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1 Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Mich
2 Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Mich
3 University of Michigan Depression Center, Ann Arbor, Mich
4 College of Pharmacy, University of Michigan Medical School, Ann Arbor, Mich
CORRESPONDING AUTHOR: James E. Aikens, PhD, Department of Family Medicine University of Michigan 1018 Fuller Street, Box 0708 Ann Arbor, MI, 48109 aikensj{at}umich.edu
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.
Key Words: Treatment refusal • patient nonadherence • depression/drug therapy • health beliefs • attitude to health • patient compliance
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