Association Between Depressive and Anxiety Disorders and Adherence to Antihypertensive Medication in Community-Living Elderly Adults

Santé Communautaire, University of Sherbrook, Longueuil, Quebec, Canada.
Journal of the American Geriatrics Society (Impact Factor: 4.22). 10/2012; 60(12). DOI: 10.1111/j.1532-5415.2012.04239.x
Source: PubMed

ABSTRACT OBJECTIVES: To identify the determinants of antihypertensive medication adherence in community-living elderly adults. DESIGN: Longitudinal observational study. SETTING: Population-based health survey in the province of Quebec, Canada. PARTICIPANTS: Data from a representative sample (N = 2,811) of community-dwelling adults in Quebec aged 65 and older participating in the Étude sur la Santé des Aînés study. The final study sample analyzed consisted of 926 participants taking antihypertensive drugs during the 2 years of the study. MEASUREMENTS: Adherence to antihypertensive medication was measured using days of supply obtained during a specified time period. Depression and anxiety disorders were assessed using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria, and physical health status was measured using the Charlson Comorbidity Index. Other factors considered were age, education, marital status, annual family income, and number of antihypertensive drugs that participants used. RESULTS: Mean antihypertensive proportion (percentage) of days supplied in was 92.5% in Year 1 and 59.4% in Year 2. The presence of depression and anxiety disorders and the number of antihypertensive medications significantly predicted medication adherence. The sex by depression and anxiety disorders interaction term was significant. CONCLUSION: Adherence to antihypertensive medication was significantly associated with depression and anxiety disorders in men but not women. The treatment of depression and anxiety disorders in individuals with hypertension may be helpful in improving medication adherence rates and healthcare outcomes.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract We examined the relationship between self-reported and assessed mental health status and service use, using data from the Health and Retirement Study (N=9,547). Twelve percent and thirty percent had inaccurate perceptions of their mood and memory status, respectively. No significant difference was found in the likelihood of service use between older adults who were unaware of current depressive symptoms and those who self-reported problems but had no assessed symptoms. Older adults who scored low in cognitive test were more likely to use services, regardless of self-reported memory status. Discrepancies between self-reported and assessed status may contribute to service utilization.
    Journal of Gerontological Social Work 06/2014; DOI:10.1080/01634372.2014.919978
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Persons with depressive symptoms generally have higher rates of medication nonadherence than persons without depressive symptoms. However, little is known about whether this association differs by comorbid medical condition or whether reasons for nonadherence differ by depressive symptoms or comorbid medical condition. Self-reported extent of nonadherence, reasons for nonadherence, and depressive symptoms among 1,026 veterans prescribed medications for hypertension, dyslipidemia, and/or type 2 diabetes were assessed. In multivariable logistic regression adjusted for clinical and demographic factors, the odds of nonadherence were higher among participants with high depressive symptom burden for dyslipidemia (n=848; odds ratio [OR]: 1.42, P=0.03) but not hypertension (n=916; OR: 1.24, P=0.15), or type 2 diabetes (n=447; OR: 1.15, P=0.51). Among participants reporting nonadherence to antihypertensive and antilipemic medications, those with greater depressive symptom burden had greater odds of endorsing medication nonadherence reasons related to negative expectations and excessive economic burden. Neither extent of nonadherence nor reasons for nonadherence differed by depressive symptom burden among patients with diabetes. These findings suggest that clinicians may consider tailoring interventions to improve adherence to antihypertensive and antilipemic medications to specific medication concerns of participants with depressive symptoms.
    Patient Preference and Adherence 02/2015; 9:327-336. DOI:10.2147/PPA.S74531 · 1.49 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective Anxiety sensitivity—fear of the negative social, physical, or cognitive consequences of anxiety related sensations — has been linked to cardiovascular disease and adverse cardiovascular health behaviors. Medication nonadherence may account for this association. We examined whether anxiety sensitivity was independently associated with objectively measured medication nonadherence in a multi-ethnic primary care sample. Methods Eighty-eight patients with uncontrolled hypertension completed the Anxiety Sensitivity Index and had their adherence to blood pressure (BP) medications measured during the interval between two primary care visits using an electronic pillbox (MedSignals®). Multivariable Poisson regressions were conducted to determine the relative risks of medication nonadherence associated with anxiety sensitivity after adjustment for age, gender, Hispanic/Latino ethnicity, education, total number of prescribed medications, and depressive and posttraumatic stress disorder (PTSD) symptoms. Results Nearly twice as many patients with high anxiety sensitivity were nonadherent to BP medications compared to patients with low anxiety sensitivity (65.0% vs. 36.8%; p = 0.03). Patients with high anxiety sensitivity had higher relative risks of medication nonadherence than their low anxiety sensitivity counterparts (adjusted relative risk [RR] = 1.76; 95% CI: 1.03-3.03). Conclusions In this first study of the association between anxiety sensitivity and medication adherence, we found that high anxiety sensitivity was strongly associated with BP medication nonadherence, even after adjustment for known confounders. Our results suggest that teaching patients who have uncontrolled hypertension adaptive strategies to manage their anxiety sensitivity may help improve their medication adherence, and thereby lower their cardiovascular risk.
    Journal of Psychosomatic Research 10/2014; 77(4). DOI:10.1016/j.jpsychores.2014.07.009 · 2.84 Impact Factor