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. 2025 Jun;91(6):1749-1759.
doi: 10.1111/bcp.16403. Epub 2025 Jan 31.

Setting of initiation and factors associated with antidepressant use on entry to long-term care facilities

Georgina A Hughes  1   2 , Maria C Inacio  2   3 , Debra Rowett  1   4 , Catherine Lang  2 , Robert N Jorissen  2   3 , Megan Corlis  5 , Janet K Sluggett  2   3
Affiliations

Setting of initiation and factors associated with antidepressant use on entry to long-term care facilities

Georgina A Hughes et al. Br J Clin Pharmacol. 2025 Jun.

Abstract

Aims: Antidepressant use increases around long-term care facility (LTCF) entry, and initiation during hospitalizations may contribute to this. This study characterized the care setting (i.e., community-based, hospital or LTCF) where antidepressants were initiated and determined associated resident characteristics.

Methods: A cross-sectional study including non-Indigenous individuals aged 65-105 years who entered LTCFs in two Australian states during 2015-2019, and were dispensed an antidepressant within 2 months, was conducted. Care settings (community-based, hospital or LTCF) were determined from linked LTCF records, and hospitalizations ≤30 days before LTCF entry. Pharmaceutical claims before and after LTCF entry were screened to determine antidepressant initiation. Multivariate multinomial logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) for resident characteristics associated with care settings of antidepressant initiation.

Results: This study included 34 525 residents from 1046 LTCFs. Overall, 27 160 (78.7%) commenced antidepressants prior to entry, 2552 (7.4%) in hospital and 4813 (13.9%) in LTCFs. Mirtazapine constituted 44.8% (n = 1143) of antidepressants initiated in hospitals and 39.5% (n = 1902) in LTCFs. Residents who were aged ≥90 years were more likely to start an antidepressant in the LTCF compared to community-based settings (aOR = 1.97, 95% CI 1.74-2.23). Residents recently using a psychotropic were more likely to start an antidepressant in community-based settings before LTCF entry, compared to a hospital or LTCF.

Conclusions: Individuals receiving antidepressants during transition to LTCFs are often already taking antidepressants prior to entry. Future interventions to optimize antidepressant use in LTCFs should consider setting, recency and indication for antidepressant initiation, and ongoing monitoring for safety.

Keywords: aged; antidepressant; hospital; long‐term care; mirtazapine; nursing home.

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Conflict of interest statement

J.K.S. is a non‐executive director of Southern Cross Care SA, NT, VIC (an aged care provider organization). There are no other competing interests to declare.

Figures

FIGURE 1
FIGURE 1
Flow chart for study cohort selection. LTC, long‐term care; LTCF, long‐term care facility; SA, South Australia; VIC, Victoria.
FIGURE 2
FIGURE 2
First day of antidepressant initiation relative to LTCF entry among individuals who were not hospitalized or taking an antidepressant before entering long‐term care (n = 1839). Day 0 is day of LTCF admission. LTCF, long‐term care facility.
FIGURE 3
FIGURE 3
Adjusted odds ratio with 95% confidence intervals for multivariate multinomial logistic regression models evaluating resident characteristics associated with antidepressant initiation in (A) LTCF and (B) hospital. Reference group = individuals initiating prior to entry (i.e., in community). BZD, benzodiazepine; LTCF, long‐term care facility.
FIGURE 4
FIGURE 4
Proportion of individuals who initiated an antidepressant, by antidepressant class and setting of initiation. Monoamine oxidase inhibitors excluded due to low counts. All antidepressant types were counted for n = 560 (1.6%) of people who initiated >1 antidepressant on the same date. Other, other antidepressants; RACF, residential aged care facility (interchangeable term for long‐term care facility); SNRIs, serotonin and noradrenaline reuptake inhibitors; SSRIs, selective serotonin reuptake inhibitors; TCAs, tricyclic antidepressants.
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