Department of Old Age Psychiatry, Institute of Psychiatry, King's College London, UK.
Int Psychogeriatr. 2012 Jan;24(1):159-69. doi: 10.1017/S1041610211001049. Epub 2011 Jun 28.
Adherence to treatment is a complex and poorly understood phenomenon. This study investigates the relationship between older depressed patients' adherence to antidepressants and their beliefs about and knowledge of the medication.
Assessment was undertaken of 108 outpatients over the age of 55 years diagnosed with depressive disorder and treated for at least four weeks with antidepressants. Adherence was assessed using two self-report measures: the Medication Adherence Rating Scale (MARS) and a Global Adherence Measure (GAM). Potential predictors of adherence investigated included sociodemographic, medication and illness variables. In addition, 33 carers were interviewed regarding general medication beliefs.
56% of patients reported 80% or higher adherence on the GAM. Sociodemographic variables were not associated with adherence on the MARS. Specific beliefs about medicines, such as "my health depends on antidepressants" (necessity) and being less worried about becoming dependant on antidepressants (concern) were highly correlated with adherence. General beliefs about medicines causing harm or being overprescribed, experiencing medication side-effects and severity of depression also correlated with poor adherence. Linear regression with the MARS as the dependent variable explained 44.3% of the variance and showed adherence to be higher in subjects with healthy specific beliefs who received more information about antidepressants and worse with depression severity and autonomic side-effects.
Our findings strongly support a role for specific beliefs about medicines in adherence. Challenging patients' beliefs, providing information about treatment and discussing side-effects could improve adherence. Poor response to treatment and medication side-effects can indicate poor adherence and should be considered before switching medications.
治疗依从性是一种复杂且尚未被充分理解的现象。本研究旨在调查老年抑郁患者对药物的信念和认识与其对抗抑郁药物的依从性之间的关系。
评估了 108 名年龄在 55 岁以上、被诊断为抑郁症且至少接受四周抗抑郁药物治疗的门诊患者。使用两种自我报告的测量方法评估了依从性：用药依从性评定量表（MARS）和总体用药依从性量表（GAM）。调查了可能影响依从性的社会人口统计学、药物和疾病变量。此外，还对 33 名照顾者进行了有关一般药物信念的访谈。
56%的患者在 GAM 上报告了 80%或更高的依从性。社会人口统计学变量与 MARS 上的依从性无关。对药物的具体信念，如“我的健康依赖于抗抑郁药”（必要性）和减少对抗抑郁药产生依赖的担忧（关注），与依从性高度相关。对药物会造成伤害或过度处方、出现药物副作用和抑郁严重程度的一般信念也与较差的依从性相关。以 MARS 为因变量的线性回归解释了 44.3%的方差，表明具有健康特定信念的受试者依从性更高，接受了更多关于抗抑郁药物的信息，而抑郁严重程度和自主副作用则使依从性变差。
我们的研究结果强烈支持了药物特定信念在依从性中的作用。挑战患者的信念，提供有关治疗的信息，并讨论副作用，可以提高依从性。治疗反应差和药物副作用可能表明依从性差，在更换药物之前应考虑这一点。
