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Kara Zivin Bambauer, PhD; Dana Gelb Safran, ScD; Dennis Ross-Degnan, ScD; Fang Zhang, PhD; Alyce S. Adams, PhD; Jerry Gurwitz, MD; Marsha Pierre-Jacques, BA; Stephen B. Soumerai, ScD

Arch Gen Psychiatry. 2007;64(5):602-608.

Context  Treatment for depression can be expensive and depression can affect the use of other medical services, yet there is little information on how depression affects the prevalence of cost-related medication nonadherence (CRN) in elderly patients and patients with disabilities.

Objective  To quantify the presence of CRN in depressed and nondepressed elderly Medicare beneficiaries and nonelderly Medicare beneficiaries with disabilities prior to the implementation of the Medicare Drug Benefit.

Design and Setting  2004 Medicare Current Beneficiary Survey.

Participants  Depressed and nondepressed elderly Medicare beneficiaries and beneficiaries with disabilities.

Main Outcome Measures  Cost-related medication nonadherence included taking smaller doses or skipping doses of a prescription to make it last longer, or failing to fill a prescription because of cost, controlling for health insurance status, comorbid conditions, age, race, sex, and functional status.

Results  In a nationally representative sample of 13 835 noninstitutionalized elderly Medicare enrollees and Medicare enrollees with disabilities, 44% of beneficiaries with disabilities and 13% of elderly beneficiaries reported being depressed during the previous year. Among enrollees with disabilities reporting depressive symptoms, 38% experienced CRN compared with 22% of enrollees with disabilities who did not report depressive symptoms. Among elderly enrollees who reported depressive symptoms, 19% experienced CRN, compared with 12% of elderly enrollees who did not report such symptoms. In adjusted analyses, depressive symptoms remained a significant predictor of CRN in both groups (persons with disabilities: odds ratio, 1.7; 95% confidence interval, 1.3-2.3; elderly persons: odds ratio, 1.4; 95% confidence interval, 1.1-1.7).

Conclusions  Depressive symptoms were associated with CRN in elderly Medicare enrollees and Medicare enrollees with disabilities. Providers should elicit information on economic barriers that might interfere with treatment of Medicare beneficiaries with depression.

Author Affiliations: Harvard Medical School and Harvard Pilgrim Health Care (Drs Bambauer, Ross-Degnan, Zhang, Adams, and Soumerai, and Ms Pierre-Jacques), and The Health Institute at Tufts–New England Medical Center and Tufts University School of Medicine (Dr Safran), Boston, Mass; and Meyers Primary Care Institute, Worcester, Mass (Dr Gurwitz). Dr Bambauer is now with the Department of Veterans Affairs, Health Services Research and Development, Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), and the Department of Psychiatry, University of Michigan Medical School, Ann Arbor.

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