The purposes of this study were to examine (1) the class and type of antidepressants that low-income, depressed, homebound older adults reported that they were taking; (2) the individual-level correlates of antidepressant use versus nonuse;

and (3) these older adults’ perceptions about the effectiveness of antidepressants that they reported Inhibitors,research,lifescience,medical they had been taking. Conceptual Framework and Study Hypothesis The Andersen-Newman behavioral model of health services use (Andersen 1995) provides the conceptual formulation for understanding homebound older adults’ antidepressant intake. This behavioral model suggests that people’s use of health services is a function of their predisposition to use services, of factors that enable or impede use, and of their need for care. Among predisposing factors are demographic characteristics (age and sex,

which represent differences in biology and in values and beliefs about illnesses and acceptable courses of treatment); social structure (a broad array of factors, such as race/ethnicity and Inhibitors,research,lifescience,medical occupation, that determine the status Inhibitors,research,lifescience,medical of a person in the community and his/her ability and resources to cope with presenting problems); and health beliefs (attitudes, values, and knowledge, culturally determined or otherwise, that people have about health and health services). Enabling factors are at both personal (means/resources and know-how to access services that may be determined by education, income, health insurance, and social support) Inhibitors,research,lifescience,medical and community (healthcare provider and facility) levels. Need factors refer to the most immediate reason(s) the services are needed: the illness- and/or impairment-related

conditions, perceived and/or evaluated, for which the services are sought. In the present study, we examined the influence of sex, age, and race/ethnicity as predisposing factors. Sex is likely to play a role in antidepressant use, as older men are less likely than their female counterparts to admit their depression and seek treatment (Hinton et al. 2006). With regard to age and Inhibitors,research,lifescience,medical racial/ethnic difference, based on data from older Medicare beneficiaries with a diagnosis of depression, Crystal et al. (2003) found that those aged 75 or older and of “Hispanic and other ethnicity” were significantly less likely than those aged 65–69 and check details non-Hispanic Whites to receive either antidepressants or psychotherapy. Weissman et al. (2011) also found that, controlling for depression, Black homecare older adults (aged 65 the or older) were less likely than White homecare older adults to use any antidepressant. One study (Cooper et al. 2003) found that Black and Hispanic adults of mixed age groups had lower odds than White adults of the same age groups finding antidepressant medications acceptable, while others did not find any racial/ethnic difference in older adults’ preference for depression treatment modality (Landreville et al. 2001; Gum et al.