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Beliefs about medications predict adherence to antidepressants in older adults

Published online by Cambridge University Press:  28 June 2011

Waleed Fawzi ,
Mohamed Yousry Abdel Mohsen ,
Abdel Hamid Hashem ,
Suaad Moussa ,
Elizabeth Coker  and
Kenneth C.M. Wilson
Waleed Fawzi*
Affiliation:
Department of Old Age Psychiatry, Institute of Psychiatry, King's College London, UK
Mohamed Yousry Abdel Mohsen
Affiliation:
Department of Psychiatry, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
Abdel Hamid Hashem
Affiliation:
Department of Psychiatry, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
Suaad Moussa
Affiliation:
Department of Psychiatry, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
Elizabeth Coker
Affiliation:
The Lenox Hill Neighborhood House, New York, USA
Kenneth C.M. Wilson
Affiliation:
EMI Academic Unit, University of Liverpool, Liverpool, UK
*
Correspondence should be addressed to: Dr Waleed Fawzi, Institute of Psychiatry, Box PO70, De Crespigny Park, London, SE5 8AF, UK. Phone: +44 7841 436162; Fax: +44 20 7848 0632. Email: waleed.fawzi@kcl.ac.uk.
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Abstract

Background: Adherence to treatment is a complex and poorly understood phenomenon. This study investigates the relationship between older depressed patients’ adherence to antidepressants and their beliefs about and knowledge of the medication.

Methods: Assessment was undertaken of 108 outpatients over the age of 55 years diagnosed with depressive disorder and treated for at least four weeks with antidepressants. Adherence was assessed using two self-report measures: the Medication Adherence Rating Scale (MARS) and a Global Adherence Measure (GAM). Potential predictors of adherence investigated included sociodemographic, medication and illness variables. In addition, 33 carers were interviewed regarding general medication beliefs.

Results: 56% of patients reported 80% or higher adherence on the GAM. Sociodemographic variables were not associated with adherence on the MARS. Specific beliefs about medicines, such as “my health depends on antidepressants” (necessity) and being less worried about becoming dependant on antidepressants (concern) were highly correlated with adherence. General beliefs about medicines causing harm or being overprescribed, experiencing medication side-effects and severity of depression also correlated with poor adherence. Linear regression with the MARS as the dependent variable explained 44.3% of the variance and showed adherence to be higher in subjects with healthy specific beliefs who received more information about antidepressants and worse with depression severity and autonomic side-effects.

Conclusions: Our findings strongly support a role for specific beliefs about medicines in adherence. Challenging patients’ beliefs, providing information about treatment and discussing side-effects could improve adherence. Poor response to treatment and medication side-effects can indicate poor adherence and should be considered before switching medications.

Keywords

compliancedepressionelderlyside-effectscarerseducationcognitionconcordance
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 1 , January 2012 , pp. 159 - 169
Copyright
Copyright © International Psychogeriatric Association 2011

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References

Akerblad, A. C., Bengtsson, F., von Knorring, L. and Ekselius, L. (2006). Response, remission and relapse in relation to adherence in primary care treatment of depression: a 2-year outcome study. International Clinical Psychopharmacology, 21, 117–124.CrossRefGoogle ScholarPubMed
Akincigil, A., Bowblis, J. R., Levin, C., Walkup, J. T., Jan, S. and Crystal, S. (2007). Adherence to antidepressant treatment among privately insured patients diagnosed with depression. Medical Care, 45, 363–369.CrossRefGoogle ScholarPubMed
Ayalon, L., Arean, P. and Alvidrez, J. (2005). Adherence to antidepressant medications in Black and Latino elderly patients. American Journal of Geriatric Psychiatry, 13, 572–580.CrossRefGoogle ScholarPubMed
Bambauer, K. Z., Soumerai, S. B., Adams, A. S., Zhang, F. and Ross-Degnan, D. (2007). Provider and patient characteristics associated with antidepressant nonadherence: the impact of provider specialty. Journal of Clinical Psychiatry, 68, 867–873.CrossRefGoogle ScholarPubMed
Blackwell, B. (1976). Treatment adherence. British Journal of Psychiatry, 129, 513–531.CrossRefGoogle ScholarPubMed
Brown, C., Battista, D. R., Bruehlman, R., Sereika, S. S., Thase, M. E. and Dunbar-Jacob, J. (2005). Beliefs about antidepressant medications in primary care patients: relationship to self-reported adherence. Medical Care, 43, 1203–1207.CrossRefGoogle ScholarPubMed
Central Agency for Public Mobilization and Statistics (2005). General Census of Population, Housing, and Buildings in Egypt. Cairo: CAPMAS.Google Scholar
Cooper, C. et al. (2005). The AdHOC study of older adults’ adherence to medication in 11 countries. American Journal of Geriatric Psychiatry, 13, 1067–1076.CrossRefGoogle ScholarPubMed
Feinstein, A. R. (1979). Compliance bias. In Haynes, Brian and Sackett, David L. (eds.), Compliance in Health Care (pp. 309–322), Baltimore: The Johns Hopkins University Press.Google Scholar
Folstein, M., Folstein, S. and McHugh, P. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle Scholar
George, C., Peveler, R., Heiliger, S. and Thompson, C. (2000). Compliance with tricyclic antidepressants: the value of four different methods of assessment. British Journal of Clinical Pharmacology, 50, 166–171.CrossRefGoogle ScholarPubMed
Givens, J. et al. (2006). Older patients’ aversion to antidepressants: a qualitative study. Journal of General Internal Medicine, 21, 146–151.Google ScholarPubMed
Hogan, T. P., Awad, A. G. and Eastwood, R. (1983). A self-report scale predictive of drug compliance in schizophrenics: reliability and discriminative validity. Psychological Medicine, 13, 177–183.CrossRefGoogle ScholarPubMed
Horne, R. (2000). Assessing perceptions of medication: psychological perspectives. In McGavock, H. (ed.), Handbook of Drug Use Research Methodology (pp. 299–319). Newcastle: United Kingdom Drug Utilisation Research GroupGoogle Scholar
Horne, R., Weinman, J. and Hankins, M. (1999). The beliefs about medicines questionnaire: the development and evaluation of a new method for assessing the cognitive representation of medication. Psychology and Health, 14, 1–24.CrossRefGoogle Scholar
Hunot, V., Horne, R., Leese, M. and Churchill, R. (2007). A cohort study of adherence to antidepressants in primary care: the influence of antidepressant concerns and treatment preferences. Primary Care Companion to the Journal of Clinical Psychiatry, 9, 91–99.CrossRefGoogle ScholarPubMed
Inzelberg, R. et al. (2007). Education effects on cognitive function in a healthy aged Arab population. International Psychogeriatrics, 19, 593–603.CrossRefGoogle Scholar
Lin, E. et al. (1995). The role of the primary care physician in patients’ adherence to antidepressant therapy. Medical Care, 33, 67–74.CrossRefGoogle ScholarPubMed
Lingjaerde, O., Ahlfors, U., Bech, P., Dencker, S. and Elgen, K. (1987). The UKU side effect rating scale: a new comprehensive rating scale for psychotropic drugs and a cross-sectional study of side effects in neuroleptic-treated patients. Acta Psychiatrica Scandinavica, 76, 1–100.CrossRefGoogle Scholar
Maidment, R., Livingston, G. and Katona, C. (2002). “Just keep taking the tablets”: adherence to antidepressant treatment in older people in primary care. International Journal of Geriatric Psychiatry, 17, 752–757.CrossRefGoogle ScholarPubMed
Morisky, D. E., Green, L. W. and Levine, D. M. (1986). Concurrent and predictive validity of a self-reported measure of medication adherence. Medical Care, 24, 67–74.CrossRefGoogle ScholarPubMed
Mottram, P., Wilson, K. and Strobl, J. (2006). Antidepressants for depressed elderly. Cochrane Database of Systematic Reviews, 1, CD003491.Google Scholar
Osterberg, L. and Blaschke, T. (2005). Adherence to medication. New England Journal of Medicine, 353, 487–497.CrossRefGoogle ScholarPubMed
Ravindran, A., Welburn, K. and Copeland, J. (1994). Semi-structured depression scale sensitive to change with treatment for use in the elderly. British Journal of Psychiatry, 164, 522–527.CrossRefGoogle ScholarPubMed
Sher, I., McGinn, L., Sirey, J. and Meyers, B. (2005). Effects of caregivers’ perceived stigma and causal beliefs on patients’ adherence to antidepressant treatment. Psychiatric Services, 56, 564–569.CrossRefGoogle ScholarPubMed
Thompson, C., Peveler, R., Stephenson, D. and McKendrick, J. (2000a). Compliance with antidepressant medication in the treatment of major depressive disorder in primary care: a randomized comparison of fluoxetine and a tricyclic antidepressant. American Journal of Psychiatry, 157, 338–343.CrossRefGoogle Scholar
Thompson, K., Kulkarni, J. and Sergejew, A. (2000b). Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. Schizophrenia Research, 42, 241–247.CrossRefGoogle ScholarPubMed
Topinkova, E., Fialova, D., Carpenter, G. and Bernabei, R. (2006). Cross-national comparison of drug compliance and non-compliance associated factors in the elderly with polypharmacotherapy. Casopis Lekaru Ceskych, 145, 726–732.Google ScholarPubMed
Vermeire, E., Hearnshaw, H., van Royen, P. and Denekens, J. (2001). Patient adherence to treatment: three decades of research – a comprehensive review. Journal of Clinical Pharmacy and Therapeutics, 26, 331–342.CrossRefGoogle ScholarPubMed
Voils, C., Steffens, D., Flint, E. and Bosworth, H. (2005). Social support and locus of control as predictors of adherence to antidepressant medication in an elderly population. American Journal of Geriatric Psychiatry, 13, 157–165.CrossRefGoogle Scholar
Wilson, K. and Mottram, P. (2004). A comparison of side effects of selective serotonin reuptake inhibitors and tricyclic antidepressants in older depressed patients: a meta-analysis. International Journal of Geriatric Psychiatry, 19, 754–762.CrossRefGoogle ScholarPubMed