Explanatory models of depression and treatment adherence to antidepressant medication: A qualitative interview study
ABSTRACT Adherence to antidepressant medication is a challenging clinical issue, which reduces treatment efficacy: 30-60% of all patients commencing treatment with antidepressants are estimated to stop taking the medication within the first 12 weeks. Patients' personal beliefs about depression and antidepressants are regarded as central influences on adherence.
The aim was to gain detailed insight into patients' personal accounts of depression and use of antidepressant medication and to relate these accounts to the patients' self-reported level of adherence.
In-depth, qualitative interviews of 16 depressed patients one, four, eight and twelve months after hospital discharge supplemented by diagnostic interviews and self-report measures. Kleinman's notion of "explanatory model" was used as the theoretical perspective on the patients' illness narratives. Interview transcripts were analysed thematically with "explanatory models" as the starting point.
Patients had ambiguous experiences of depression and antidepressants. Patients explained their illness and the medical treatment in experience-near terms. Explanations of the reasons for depression were psychosocial and biology and medicine were not central. However, taking antidepressant medication was a meaningful part of being admitted to hospital, and the adoption of the rhetoric and practices of biomedicine strengthened patients' sense of control and hope for recovery. If medicine was ineffective, the explanatory models legitimised alternative strategies towards recovery, including non-adherence.
The patients' reasons for adhering to antidepressants included a range of diverse psychosocial issues, and could be regarded as a central part of their common sense illness management.
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ABSTRACT: BACKGROUND: Depression is one of the most commonly encountered mental health problems leading to significant morbidity and mortality and high medical and societal costs. Antidepressant prescribing in the UK has more than doubled in the last decade. There are a variety of factors that have been shown to affect a patient's experience of taking antidepressants The aim of this research was to explore patient narratives interviews about depression and its treatment in order to improve patient and health professional understanding of what it is like to use antidepressants. METHODS: This study involved a supplementary secondary qualitative analysis of 80 in-depth narrative interviews from Healthtalkonline. Patients' experiences of using medicines for depression were explored in the context of their social, occupational and emotional impact, to identify any additional issues and to clarify what type of information people want to find after being prescribed a medicine. The interviews were conducted by the University of Oxford and had received ethical approval and been consented and copyrighted for this purpose. Data were analyzed thematically. RESULTS: The most prominent theme was the coexistence of several conflicting issues around the use of medicines and participants were mostly influenced by the reality of their experiences, beliefs, attitudes and interaction with health care. Antidepressants appear to occupy a central place in many people' lives. Many people described how their medicines had helped them and how this served as a reinforcement to continue taking them in order to maintain a "normal life." Those who had stopped taking their antidepressants were likely to have experienced adverse reactions and had unsatisfactory interactions with health care professionals. A lack of information about antidepressants was a major cause of dissatisfaction often shaping attitudes to antidepressants'. CONCLUSIONS: People's experiences with antidepressant use have a major impact on treatment continuation and hence treatment outcomes. Further studies are needed on depressed patients' beliefs about their depression and treatment and how they relate to different stages of illness, their interactions with health care and their adherence to antidepressants.Research in Social and Administrative Pharmacy 12/2012; 9(6). DOI:10.1016/j.sapharm.2012.11.002 · 2.35 Impact Factor
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ABSTRACT: In South Africa, epilepsy is poorly understood and managed. The different cultural understandings and terms used to explain the condition across the diverse population groups exacerbate this problem. In this article, we describe the findings from a single story about epilepsy which we elicited through a semistructured interview guide in the respondents' natural setting. We used Kleinman and Benson's mini-ethnographic questions to explore the lay carer's explanatory models about epilepsy. Our respondent had different descriptors for epilepsy which include 'an illness of falling', 'an illness of fitting', and 'a thing'. His explanatory models concerning epilepsy were predominantly sociocultural, psychological, economical, and political in nature and were supported by personal examples from his past and present experiences. Key to this man's story is the reality of a strong cultural base of understanding epilepsy, with the added reality of an urbanized world in which people feel alienated from one another and do not necessarily share the same cultural beliefs and practices. Instead of viewing understandings of epilepsy as either 'traditional' or 'western', community-based health promotion interventions must therefore recognize both cultural issues and urban realities and should also incorporate approaches that foster a common ground for patients and carers with very diverse views. The findings of this one interview cannot be generalized but have implications for managing epilepsy in an urban African context.Epilepsy & Behavior 07/2013; 28(3). DOI:10.1016/j.yebeh.2013.05.025 · 2.06 Impact Factor
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ABSTRACT: OBJECTIVE Information is limited concerning the role of religious and spiritual advisors in providing help to people with mental illnesses in Singapore. This study examined that role, as well as the satisfaction with and the perceived effectiveness of the services provided, among people with mental health problems. METHODS Data were collected as part of a nationally representative household survey of residents 18 years and older in Singapore. The Composite International Diagnostic Interview, version 3.0, was used to diagnose mental illness as well as to collect information about the mental health services respondents had sought. RESULTS A total of 6,616 respondents completed the survey; in the overall sample, 1.5% reported seeking help from religious or spiritual advisors. This rate increased to 6.6% among those with at least one mental illness, with the prevalence being higher among respondents with lifetime dysthymia, generalized anxiety disorder, or bipolar disorder. Sociodemographic correlates associated with a lower likelihood of consultation with a religious or spiritual advisor included reporting "other" race-ethnicity as well as faith in Buddhism, Hinduism, or Islam. Most respondents who sought help from a religious or spiritual advisor in the last 12 months were satisfied with the help they received, and about half reported it to be very useful. CONCLUSIONS Religious and spiritual advisors are an important source of help for people with mental illness, and a majority of respondents with a mental illness were satisfied with the support they received from these sources.Psychiatric services (Washington, D.C.) 08/2013; 64(11). DOI:10.1176/appi.ps.201200533 · 1.99 Impact Factor