51
|
Van Voorhees BW, Fogel J, Houston TK, Cooper LA, Wang NY, Ford DE. Attitudes and illness factors associated with low perceived need for depression treatment among young adults. Soc Psychiatry Psychiatr Epidemiol 2006; 41:746-54. [PMID: 16896516 DOI: 10.1007/s00127-006-0091-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2006] [Indexed: 11/27/2022]
Abstract
BACKGROUND We do not yet fully understand how low perceived need for treatment leads many young adults to not seek care for their depression. METHODS A cross-sectional study of 10,962 depressed young adults (ages 16-29) who visited a depression screening/education Internet website. Based on the Theory of Reasoned Action, we developed a multivariate model to determine the effects of beliefs and attitudes, social norms, past treatment behavior, and symptom severity on low perceived depression treatment need (i.e., not agreeing that one needs depression treatment). RESULTS Negative beliefs and attitudes, social norms, and past treatment behavior predicted low perceived depression treatment need and explained more than half the model variance. Even after adjusting for depression severity and symptoms of other mental disorders, lacking confidence in either a biological or counseling based explanation or treatment approach for depression predicted low perceived depression treatment need. CONCLUSIONS Lack of helpful treatment experiences and/or confidence in either of the currently practiced depression treatment models may prevent many young adults from seeking depression treatment.
Collapse
Affiliation(s)
- Benjamin W Van Voorhees
- Department of Medicine, Section of General Internal Medicine, The University of Chicago, 5841 South Maryland Avenue, MC 20007, Chicago, IL 60637, USA.
| | | | | | | | | | | |
Collapse
|
52
|
Givens JL, Datto CJ, Ruckdeschel K, Knott K, Zubritsky C, Oslin DW, Nyshadham S, Vanguri P, Barg FK. Older patients' aversion to antidepressants. A qualitative study. J Gen Intern Med 2006; 21:146-51. [PMID: 16336620 PMCID: PMC1484662 DOI: 10.1111/j.1525-1497.2005.00296.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2005] [Revised: 09/15/2005] [Indexed: 11/30/2022]
Abstract
BACKGROUND Depression is common among older patients yet is often inadequately treated. Patient beliefs about antidepressants are known to affect treatment initiation and adherence, but are often not expressed in clinical settings. OBJECTIVE To explore attitudes toward antidepressants in a sample of depressed, community-dwelling elders who were offered treatment. DESIGN. Cross-sectional, qualitative study utilizing semi-structured interviews. PARTICIPANTS Primary care patients age 60 years and over with depression, from academic and community primary care practices of the University of Pennsylvania Health System and the Philadelphia Department of Veterans Affairs. Patients participated in either the Prevention of Suicide in Primary Care Elderly: Collaborative Trial or the Primary Care Research in Substance Abuse and Mental Health for the Elderly Trial. Sixty-eight patients were interviewed and responses from 42 participants with negative attitudes toward medication for depression were analyzed. MEASUREMENTS Interviews were audiotaped, transcribed, and entered into a qualitative software program for coding and analysis. A multidisciplinary team of investigators coded the transcripts and identified key features of narratives expressing aversion to antidepressants. RESULTS Four themes characterized resistance to antidepressants: (1) fear of dependence; (2) resistance to viewing depressive symptoms as a medical illness; (3) concern that antidepressants will prevent natural sadness; (4) prior negative experiences with medications for depression. CONCLUSIONS Many elders resisted the use of antidepressants. Patients expressed concerns that seem to reflect their concept of depression as well as their specific concerns regarding antidepressants. These findings may enhance patient-provider communication about depression treatment in elders.
Collapse
Affiliation(s)
- Jane L Givens
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
53
|
Cooper LA. At the Center of Decision Making in Mental Health Services and Interventions Research: Patients, Clinicians, or Relationships? CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2006. [DOI: 10.1111/j.1468-2850.2006.00003.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
54
|
Wills CE, Holmes-Rovner M. Integrating Decision Making and Mental Health Interventions Research: Research Directions. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2006; 13:9-25. [PMID: 16724158 PMCID: PMC1466549 DOI: 10.1111/j.1468-2850.2006.00002.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The importance of incorporating patient and provider decision-making processes is in the forefront of the National Institute of Mental Health (NIMH) agenda for improving mental health interventions and services. Key concepts in patient decision making are highlighted within a simplified model of patient decision making that links patient-level/"micro" variables to services-level/"macro" variables via the decision-making process that is a target for interventions. The prospective agenda for incorporating decision-making concepts in mental health research includes (a) improved measures for characterizing decision-making processes that are matched to study populations, complexity, and types of decision making; (b) testing decision aids in effectiveness research for diverse populations and clinical settings; and (c) improving the understanding and incorporation of preference concepts in enhanced intervention designs.
Collapse
|
55
|
Thacher JA, Morey E, Craighead WE. Using patient characteristics and attitudinal data to identify depression treatment preference groups: a latent-class model. Depress Anxiety 2005; 21:47-54. [PMID: 15884093 DOI: 10.1002/da.20057] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A latent-class model is used to identify and characterize groups of patients who share similar attitudes towards treating depression. The results predict the probability of preference-group membership on the basis of observable characteristics and answers to attitudinal questions. Understanding the types of preference groups that exist and a patient's probability of membership in each of the groups can help clinicians tailor the treatment to the patient and may increase patient adherence. One hundred four depressed patients completed a survey on attitudes towards treatment of Major Depressive Disorder. Analysis shows that treatment preferences vary among depressed patients. Three classes are identified that differ in their sensitivity to treatment costs and side effects. One class cares primarily about treatment effectiveness; side effects and the cost of treatment have little impact on this class's treatment decisions. Another class is highly sensitive to cost and side effects. A third class is somewhat sensitive to cost and side effects. Younger and male patients are more likely to be sensitive to treatment costs and side effects.
Collapse
Affiliation(s)
- Jennifer A Thacher
- Department of Economics, University of New Mexico, Albuquerque, New Mexico 87131, USA.
| | | | | |
Collapse
|
56
|
Fogel J, Ford DE. Stigma beliefs of Asian Americans with depression in an internet sample. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2005; 50:470-8. [PMID: 16127965 DOI: 10.1177/070674370505000807] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study the beliefs of Asian Americans with depression about stigma associated with depression treatment among friends, employers, and family. METHOD Participants completed the Center for Epidemiologic Studies-Depression Scale (CES-D) anonymously on the Internet. In this cross-sectional design, those who screened positive for depression were asked questions regarding stigma (n = 68 656). We used analysis of variance (ANOVA) and analysis of covariance (ANCOVA) to compare Asian Americans with whites and also to make comparisons by age and sex. Further, we stratified for Asian Americans and used ANOVA and ANCOVA to compare age and sex. We used linear regression to assess how stigma beliefs were associated with self-reported need for depression treatment. RESULTS Asian Americans overall had greater stigma beliefs than did whites for all 3 stigma outcomes (P < 0.001), especially those related to family. Although this same pattern existed for subjects aged between 16 and 29 years and between 30 and 45 years (P < 0.001), among those aged under 16 years, this existed for family stigma (P < 0.001) but not for friends or employer stigma. In our stratified analyses among Asian Americans, male participants had greater stigma beliefs than did female participants for friends (P < 0.001) and employer (P < 0.05) but not for family. CONCLUSIONS The pattern of Asian Americans having greater stigma levels than whites may be changing among younger Asian Americans because of acculturation. Also, among Asian Americans, unlike previous research showing no sex differences for stigma, we show that male participants had greater stigma levels than did female participants. Future directions should include measuring stigma after culture-specific interventions.
Collapse
Affiliation(s)
- Joshua Fogel
- Department of Economics, Brooklyn College, City University of New York, Brooklyn, NY, USA.
| | | |
Collapse
|
57
|
Aikens JE, Nease DE, Nau DP, Klinkman MS, Schwenk TL. Adherence to maintenance-phase antidepressant medication as a function of patient beliefs about medication. Ann Fam Med 2005; 3:23-30. [PMID: 15671187 PMCID: PMC1466796 DOI: 10.1370/afm.238] [Citation(s) in RCA: 201] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE This study aimed to identify the demographic, psychiatric, and attitudinal predictors of treatment adherence during the maintenance phase of antidepressant treatment, ie, after symptoms and regimen are stabilized. METHODS We surveyed 81 primary care patients given maintenance antidepressant medications regarding general adherence, recent missed doses, depression and treatment features, medication beliefs (necessity, concerns, harmfulness, and overprescription), and other variables. Additional data were collected from medical and payer records. RESULTS Median treatment duration was 75 weeks. Adherence and beliefs were broadly dispersed and unrelated to treatment duration and type, physical functioning, and demographics. Multivariate analysis adjusting for social desirability, depression severity, and treatment duration indicated that an antidepressant-specific "necessity-minus-concerns" composite was strongly associated with both adherence outcomes. Specifically, adherence was highest when necessity exceeded concerns and lowest when concerns exceeded necessity. We crossed these 2 dimensions to characterize 4 patient attitudes toward antidepressants: skepticism, indifference, ambivalence, and acceptance. CONCLUSIONS Patients given maintenance antidepressants vary widely in adherence. This variation is primarily explained by the balance between their perceptions of need and harmfulness of antidepressant medication, in that adherence is lowest when perceived harm exceeds perceived need, and highest when perceived need exceeds perceived harm. We speculate on ways to tailor adherence strategies to patient beliefs. Subsequent research should determine whether patients' perceptions about medication predict depression outcomes, can be used to improve clinical management, and respond to behavioral intervention.
Collapse
Affiliation(s)
- James E Aikens
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor 48109, USA.
| | | | | | | | | |
Collapse
|
58
|
Beliefs and attitudes associated with the intention to not accept the diagnosis of depression among young adults. Ann Fam Med 2005; 3:38-46. [PMID: 15671189 PMCID: PMC1466793 DOI: 10.1370/afm.273] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Negative attitudes and beliefs about depression treatment may prevent many young adults from accepting a diagnosis and treatment for depression. We undertook a study to determine the association between depressive symptom severity, beliefs about and attitudes toward treatment, subjective social norms, and past behavior on the intent not to accept a physician's diagnosis of depression. METHODS We conducted a cross-sectional study of 10,962 persons aged 16 to 29 years who participated and had positive screening results on the Center for Epidemiologic Studies Depression (CES-D) score in an Internet-based public health depression screening program. Participants reported whether they would accept their physician's diagnosis of depression. Based on the theory of reasoned action, we developed a multivariate model of the factors that predict intent not to accept a diagnosis of depression. RESULTS Twenty-six percent of the participants stated their intent not to accept their physician's diagnosis of depression. Disagreeing that medications are effective in treating depression (strongly disagree, odds ratio ( OR ) = 6.5, 95% confidence interval (CI), 4.6-9.3), that there is a biological cause for depression (strongly disagree, OR = 1.9, 95% CI, 1.3-2.7), and agreeing that you would be embarrassed if your friends knew you had depression were associated with the intent not to accept a diagnosis of depression (strongly agree, OR = 2.3, 95% CI, 1.8-2.9). Beliefs and attitudes, subjective social norms, and past behavior explained most of the variance in this model (84%). CONCLUSIONS Negative beliefs and attitudes, subjective social norms, and lack of past helpful treatment experiences are associated with the intent to not accept the diagnosis of depression and may contribute to low rates of treatment among young adults.
Collapse
|
59
|
van Schaik DJF, Klijn AFJ, van Hout HPJ, van Marwijk HWJ, Beekman ATF, de Haan M, van Dyck R. Patients' preferences in the treatment of depressive disorder in primary care. Gen Hosp Psychiatry 2004; 26:184-9. [PMID: 15121346 DOI: 10.1016/j.genhosppsych.2003.12.001] [Citation(s) in RCA: 276] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2003] [Accepted: 12/04/2003] [Indexed: 11/19/2022]
Abstract
Patients' preferences in the treatment of depression are important in clinical practice and in research. Antidepressant medication is often prescribed, but adherence is low. This may be caused by patients preferring psychotherapy, which is often not available in primary care. In randomized clinical trials, patients' preferences may affect the external validity. The aim of this article is to study patients' preferences regarding psychotherapy and antidepressant medication and the impact of these preferences on treatment outcome. A systematic review of the literature was performed. The majority of patients preferred psychotherapy in all available studies. Antidepressants were often regarded as addictive and psychotherapy was assumed to solve the cause of depression. Discussing and supporting preferences as part of a quality improvement program of depression care, resulted in more patients receiving the treatment that was most suitable to them. In two patient-preference trials, preferences did not influence treatment outcome. It can be concluded that a substantial percentage of well-informed patients prefer psychotherapy. Patients with strong preferences, mostly for psychotherapy, are likely not to enter antidepressant treatment or randomized clinical trials if their preferences are not supported.
Collapse
Affiliation(s)
- Digna J F van Schaik
- Department of General Practice, Institute of Extramural Medicine (EMGO), VU University Medical Centre, Amsterdam, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
60
|
Van Voorhees BW, Cooper LA, Rost KM, Nutting P, Rubenstein LV, Meredith L, Wang NY, Ford DE. Primary care patients with depression are less accepting of treatment than those seen by mental health specialists. J Gen Intern Med 2003; 18:991-1000. [PMID: 14687257 PMCID: PMC1494953 DOI: 10.1111/j.1525-1497.2003.21060.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study examined whether depressed patients treated exclusively in primary care report less need for care and less acceptability of treatment options than those depressed patients treated in the specialty mental health setting after up to 6 months of treatment. DESIGN Cross-sectional study. SETTING Forty-five community primary care practices. PARTICIPANTS A total of 881 persons with major depression who had received mental health services in the previous 6 months and who enrolled in 3 of the 4 Quality Improvement for Depression Collaboration Studies. MEASUREMENTS AND RESULTS Patients were categorized into 1 of 2 groups: 1) having received mental health services exclusively from a primary care provider (45%), or 2) having received any services from a mental health specialist (55%) in the previous 6 months. Compared with patients who received care from mental health specialists, patients who received mental health services exclusively from primary care providers had 2.7-fold the odds (95% confidence interval [CI], 1.6 to 4.4) of reporting that no treatment was definitely acceptable and had 2.4-fold the odds (95% CI, 1.5 to 3.9) of reporting that evidence-based treatment options (antidepressant medication) were definitely not acceptable. These results were adjusted for demographic, social/behavioral, depression severity, and economic factors using multiple logistic regression analysis. CONCLUSIONS Patients with depression treated exclusively by primary care providers have attitudes and beliefs more averse to care than those seen by mental health specialists. These differences in attitudes and beliefs may contribute to lower quality depression care observed in comparisons of primary care and specialty mental health providers.
Collapse
Affiliation(s)
- Benjamin W Van Voorhees
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | | | | | | | | | | | | | | |
Collapse
|
61
|
O'Malley AS, Forrest CB, Miranda J. Primary care attributes and care for depression among low-income African American women. Am J Public Health 2003; 93:1328-34. [PMID: 12893623 PMCID: PMC1447965 DOI: 10.2105/ajph.93.8.1328] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the association between attributes of primary care providers and care for depression, from a patients' perspective, among a sample of predominantly low-income African American women. METHODS Computer-assisted telephone interviews were conducted among a population-based sample of 1202 women residing in Washington, DC. RESULTS Respondents whose primary care physicians provided more comprehensive medical services were more likely to be asked about and treated for depressive symptoms than women whose providers were less medically comprehensive. Women who rated their providers as having more respect for them also were more likely to be asked about and treated for depression. CONCLUSIONS More comprehensive primary care delivery and a physician-patient relationship focused on mutual respect are associated with greater rates of physician inquiry about and treatment for depression among vulnerable women.
Collapse
Affiliation(s)
- Ann S O'Malley
- Department of Medicine, Georgetown University Medical Center, Washington, DC, USA.
| | | | | |
Collapse
|
62
|
Cooper LA, Gonzales JJ, Gallo JJ, Rost KM, Meredith LS, Rubenstein LV, Wang NY, Ford DE. The acceptability of treatment for depression among African-American, Hispanic, and white primary care patients. Med Care 2003; 41:479-89. [PMID: 12665712 DOI: 10.1097/01.mlr.0000053228.58042.e4] [Citation(s) in RCA: 382] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ethnic minority patients are less likely than white patients to receive guideline-concordant care for depression. It is uncertain whether racial and ethnic differences exist in patient beliefs, attitudes, and preferences for treatment. METHODS A telephone survey was conducted of 829 adult patients (659 non-Hispanic whites, 97 African Americans, 73 Hispanics) recruited from primary care offices across the United States who reported 1 week or more of depressed mood or loss of interest within the past month and who met criteria for Major Depressive Episode in the past year. Within this cohort, we examined differences among African Americans, Hispanics, and whites in acceptability of antidepressant medication and acceptability of individual counseling. RESULTS African Americans (adjusted OR, 0.30; 95% CI 0.19-0.48) and Hispanics (adjusted OR, 0.44; 95% CI, 0.26-0.76) had lower odds than white persons of finding antidepressant medications acceptable. African Americans had somewhat lower odds (adjusted OR, 0.63; 95% CI, 0.35-1.12), and Hispanics had higher odds (adjusted OR, 3.26; 95% CI, 1.08-9.89) of finding counseling acceptable than white persons. Some negative beliefs regarding treatment were more prevalent among ethnic minorities; however adjustment for these beliefs did not explain differences in acceptability of treatment for depression. CONCLUSIONS African Americans are less likely than white persons to find antidepressant medication acceptable. Hispanics are less likely to find antidepressant medication acceptable, and more likely to find counseling acceptable than white persons. Racial and ethnic differences in beliefs about treatment modalities were found, but did not explain differences in the acceptability of depression treatment. Clinicians should consider patients' cultural and social context when negotiating treatment decisions for depression. Future research should identify other attitudinal barriers to depression care among ethnic minority patients.
Collapse
Affiliation(s)
- Lisa A Cooper
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
| | | | | | | | | | | | | | | |
Collapse
|
63
|
Cooper LA, Brown C, Vu HT, Ford DE, Powe NR. How important is intrinsic spirituality in depression care? A comparison of white and African-American primary care patients. J Gen Intern Med 2001; 16:634-8. [PMID: 11556945 PMCID: PMC1495266 DOI: 10.1046/j.1525-1497.2001.016009634.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We used a cross-sectional survey to compare the views of African-American and white adult primary care patients (N = 76) regarding the importance of various aspects of depression care. Patients were asked to rate the importance of 126 aspects of depression care (derived from attitudinal domains identified in focus groups) on a 5-point Likert scale. The 30 most important items came from 9 domains: 1) health professionals' interpersonal skills, 2) primary care provider recognition of depression, 3) treatment effectiveness, 4) treatment problems, 5) patient understanding about treatment, 6) intrinsic spirituality, 7) financial access, 8) life experiences, and 9) social support. African-American and white patients rated most aspects of depression care as similarly important, except that the odds of rating spirituality as extremely important for depression care were 3 times higher for African Americans than the odds for whites.
Collapse
Affiliation(s)
- L A Cooper
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Md, USA.
| | | | | | | | | |
Collapse
|