Sociodemographic and clinical factors associated with antidepressant type in a national sample of the home health care elderly

Abstract

Objective The study examined in home health care (HHC) the demographic, functional and clinical factors by antidepressant (AD) type including selective serotonin reuptake inhibitors (SSRIs), serotonin–norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs) and “Other” ADs such as bupropion and mirtazapine. Method Cross-sectional sample ( N=909) was analyzed from the 2007 National Home Health and Hospice Care Survey that included patients 65 years and older [mean=78.79 years, confidence interval (CI)=77.88–79.69 years] taking one AD. Results Selective serotonin reuptake inhibitors were the most commonly used (63.89%) AD, followed by “Other” ADs (14.29%), TCAs (11.31%) and SNRIs. In a multinomial regression referencing SSRIs, blacks had increased odds of tricyclic use compared to whites [odds ratio (OR)=5.96, CI=1.85–19.19]. Hispanics had decreased odds of “Other” AD (OR=0.13, CI=0.02–0.73) and SNRI use (OR=0.06, CI=0.008–0.45) compared to non-Hispanics. The HHC elderly taking psychotropic medications besides ADs were less likely to use SNRIs (OR=0.31, CI=0.11–0.88) and tricyclics (OR=0.27, CI=0.08–0.87). Advancing age was marginally associated with tricyclic use (OR=1.04, CI=0.99–1.09). Conclusion Race/ethnicity and age differences by AD type — including blacks' increased TCA use, Hispanics' decreased SNRI and “Other” AD use, and older elderly's increased tricyclic use — suggest systematic differences in prescribing practice variations including differences by geography, patient preferences or access to care in the HHC elderly.