Stigma as a Barrier to Recovery: Perceived Stigma and Patient-Rated Severity of Illness as Predictors of Antidepressant Drug Adherence

Sirey, Jo Anne; Bruce, Martha L.; Alexopoulos, George S.; Perlick, Deborah A.; Friedman, Steven; Meyers, Barnett S.

doi:10.1176/appi.ps.52.12.1615

Cited by 684 publications

(440 citation statements)

References 20 publications

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“…A four-month follow-up was chosen because the early phase of treatment is a particularly critical time period with an increased risk of treatment drop-out, medication discontinuation [35, 36], and vulnerability to suicide [37]. Assessments were conducted by trained research assistants and all participants provided written informed consent prior to study participation.…”

Section: Methodsmentioning

confidence: 99%

Racial Differences in Adherence to Antidepressant Treatment in Later Life

Kales

Nease

Sirey

et al. 2013

The American Journal of Geriatric Psychiatry

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Objective Although antidepressants are an effective treatment for later-life depression, older patients often choose not to initiate or to discontinue medication treatment prematurely. While racial differences in depression treatment preferences have been reported, little is known about racial differences in antidepressant medication adherence among older patients. Design Prospective, observational study comparing antidepressant adherence for older African-American and white primary care patients. Participants One hundred and eighty-eight subjects aged 60 and older, diagnosed with clinically significant depression with a new recommendation for antidepressant treatment by their primary care physician. Measurement Study participants were assessed at study entry and at four-month follow-up (encompassing the acute treatment phase). Depression medication adherence was based on a well-validated self-report measure. Results At four-month follow-up, 61.2% of subjects reported that they were adherent to their antidepressant medication. In unadjusted and two of the three adjusted analyses, African-American subjects (n=82) had significantly lower rates of four-month antidepressant adherence than white subjects (n=106). African-American females had the lowest adherence rates (44.4%) followed by African-American males (56.8%), white males (65.3%) and white females (73.7%). In logistic regression models controlling for demographic, illness, and functional status variables, significant differences persisted between African-American women and white women in reported four-month antidepressant adherence (OR 3.58, 95% CI 1.27-10.07, Wald Chi-square =2.42, df=1, p<0.02). Conclusions The results demonstrate racial and gender differences in antidepressant adherence in older adults. Depression treatment interventions for the older adults should take into account the potential impact of race and gender on adherence to prescribed medications.

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Section: Methodsmentioning

confidence: 99%

Racial Differences in Adherence to Antidepressant Treatment in Later Life

Kales

Nease

Sirey

et al. 2013

The American Journal of Geriatric Psychiatry

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“…The 1999 US Surgeon General report regarding mental health offered that stigma associated with mental health may be the reason why nearly one-half of those with a mental illness in the US do not seek treatment [6]. Looking at depression specifically, individuals with greater depression severity have been found to experience greater stigma [7]. Unfortunately, even those who do seek treatment may be negatively affected by stigma.…”

Section: Introductionmentioning

confidence: 99%

Cross-sectional population based study ascertaining the characteristics of US rural adults with mental health concerns who perceived a stigma regarding mental health issues

Pederson¹,

Lutfiyya²,

Palombi³

et al. 2013

Health

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Introduction: Mental health is an important component of overall health. Mental illness is a leading cause of morbidity and mortality in the US and is associated with chronic diseases such as heart disease, diabetes, and arthritis. In the US, most people with mental health issues or disorders remain untreated. Epidemiological studies have identified rural residents as being at greater risk for health disparities; as a result, rural residents are a vulnerable population in terms of mental health and mental health care. Research has demonstrated that perceived stigma can be a significant barrier to rural residents seeking mental health care. This study examined the research question: What are the characteristics of US rural adults with mental health concerns who perceived stigma? Methods: 2007 Behavioral Risk Factor Surveillance System (BRFSS) data were analyzed using bivariate and multivariate techniques to answer the research question. 2007 BRFSS data were used because in that year non-institutionalized US adults in 37 states and territories were queried about their attitudes toward mental illness. BRFSS is a random digit telephone survey that uses a complex multi-stage sampling approach and subsequently a weighting factor is calculated for application to the data in order to ensure that they are representative of the US population based on the most recent census data.Only weighted data were analyzed. Results: Logistic regression analysis revealed that rural adults reporting mental health concerns who perceived stigma regarding mental health were more likely to be unemployed seeking work or not working and not seeking work, military veterans, or to have deferred medical care because of cost. They were also more likely to not have a health care provider and to rarely or never feel supported emotionally. Conclusions: Support systems may render people with mental health issues less vulnerable to perceiving stigma, thus assisting with removing stigma as a barrier to care. Pharmacist may play a role as support in communities, especially where access to health care providers may be limited.

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“…Therefore, it could be helpful to advise patients who exhibit pre-treatment symptoms of depression that taking antidepressant medication will increase their odds of success. However, several smokers may resist treatment with antidepressant medication to avoid the stigma of being labeled as ''mentally ill'' [23]. Those who initially refuse should be counseled that depression is caused by a chemical imbalance, and is a treatable medical problem, not a character flaw.…”

Section: Notes On Relapse Preventionmentioning

confidence: 99%

Handling relapse in smoking cessation: strategies and recommendations

Caponnetto

Keller²,

Bruno

et al. 2012

Intern Emerg Med

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Once established, smoking is a very difficult addiction to break. Many smokers persist in tobacco use for several years and typically cycle through multiple periods of remission and relapse. Smoking cessation is not a single event but a process, and relapse is an ordinary component of this process. While international guidelines place great emphasis on relapse prevention, very little can be found about managing smokers who have relapsed. This article is intended to address the challenge of managing smokers who relapse in the course of a smoking cessation program. This knowledge may lead to an improved smoking cessation outcomes.

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Stigma as a Barrier to Recovery: Perceived Stigma and Patient-Rated Severity of Illness as Predictors of Antidepressant Drug Adherence

Cited by 684 publications

References 20 publications

Racial Differences in Adherence to Antidepressant Treatment in Later Life

Racial Differences in Adherence to Antidepressant Treatment in Later Life

Cross-sectional population based study ascertaining the characteristics of US rural adults with mental health concerns who perceived a stigma regarding mental health issues

Handling relapse in smoking cessation: strategies and recommendations

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