&D) Center of Excellence, Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI, USA

    Kara Zivin, Dara Ganoczy, Paul N. Pfeiffer & Marcia Valenstein

  2. Department of Psychiatry, University of Michigan Medical School, Rachel Upjohn Building, 4250 Plymouth Road, Box 5765, Ann Arbor, MI, 48109, USA

    Kara Zivin, Paul N. Pfeiffer, Erin M. Miller & Marcia Valenstein

  3. University of Michigan Depression Center, Ann Arbor, MI, USA

    Kara Zivin, Paul N. Pfeiffer, Erin M. Miller & Marcia Valenstein

Authors
  1. Kara Zivin
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  2. Dara Ganoczy
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  3. Paul N. Pfeiffer
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  4. Erin M. Miller
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  5. Marcia Valenstein
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Corresponding author

Correspondence to Kara Zivin.

Additional information

Previous presentation: This paper was presented in poster form at the Annual Health Services Research and Development Meeting of the Department of Veterans Affairs, Baltimore, MD, February 2009.

Appendices

Appendix 1: Patient Depression and Other Psychiatric Disorder ICD-9 Codes and Corresponding Diagnoses

See Tables 3 and 4.

Table 3 Depression ICD-9 codes and corresponding diagnoses
Full size table
Table 4 Other psychiatric disorder ICD-9 codes and corresponding diagnoses
Full size table

Appendix 2: Types of Antidepressants Included in this Study

 

Amitriptyline (high dose only)

Amoxapine

Atomoxetine

Buproprion

Citalopram

Clomipramine

Desipramine

Doxepin

Duloxetine

Escitalopram

Fluoxetine

Fluvoxamine

Imipramine

Isocarboxazid

Maprotiline

Mirtazapine (high dose only)

Nefazodone

Nortriptyline (high dose only)

Paroxetine

Phenelzine

Protriptyline

Sertraline

Tranylcypromine

Trazodone (high dose only)

Trimipramine

Venlafaxine

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Zivin, K., Ganoczy, D., Pfeiffer, P.N. et al. Antidepressant Adherence After Psychiatric Hospitalization Among VA Patients with Depression. Adm Policy Ment Health 36, 406–415 (2009). https://doi.org/10.1007/s10488-009-0230-2

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  • DOI: https://doi.org/10.1007/s10488-009-0230-2

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