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ObjectivePrimary care is the de facto mental health system in the United States where physicians treat large numbers of depressed older adults with antidepressant medication. This study aimed to examine whether antidepressant dosage adequacy and patient adherence are associated with depression response among middle-aged and older adults prescribed with antidepressants by their primary care provider.DesignA secondary analysis was conducted on a sample drawn from a randomized controlled trial comparing Treatment as Usual to Treatment Initiation Program, an adherence intervention. Treatment Initiation Program improved adherence but not depression compared to Treatment as Usual (Sirey et al., 2017). For this analysis, we examined dosing adequacy and adherence at 6 and 12 weeks as predictors of depression response in both groups at 12 and 24 weeks.SettingPrimary care practices.ParticipantsOne hundred eighty-seven older adults with depression prescribed an antidepressant for depression by their primary care provider.MeasurementsDepression response was defined as 50% reduction on the Hamilton Rating Scale for Depression. Adherence was defined as taking 80% of doses at follow-up interviews (6 and 12 weeks). Patient-reported dosage and duration of antidepressant therapy was collected using the Composite Antidepressant Score (adequacy score of >3) at follow-up.ResultsGreater adherence, but not receipt of adequate dosage, was associated with higher likelihood of treatment response at both 12 (Odds ratio (OR) = 2.63; 95% Confidence Interval (CI), 1.19-5.84) and 24 weeks (OR = 3.09; 95% CI, 1.46-6.55).ConclusionAs physicians prescribe antidepressants to the diverse group of adults seen in primary care, special attention to patients' views and approach to adherence may improve depression outcomes.

ObjectivesMethodsResultsConclusionsClinical ImplicationsOur understanding of elder abuse (EA) phenomena has largely been shaped from the perspective of researchers and professionals whose conceptualizations often differ from the perceptions of older adults who experience mistreatment. This study sought to understand the most distressing aspects of EA victimization from the perspective of survivors.Using a descriptive phenomenological approach, individual interviews were conducted with a diverse sample (n = 32) of EA survivors, recruited from EA support and Adult Protective Services programs in New York City and Los Angeles. Analysis followed a constant comparison process involving two independent coders to understand distressing aspects of EA victimization.The following themes emerged as the most distressing aspects of EA victimization: fear, disbelief, disrespect, concern for perpetrator and other family members, feelings of loss, and incongruity between survivor wishes and systemic responses. Distressing aspects of EA victimization spanned personal, relational, and systemic levels of ecological influence.Findings from this study advance basic knowledge on EA phenomena and carry direct implications for programs designed to support and meet the needs of survivors.Findings identify particularly distressing psycho-emotional aspects of EA victimization for clinicians interacting with survivors that can serve as targets of intervention. [ABSTRACT FROM AUTHOR]