精神障害と治療

Improving Antidepressant Treatment Adherence among Homeless Population: A Review of Possible Interventions

Abstract

Anne A and Anthony A

Inequality to mental health treatment among homeless populations in the U.S has become a major national concern, and non-adherence to antidepressant treatment is increasing. To address this problem, a systemic literature review was conducted to identify interventions that can improve antidepressant treatment adherence among this population in primary care settings. A literature search using CINAHL, PubMed, EMBASE, PsychINFO, and Google Scholar electronic databases yielded 6,041 studies that were reviewed according to several inclusion criteria: studies published in peer-reviewed journals between 2013 and 2017, sufficient racial ethnic representation from underserved groups, randomized control trial to improve adherence to prescribed antidepressants, participants with primary diagnosis of depression, follow up period of at least 6 months. Ten studies met inclusion criteria. Evidence revealed that improving antidepressant treatment adherence among underserved communities requires multifaceted interventions that employ the following: a) shared decision making, b) practice-based collaborative care and telemedicine collaborative care, and c) treatment retention and therapy participation. Interventions that can improve antidepressant treatment adherences in the homeless communities are multilayered. However, shareddecision making and collaborative care between patients and providers is critical in realizing positive outcomes. Because depression is chronic and recurring, continuous supportive services are needed. Some interventions have to be tailored to specific homeless patients depending on their response to therapy and treatment.