Garfield, Sara; (2002) Factors affecting patients' decisions about their therapy when beginning courses of treatment for depression. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

The World Health Organisation (2001) has predicted that depressive disorder will be the highest cause of disease in the developed region by 2020. Studies have shown that compliance with antidepressant medication is approximately 50% after 3 months of therapy (Maddox et al. 1994; Lin et al. 1995) whereas it is recommended that medication is taken for at least 4 to 6 months (Paykel and Priest, 1992). Little is known about patients' perspectives of treatment at the initial stages of therapy and the influence of these on decision-making. This thesis presents an in-depth view of patients' decision-making regarding medication at the beginning of treatment for depression in primary care and informs the development of healthcare services in supporting individuals in their decision-making. Preliminary fieldwork involved meeting with local self help groups of national organisations for people with depression. Further to this, patients beginning courses of antidepressant medication were identified through general practice surgeries. A semi-structured interview, based on the combination of a qualitative interview and 3 quantitative instruments, was administered on 2 occasions after commencement of therapy. The qualitative component of the interview was audio taped, transcribed verbatim and coded. With regards to the quantitative data, bivariate analysis was carried out to identify factors which distinguished between those who continued with their mediation and those who discontinued. Out of 171 eligible patients who were invited to participate, 51 completed a first interview and 41 of these subsequently completed a follow-up interview. Twenty two respondents were male and 29 were female. The age of respondents ranged from 19 to 61. The majority reported their ethnic group as White Non Irish. All social classes were represented amongst the respondents. Antidepressant medication which had been prescribed included SSRIs, tricyclics and venlafaxine. Analysis of interview data demonstrated that decision-making about taking antidepressant medication was a complex process. Few factors distinguished between those who continued with their medication and those who discontinued. Respondents identified both positive and negative aspects of taking antidepressant medication. Positive aspects included a return to normal life and functioning whereas negative aspects included stigma, adverse drug reactions and dependency. Respondents assessed their circumstances at a particular point in time and made a decision as to whether or not it would be beneficial to take medication. Decisions about taking antidepressant medication were made alongside consideration of other treatment strategies. The level of personal involvement which respondents wished to have concerning decisions with their medication varied both between respondents and at different points of therapy. Respondents required a large amount of information to support their decision-making, including that concerning adverse drug reactions, process of recovery, dosage and dependency. Current healthcare services did not provide all information needs. Roles were identified for the community pharmacist in order to meet information needs, thereby enabling them to support individuals in maintaining adherence to treatment. This role of maintaining adherence to treatment has been identified for pharmacists in the management of people with mental health problems by the RPSGB (2000). The constraints which need to be overcome in order for pharmacists to fulfill such roles are also reviewed.

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