Taking the edge off: why patients choose St. John's Wort.
BACKGROUND
The number of visits to alternative medicine practitioners in this country is estimated at 425 million, which is more than the number of visits to allopathic primary care physicians in 1990. Patients' use of St. John's Wort (SJW) has followed this sweeping trend. The purpose of our study was to examine the reasons people choose to self-medicate with SJW instead of seeking care from a conventional health care provider.


METHODS
We used open-ended interviews with key questions to elicit information. Twenty-two current users of SJW (21 women; 20 white; mean age = 45 years) in a Southern city participated. All interviews were transcribed, and descriptive participant quotes were extracted by a research assistant. Quotes were reviewed for each key question for similarities and contextual themes.


RESULTS
Four dominant decision-making themes were consistently noted. These were: (1) Personal Health Care Values: subjects had a history of alternative medicine use and a belief in the need for personal control of health; (2) Mood: all SJW users reported a depressed mood and occasionally irritability, cognitive difficulties, social isolation, and hormonal mood changes; (3) Perceptions of Seriousness of Disease and Risks of Treatment: SJW users reported the self-diagnosis of "minor" depression, high risks of prescription drugs, and a perception of safety with herbal remedies; and (4) Accessibility Issues: subjects had barriers to and lack of knowledge of traditional health care providers and awareness of the ease of use and popularity of SJW. Also of note was the fact that some SJW users did not inform their primary care providers that they were taking the herb (6 of 22). Users reported moderate effectiveness and few side effects of SJW.


CONCLUSIONS
SJW users report depression, ease of access to alternative medicines, and a history of exposure to and belief in the safety of herbal remedies. Users saw little benefit to providing information about SJW to primary care physicians.
Wagner
P J
PJ
Department of Family Medicine, Medical College of Georgia, Augusta 30912-3500, USA. pwagner@mail.mcg.edu
Jester
D
D
LeClair
B
B
Taylor
A T
AT
Woodward
L
L
Lambert
J
J
D000328:Adult; D000339:Affect; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001294:Attitude to Health; D002755:Choice Behavior; D000529:Complementary Therapies; D003863:Depression / Q000188:drug therapy* / Q000523:psychology; D020448:Ericales / Q000627:therapeutic use*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D008517:Phytotherapy; D010946:Plants, Medicinal / Q000627:therapeutic use*; D012307:Risk Factors; D012651:Self Medication / Q000523:psychology*; D015144:Southeastern United States
D000928:Antidepressive Agents