Article Title

Antidepressant Adherence Across Diverse Populations and Health Care Settings

Publication Date



depression, adherence


Background/Aims: Much of the work in antidepressant adherence relies on self-report and small sample sizes with limited racial/ethnic representation. Our study aimed to determine factors associated with poor early adherence to antidepressants in a large diverse sample of patients using pharmacy refill data.

Methods: Electronic medical record data for patients 18 and older with depression who filled a new outpatient antidepressant prescription between Jan. 1, 2010, and Dec. 31, 2012, in one of six Mental Health Research Network health care systems were obtained. Self-reported race/ethnicity and pharmacy fill data were obtained from electronic medical records. Patients were considered to have early adherence if they had a second antidepressant fill within 180 days of the first.

Results: 177,469 adult patients had 184,967 new episodes of depression associated with a filled antidepressant prescription. Patients refilled their antidepressants within 180 days of the first dispensing in 71% of treatment episodes. Race/ethnicity was a strong predictor of early adherence, with patients who self-identified as Asian, non-Hispanic black, Hispanic or Native Hawaiian/Pacific Islander significantly less likely to refill their antidepressant prescriptions than were non-Hispanic whites or Native Americans/Alaskan Natives. Other apparent predictors of early adherence, including neighborhood income and education, gender and prior mental health hospitalizations, were no longer significant after adjusting for race/ethnicity.

Conclusion: Race/ethnicity was a robust predictor of antidepressant adherence, with racial/ethnic minority groups other than Native Americans/Alaskan Natives less likely to be adherent. Patients from these racial and ethnic minority groups may have the greatest potential benefit from targeted interventions to improve early antidepressant adherence.




July 5th, 2016


August 12th, 2016