PTSD and Treatment Adherence: the role of health beliefs.
Health beliefs have been shown to influence a myriad of medical treatment decisions. More recently, the impact of health beliefs on treatment decisions for mental illness has become a focus of study. This study examines the health beliefs and treatment behavior of veterans with posttraumatic stress disorder (PTSD). Using standard survey methodology, we assessed beliefs about the cause of PTSD, expected duration and controllability of symptoms, and life consequences of having PTSD. Treatment participation and medication compliance were assessed, as were common treatment correlates, such as patient-provider relationships, dosing frequency, side effect severity, number of prescribed medications, and use of drugs or alcohol to control PTSD symptoms. Explanatory models of PTSD, perceived controllability, and use of benzodiazepines were found to predict psychiatric medication use. Negative life consequences of PTSD were associated with participation in psychotherapy. Assessment of health beliefs may help providers to understand their patients' treatment behavior and to facilitate treatment engagement.
Available from: Ian M Kronish
- "For example, PTSD has been associated with a sense of foreshortened future (Greenwell & Cosden, 2009; Rodriguez et al., 2008) and a lack of personal control over the illness that triggered PTSD (Wikman et al., 2011); these distinct illness representations may lead affected patients to miss preventive medications out of a fatalistic sense that such medications are not worth taking, particularly for asymptomatic conditions like hypertension or hyperlipidemia. Although some researchers have begun to look at the association between PTSD and beliefs about PTSD treatment (Spoont et al., 2005), we could find no published studies that explored beliefs about treatment for medical conditions in patients with PTSD. Our findings should be interpreted in light of several potential limitations. "
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Patients with post-traumatic stress disorder (PTSD) are at increased risk for adverse outcomes from comorbid medical conditions. Medication non-adherence is a potential mechanism explaining this increased risk.
We examined the association between PTSD and medication adherence in a cross-sectional study of 724 patients recruited from two Department of Veterans Affairs Medical Centers between 2008 and 2010. PTSD was assessed using the Clinician Administered PTSD Scale. Medication adherence was assessed using a standardized questionnaire. Ordinal logistic regression models were used to calculate the odds ratios (ORs) for medication non-adherence in patients with versus without PTSD, adjusting for potential confounders.
A total of 252 patients (35%) had PTSD. Twelve percent of patients with PTSD reported not taking their medications as prescribed compared to 9% of patients without PTSD (unadjusted OR 1.85, 95% CI 1.37-2.50, P<0.001). Forty-one percent of patients with PTSD compared to 29% of patients without PTSD reported forgetting medications (unadjusted OR 1.90, 95% CI 1.44-2.52, P<0.001). Patients with PTSD were also more likely to report skipping medications (24% versus 13%; unadjusted OR 2.01, 95% CI 1.44-2.82, P<0.001). The association between PTSD and non-adherence remained significant after adjusting for demographics, depression, alcohol use, social support, and medical comorbidities (adjusted OR 1.47, 95% CI 1.03-2.10, P=0.04 for not taking medications as prescribed and 1.95, 95% CI 1.31-2.91, P=0.001 for skipping medications).
PTSD was associated with medication non-adherence independent of psychiatric and medical comorbidities. Medication non-adherence may contribute to the increased morbidity and mortality observed in patients with PTSD.
Available from: David Eisenman
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ABSTRACT: BACKGROUND: Little is known about how Latinos with post-traumatic stress disorder (PTSD) understand their illness and their preferences for mental health treatment.
Available from: Maarten J Fischer
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ABSTRACT: To examine patients' pretreatment beliefs and goals regarding pulmonary rehabilitation.
Qualitative study using semi-structured interviews.
Interviews conducted at participants' homes.
Twelve patients with chronic obstructive pulmonary disease who had been referred to a rehabilitation clinic.
Patients' beliefs about pulmonary rehabilitation, self-set treatment goals and anticipated reasons for drop-out.
Patients' beliefs about pulmonary rehabilitation comprised positive aspects (participation as an opportunity for improvement, a safe and multidisciplinary setting, presence of motivating and supporting patients) and negative aspects of exercising in a rehabilitation centre (e.g. disruption of normal routine, being tired after training, transportation difficulties, limited privacy and confrontation with severely ill patients). Four types of treatment goals were formulated: increase in functional performance, weight regulation, reduction of dyspnoea, and improvement of psychosocial well being. Four clusters of anticipated reasons for drop-out were identified: the intensity of the programme, barriers to attending (e.g. transportation problems, sudden illness and other duties/responsibilities), lack of improvement and social factors. Four different attitudes towards pulmonary rehabilitation could be distinguished: optimistic, 'wait and see', sceptic and pessimistic. Follow-up data revealed that whereas a pessimistic attitude (high disability, low self-confidence, many concerns) was related to decline, the 'sceptic' patients had dropped out during the course.
Uptake and drop-out may be related to patients' perceived disabilities, expected benefits and concerns with regard to rehabilitation, practical barriers and confidence in their own capabilities.
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