Abstract
Objectives
Depression is a known risk factor for poor medication adherence, but it is unclear
whether depression treatment affects adherence rates. In this study, we examined the
association between pharmacologic treatment of a new depressive episode and subsequent
adherence to oral anti-hyperglycemic medications.
Methods
In this retrospective cohort study we used administrative health data to follow adult
new metformin users in Alberta, Canada, between 2008 and 2018. Depressive episodes
starting ≥1 year after metformin initiation were identified and individuals starting
antidepressant treatment within the first 90 days were compared with those who did
not. The proportion of days covered (PDC) with oral anti-hyperglycemic medications
in the subsequent year (days 91 to 455) was used to estimate adherence. The association
between antidepressant treatment and poor adherence (PDC<0.8) was examined using multivariate
logistic regression models.
Results
A new depressive episode occurred in 6,201 people, with a mean age of 56.0 (standard
deviation [SD], 15.4) years. Of this cohort, 3,303 (53.2%) were women. Mean PDC was
0.55 (SD, 0.41); 924 (57.0%) of 1,621 people who started antidepressant treatment
and 2,709 (59.2%) of 4,580 controls had poor adherence (p=0.13). After adjusting for
baseline comorbidities and other characteristics, antidepressant treatment was associated
with a lower likelihood of poor adherence (adjusted odds ratio, 0.85; 95% confidence
interval, 0.75 to 0.96; p=0.007).
Conclusions
Although overall adherence to anti-hyperglycemic medications was low after onset of
a depressive episode, antidepressant treatment was associated with a lower likelihood
of poor adherence.
Résumé
Objectifs
La dépression est un facteur de risque connu de la mauvaise observance du traitement
médicamenteux, mais on ignore si le traitement de la dépression nuit aux taux d’observance.
Dans la présente étude, nous avons examiné l’association entre le traitement pharmacologique
d’un nouvel épisode dépressif et l’observance subséquente aux médicaments antihyperglycémiants
par voie orale.
Méthodes
Dans cette étude de cohorte rétrospective, nous avons utilisé les données administratives
sur la santé pour suivre les nouveaux utilisateurs adultes de metformine en Alberta,
au Canada, entre 2008 et 2018. Nous avons recensé les épisodes dépressifs qui avaient
commencé ≥ 1 an après l’amorce de la metformine et avons comparé les individus qui
avaient commencé le traitement antidépresseur au cours des 90 premiers jours à ceux
qui ne l’avaient pas commencé. Nous avons utilisé la proportion de jours couverts
(PJC) par les médicaments antidépresseurs dans l’année subséquente (jours 91 à 455)
pour estimer l’observance. Nous avons examiné l’association entre le traitement antidépresseur
et la mauvaise observance (PJC < 0,8) à l’aide de modèles de régression logistique
multivariée.
Résultats
Un nouvel épisode dépressif était survenu chez 6201 personnes, d’âge moyen de 56,0
(écart type [σ], 15,4) ans. Cette cohorte avait regroupé 3303 (53,2 %) femmes. La
PJC moyenne était de 0,55 (σ, 0,41); 924 (57,0 %) personnes sur 1621 avaient commencé
le traitement antidépresseur et 2709 (59,2 %) témoins sur 4580 avaient eu une mauvaise
observance (p = 0,13). Après l’ajustement des maladies associées initiales et d’autres
caractéristiques, le traitement antidépresseur a été associé à une probabilité plus
faible de mauvaise observance (rapport de cotes ajusté, 0,85; intervalle de confiance
à 95 %, de 0,75 à 0,96; p = 0,007).
Conclusions
Bien que l’observance globale du traitement antihyperglycémiant ait été faible après
l’apparition de l’épisode dépressif, le traitement antidépresseur a été associé à
une probabilité plus faible de mauvaise adhésion.
Keywords
Mots clés
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Article Info
Publication History
Published online: April 11, 2022
Accepted:
March 23,
2022
Received in revised form:
February 22,
2022
Received:
May 12,
2021
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Canadian Diabetes Association.
