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How Does Depression Influence Diabetes Medication Adherence in Older Patients?

Received November 26, 2002; revised July 9, 2003, January 12, 2004; accepted January 14, 2004. From the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (AMK,CBG,MJF), the Departments of Medicine and Psychiatry, University of Pittsburgh School of Medicine (AMK), the Departments of Psychiatry, Neurology, and Neuroscience, University of Pittsburgh School of Medicine, and the Intervention Research Center for the Study of Late-Life Mood Disorders, Pittsburgh, PA (CFR), the Center for Research in Chronic Disorders, School of Nursing, and the Departments of Biostatistics and Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA (SMS), the West Haven VA Medical Center; West Haven, CT (ACJ), and the Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA (MJF). Send correspondence to Amy M. Kilbourne, Ph.D., M.P.H., Assistant Professor of Medicine and Psychiatry, VA Pittsburgh Center for Health Equity Research and Promotion, General Internal Medicine (151-C), University Drive C, Pittsburgh, PA 15240. e-mail: Amy.Kilbourne{at}med.va.gov
© 2005 American Association for Geriatric Psychiatry

Objective: Using various measures (electronic monitoring, patient/provider report, pharmacy data), the authors assessed the association between depression and diabetes medication adherence among older patients with Type 2 diabetes. Methods: Patients completed a baseline survey on depression (Patient Health Questionnaire) and were given electronic monitoring caps (EMCs) to use with their oral hypoglycemic medication. At the time of the patient baseline survey, providers completed a survey on their patients’ overall medication adherence. Upon returning the caps after 30 days, patients completed a survey on their overall medication adherence. EMC adherence was defined as percent of days out of 30 with correct number of doses. Using pharmacy refill data from the patient baseline through 1 year later, they defined adherence as the percentage of days with adequate medication, based on days’ supply across refill periods. Results: Of 203 patients (mean age: 67 years), 10% (N=19) were depressed. Depressed patients were less likely to self-report good adherence and had a lower median percentage of days with adequate medication coverage (on the basis of pharmacy refill data). After adjustment for alcohol use, cognitive impairment, age, and other medication use, depression was still negatively associated with adequate adherence, according to patient report and pharmacy data. Depression showed no associated with adherence on the basis of provider or EMC data. Conclusions: Depression was independently associated with inadequate medication adherence on the basis of patient self-report and pharmacy data.

Key Words: Depression • Medical Comorbidity • Treatment Issues

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