Discontinuation of Antidepressant Medication Among Latinos in the US

Rationale: Despite recent growth in the variety of antidepressant medications available, many patients discontinue medication prematurely, for reasons such as nonresponse, side effects, stigma and miscommunication. Some analysts have suggested that Latinos may have higher antidepressant discontinuation rates than other US residents. Since adherence is a critical determinant of subsequent clinical and functional outcomes, elucidating problems associated with adherence is a first step toward improving these outcomes. Objectives: 1) measure the rate of antidepressant medication discontinuation for Latinos, and 2) identify demographic, economic, sociocultural and clinical characteristics of Latino patients which predict discontinuation of treatment, and 3) identify prescriber (psychiatrist vs. general practitioner) and medication (tricyclics vs. SSRI), characteristics which predict discontinuation amongst Latinos. Methodology: Bivariate tests and multivariate logistic regression to explain which antidepressant users stop, and who stops without prior medical input. Data come from the Latino portion of the National Latino and Asian American Study (NLAAS). This study is based on interviews in 2002 and 2003 with a national sample of Latinos and Asian Americans (and a nonLatino white control group). The data include questions both on utilization of prescription drugs (including antidepressants) and on a variety of economic and sociocultural variables relevant to our hypotheses. The survey is based on a stratified area probability sample design. The sample consists of persons 18 years of age and older in the non-institutionalized population of the 50 states and Washington DC. Results: Among those users, 33.3% had discontinued taking antidepressants at the time of interview, and 18.9% had done so without prior input from their physician. Even controlling for clinical and other variables, patients who reported good or excellent English proficiency were less likely to stop at all. Patients were also less likely to stop if they were older, married, had public or private insurance, or had made eight or more visits to a nonmedical therapist. Conclusions: Uninsured individuals are far more likely to discontinue treatment, compared to those with health insurance. This could relate to the price of the drugs themselves, which is high for an individual paying out-of-pocket, particularly for newer drugs. But it is worth pointing out that the uninsured people in this sample did report having used at least one antidepressant, so price was not a consistently insurmountable barrier, at least initially. Their lack of insurance may have led to prescription of less expensive medications that proved harder to tolerate. It may also have made them unable or unwilling to receive concurrent therapy or medical visits that might otherwise have discouraged discontinuation. US Latinos are known to be considerably more likely to be uninsured than other ethnic groups The results supported the study hypotheses regarding the potential importance of sociocultural factors, in particular English proficiency. The finding that having at least eight visits with a nonmedical therapist is significantly associated with patients being less likely to stop taking their medications without prior medical input is consistent with expectations. This treatment relationship may include adherence-related discussions that support communication with the prescribing physician.