Psychotropic Medication Nonadherence Among United States Latinos: A Comprehensive Literature Review

Abstract

Objective Psychotropic medication nonadherence is a major public health problem, but few studies have focused on Latinos. We systematically reviewed the literature on rates of and factors influencing antipsychotic, antidepressant, or mood stabilizer nonadherence among United States (US) Latinos. Methods Data Sources: MEDLINE and PsycINFO were searched using keywords adherence, compliance, Latino, Hispanic, psychotropic, and related terms, as well as bibliographies from relevant reviews and studies. Study Selection: 21 studies met inclusion criteria: published since 1980 in English or Spanish; measured psychotropic medication nonadherence rates among US Latino adults. Data Abstraction: We examined articles for study design and objective, location, population, medication type, participant demographics, adherence measure, adherence rates, and factors related to adherence. Results and Conclusions In studies including Latinos and other ethnic groups, mean nonadherence rates were 41%, 31%, and 43% among Latinos, Euro-Americans, and African Americans respectively, with an overall effect size of 0.64 between Latinos and Euro-Americans. In studies including only Latinos, the mean nonadherence rate was 44%. Ten of 16 studies found Latinos had significantly lower adherence rates than Euro-Americans. Risk factors for nonadherence included being monolingual Spanish speaking, lacking health insurance, experiencing barriers to quality care, and having lower socioeconomic status. Protective factors included family support and psychotherapy. Rates of nonadherence to psychotropic medications were higher for Latinos than for Euro-Americans. Further investigation is needed into the potentially modifiable individual and societal level mechanisms of this discrepancy. Clinical and research interventions to improve adherence should be culturally appropriate and incorporate identified factors.

Educational Gradients in Psychotropic Medication Use Among Older Adults in Costa Rica and the United States

“…A review of psychotropic adherence in the United States documented extensive evidence of substantially lower adherence among Latinos compared to Euro-Americans (23), but the reasons for this are still poorly understood. We are not aware of any specific research to date on cultural factors that vary across education groups in Costa Rica and that could influence psychotropic medication patterns.…”

Impact of Motivational Pharmacotherapy on Treatment Retention Among Depressed Latinos

“…Compared to non-Latino Whites, underserved racial/ethnic groups in the United States typically show higher non-adherence to antidepressant therapy, as evidenced by lower rates of initiation, retention, and medication taking (Harman, Edlund, & Fortney, 2004; Lanouette, Folsom, Sciolla, & Jeste, 2009; Olfson, Marcus, Tedeschi, & Wan, 2006; Sleath, Rubin, & Huston, 2003; Warden, et al, 2007). Likely reasons for this non-adherence include healthcare system-level and provider-level disparities affecting minority groups, such as unequal access to guideline-concordant mental healthcare (Young, Klap, Sherbourne, & Wells, 2001), limited availability of language-matched services (Lanouette et al, 2009), lack of adequate health insurance (González, et al, 2009; Lanouette et al, 2009), lower detection of depressive illness (Borowsky, et al, 2000), and less proactive and participatory communication strategies by providers (Cooper-Patrick, et al, 1999; Sleath, Rubin, & Huston, 2003; Schraufnagel, Wagner, Miranda, & Roy-Byrne, 2006).…”

“…Likely reasons for this non-adherence include healthcare system-level and provider-level disparities affecting minority groups, such as unequal access to guideline-concordant mental healthcare (Young, Klap, Sherbourne, & Wells, 2001), limited availability of language-matched services (Lanouette et al, 2009), lack of adequate health insurance (González, et al, 2009; Lanouette et al, 2009), lower detection of depressive illness (Borowsky, et al, 2000), and less proactive and participatory communication strategies by providers (Cooper-Patrick, et al, 1999; Sleath, Rubin, & Huston, 2003; Schraufnagel, Wagner, Miranda, & Roy-Byrne, 2006). …”

“…These include: lower preference for antidepressants (Givens, Houston, Van Voorhees, Ford, & Cooper, 2007; Miranda & Cooper, 2004), more concern that these medications are harmful, addictive, and ineffective for treating depression (Cabassa, Lester, & Zayas, 2007; Givens et al, 2007; Interian, Martínez, Iglesias Ríos, Krejci, & Guarnaccia, 2010), greater stigmatization of psycho-pharmacotherapy (Interian, Ang, Gara, Link, Rodríguez, & Vega, 2010; Lanouette et al, 2009; Martínez-Pincay & Guarnaccia, 2007), illness constructions inconsistent with antidepressant therapy (Cabassa et al, 2007; Lewis-Fernández, Das, Alfonso, Weissman, & Olfson, 2005; Schraufnagel et al, 2006), greater reliance on faith-based services to cope with depression (Cabassa et al, 2007; Givens et al, 2007), lower likelihood of communicating complaints to clinicians about antidepressants (Sleath, Rubin, & Wurst, 2003), and more unmet expectations about how clinicians should engage them in treatment (Cortés, Mulvaney-Day, Fortuna, Reinfeld, & Alegría, 2009; Interian, Martínez, et al, 2010; Martínez-Pincay & Guarnaccia, 2007; Schraufnagel et al, 2006). In line with the importance of cultural factors, lower acculturation among Latinos is associated with lower past-year use of antidepressants and with poorer antidepressant therapy adherence, even after adjusting for education, insurance status, and other sociodemographic and clinical covariates (González et al, 2009; Hodgkin, Volpe-Vartanian, & Alegría, 2007).…”

“…Interventions designed to enhance adherence with mental health treatment among Latino patients are hypothesized to be most efficacious if they address these cultural factors; however, research in this area remains very sparse (Lanouette et al, 2009). It is unclear if cultural adaptation is needed, since the relative efficacy in Latinos of existing adherence-enhancing interventions is unknown, due to insufficient inclusion of minorities to assess moderator effects or conduct subgroup analyses (Schraufnagel et al, 2006).…”