Impact of Psychiatric Diagnosis and Treatment on Medication Adherence in Youth With Systemic Lupus Erythematosus

Abstract

Objective. Youth with systemic lupus erythematosus (SLE) experience high rates of psychiatric comorbidities, which may affect medication adherence. We undertook this study to examine the association between psychiatric disorders and hydroxychloroquine adherence and to determine whether psychiatric treatment modifies this association. Methods. We identified incident hydroxychloroquine users among youth with SLE (ages 10-24 years) using de-identified US commercial insurance claims in Optum Clinformatics Data Mart (2000-2016). Adherence was estimated using medication possession ratios (MPRs) over a 365-day time period. Multivariable linear regression models were used to estimate the effect of having any psychiatric disorder on MPRs, as well as the independent effects of depression, anxiety, adjustment, and other psychiatric disorders. We tested for interactions between psychiatric diagnoses and treatment with psychotropic medications or psychotherapy. Results. Among 873 subjects, 20% had a psychiatric diagnosis, most commonly depression. Only adjustment disorders were independently associated with decreased MPRs (β-0.12, P = 0.05). We observed significant crossover interactions, in which psychiatric disorders had opposite effects on adherence depending on the receipt of psychiatric treatment. Among youth with any psychiatric diagnosis, psychotropic medication use was associated with a 0.15 increase in the MPR compared with no psychotropic medication use (P = 0.02 for interaction). Among youth with depression or anxiety, psychotherapy was also associated with a higher MPR compared with no psychotherapy (P = 0.05 and P < 0.01 for interaction, respectively). Conclusion. The impact of psychiatric disorders on medication adherence differed by whether youth had received psychiatric treatment. Improving recognition and treatment of psychiatric conditions may increase medication adherence in youth with SLE.

Adolescent Health Care Needs and Relationship to Disease in Patients With Childhood‐Onset Systemic Lupus Erythematosus

“…Adults with SLE and psychiatric illness typically have worse disease control, educational achievement, and work productivity, [20][21][22] and youths with concurrent chronic medical and psychiatric illnesses are more likely to report poorer school performance, quality of life, and disease control. 5,18,22,23,24 In our study, adolescents with cSLE also commonly identified issues with education, adherence to treatment, sleep, and challenges at home. Less common were issues of body image and diet, substance use, safety concerns, and sexuality, although these were still identified in 15% to 20% of our patients.…”

“…[1][2][3] A recent study found that 20% of youth aged 10 to 24 years with SLE had a concurrent psychiatric diagnosis, the most common of which was depression. 18 Despite the knowledge that youth with cSLE have higher rates of mood disorders compared to the general population, they are often underdiagnosed and undertreated. 1,19 Although 50% of adolescents in our study had identified mood concerns during their adolescent medicine visits, only 29% had a psychiatric diagnosis, highlighting that many adolescents with cSLE struggle with mood even without a formal mood disorder diagnosis.…”

Persistence of Depression and Anxiety despite Short-Term Disease Activity Improvement in Patients with Systemic Lupus Erythematosus: A Single-Centre, Prospective Study

“…Of potential relevance is the association between depression and lower treatment adherence [ 25 , 26 , 27 , 28 ], a known driver for lupus flare and activity. This finding, however, lacks extensive confirmation or may be influenced by other factors such as ethnicity [ 29 , 30 , 31 , 32 ]. Therefore, evaluation of the frequency and determinants of mental disorders in different regions and clinical settings is important.…”

Non-pharmacologic therapies in treatment of childhood-onset systemic lupus erythematosus: A systematic review

“…Chang et al 30 performed a retrospective cohort study through an online database (Clinformatics DataMart) of 873 cSLE patients (age 10–24) taking hydroxychloroquine to assess the exposure of a psychiatric diagnosis on treatment adherence and, pertinent to this review, examined the effect of psychotherapy utilization (defined in chart review as clinical treatment of at least 4 visits) on treatment adherence via MPR. This study received a lower evidence grade 3 as it lacked randomization, but had low risk of bias aside from that lack of randomization.…”