FACTORS IMPACTING DECISIONS TO DECLINE OR ADHERE TO ANTIDEPRESSANT MEDICATION IN PERINATAL WOMEN WITH MOOD AND ANXIETY DISORDERS

Authors

  • Shaila Misri M.D., F.R.C.P.C.,

    Corresponding author
    1. Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
    2. Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
    3. Reproductive Mental Health Program, BC Women's Hospital, Vancouver, British Columbia, Canada
    • Correspondence to: Shaila Misri, Reproductive Mental Health Program, BC Women's Hospital, P1-233, 4500 Oak Street, Vancouver, British Columbia, Canada V6H 3N1. E-mail: smisri@cw.bc.ca

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  • Andrea B. Eng B.Sc.,

    1. Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
    2. Reproductive Mental Health Program, BC Women's Hospital, Vancouver, British Columbia, Canada
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  • Jasmin Abizadeh B.A.,

    1. Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
    2. Reproductive Mental Health Program, BC Women's Hospital, Vancouver, British Columbia, Canada
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  • Ekin Blackwell Ph.D.,

    1. Chronic Pain Center, St. Paul's Hospital, Vancouver, British Columbia, Canada
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  • Alicia Spidel M.A.,

    1. Department of Psychology, University de Montreal, Quebec, Canada
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  • Tim F. Oberlander M.D., F.R.C.P.C.

    1. Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
    2. Community Child and Family Research Institute, Vancouver, British Columbia, Canada
    3. Children's and Women's Health Center of BC, Vancouver, British Columbia, Canada
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Abstract

Purpose

To identify specific quantitative and qualitative factors that govern the decision to adhere or decline antidepressant medication in antenatal women with moderate-to-severe mood and anxiety disorders.

Methods

Fifty women (30 adherers, 20 decliners) were recruited between 18 and 34 weeks gestation in a tertiary care clinic for perinatal mothers. They were prospectively monitored 4 weeks apart up to 1-month postpartum on the: Hamilton Anxiety Scale, Hamilton Depression Scale, Mood Disorders Insight Scale, Antidepressant Compliance Questionnaire, Penn State Worry Questionnaire, and NEO Personality Inventory. Qualitative interviews were conducted at baseline. Hierarchical linear modeling determined illness trajectories of the two groups.

Results

Significantly different course of illness was observed in adherers versus decliners. Adherers had healthier attitudes toward depression and compliance with medication (P < .005). Decliners had less illness insight (P < .001) and cited fear of fetal exposure, and thought medication was unwarranted.

Conclusions

Pregnant women experienced significantly divergent illness trajectories depending on if they accepted antidepressant medication therapy for their illness. Risk perception, attitudes, and illness insight impacted decisions surrounding adherence and decline.

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