The association between race and gender, treatment attitudes, and antidepressant treatment adherence

Authors

  • Inger Burnett-Zeigler,

    Corresponding author
    1. Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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  • H. Myra Kim,

    1. Department of Veterans Affairs, HSR&D Center for Clinical Care Management, and Serious Mental Illness Treatment, Resource and Evaluation Center (SMITREC), Ann Arbor, MI, USA
    2. Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, USA
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  • Claire Chiang,

    1. Department of Veterans Affairs, HSR&D Center for Clinical Care Management, and Serious Mental Illness Treatment, Resource and Evaluation Center (SMITREC), Ann Arbor, MI, USA
    2. Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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  • Janet Kavanagh,

    1. Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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  • Kara Zivin,

    1. Department of Veterans Affairs, HSR&D Center for Clinical Care Management, and Serious Mental Illness Treatment, Resource and Evaluation Center (SMITREC), Ann Arbor, MI, USA
    2. Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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  • Katherin Rockefeller,

    1. Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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  • Jo Anne Sirey,

    1. Weill Cornell Medical College, Department of Psychiatry, White Plains, NY, USA
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  • Helen C. Kales

    1. Department of Veterans Affairs, HSR&D Center for Clinical Care Management, and Serious Mental Illness Treatment, Resource and Evaluation Center (SMITREC), Ann Arbor, MI, USA
    2. Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Abstract

Objectives

We examined the associations between treatment attitudes and beliefs with race–gender differences in antidepressant adherence.

Methods

Subjects (n = 186) were African-American and White subjects aged ≥60 years, diagnosed with clinically significant depression, and had a new outpatient primary care recommendation for antidepressant treatment. Antidepressant adherence was assessed using the Brief Medication Questionnaire. Attitudes and beliefs were assessed using the Patients Attitudes Toward and Ratings of Care for Depression, two items rating perceived medication importance, and a modified version of the Stigma Scale for Receiving Psychological Help.

Results

African-American men and women had significantly greater concerns about antidepressants and significantly less understanding about treatment than White women. African-American men had significantly more negative attitudes toward healthcare providers than African-American and White women. African-American women were more likely than White men and women to endorse a medication other than their antidepressant as most important. Whereas some race–gender differences were found in personal spirituality, no group differences were found in perceived stigma. In a logistic regression model adjusted for key baseline variables, White women were significantly more adherent to antidepressants than African-American women (OR = 3.05, 95% CI = 1.06–8.81). Fewer concerns about antidepressants and indicating the antidepressant as the most important medication were both significantly associated with adherence. After including either of these two variables, the adherence difference between White women and African-American women was no longer significant (OR = 2.56, 95% CI = 0.84–7.80).

Conclusions

Concerns about antidepressants and the importance of antidepressant medication are associated with adherence and are potentially modifiable through improved patient–provider communication, psycho-education, and therapeutic interventions. Copyright © 2013 John Wiley & Sons, Ltd.

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