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This is an important issue because depression in adults with diabetes is often chronic and may require long-term treatment with medication, the researchers said.
The nearly 1,400 patients in the study were followed for 12 months after being prescribed an antidepressant. Most of the patients filled the prescription at least once, but 43 percent did not refill the prescription and nearly two-thirds had stopped taking their antidepressant medication by the end of the study.
The investigators found that 72 percent of the patients struggled to understand basic health instructions, which the study authors called "limited health literacy." These patients were much less likely to keep taking their antidepressants than those with good health literacy, the authors said in a news release from Kaiser Permanente.
This difference was not explained by other factors known to be associated with patients not taking prescribed medications, including age, race and ethnicity, income, and level of English-language skills, according to the study, which was published in the March issue of the Journal of General Internal Medicine.
"The high rates of early discontinuation ... among adults with diabetes who had any health literacy limitation suggest that few of these individuals received an adequate course of antidepressant therapy," lead author Dr. Amy Bauer, of the University of Washington School of Medicine, said in the news release. "Getting that sufficient treatment is critical in preventing relapse and recurrence of depression."
"Physicians should be aware of this," Bauer added. "For antidepressant treatment to succeed, patients with limited health literacy may require more intensive counseling and clearer explanations about use of antidepressant medications and closer follow-up."
Study senior author Andrew Karter, a research scientist at Kaiser Permanente, said other studies have found that "those with health literacy limitations are more likely to have poor control of their chronic medical conditions, such as diabetes, congestive heart failure and HIV."
He added, however, that "this is the first study to examine the association between health literacy and antidepressant adherence among patients with diabetes. This type of research gives our health care systems important feedback because, as providers, we often remain unsure whether the critical health information we convey to our patients is fully understood."
The researchers said the new findings highlight the importance of efforts to improve people's health literacy, simplify information about treatment options, improve public understanding about depression treatment, and monitor whether patients are taking their prescribed antidepressants.
-- Robert Preidt
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