title: Enhancing adherence to prevent depression relapse in primary care.
abstract: We performed a randomized trial to prevent depression relapse in primary care by evaluating intervention effects on medication attitudes and self-management of depression. Three hundred and eighty six primary care patients at high risk for recurrent depression were randomized to receive a 12-month intervention. Interviews at baseline, 3, 6, 9, and 12-months assessed attitudes about medication, confidence in managing side effects, and depression self-management. This depression relapse prevention program significantly increased: 1) favorable attitudes toward antidepressant medication [Beta =.26, 95% C.I. = (.18,.33)]; 2) self-confidence in managing medication side effects [Beta =.53, 95% C.I. = (.15,.91)]; 3) depressive symptom monitoring [O.R. = 4.08, 95% C.I. = (2.80, 5.94)]; 4) checking for early warning signs [O.R. = 3.27, 95% C.I. = (2.32, 4.61)]; and, 5) planful coping [O.R. = 2.01, 95% C.I. = (1.49, 2.72)]. Significant predictors of adherence to long-term pharmacotherapy were: favorable attitudes toward antidepressant treatment [OR = 2.20, 95% CI = (1.50, 3.22)], and increased confidence in managing medication side effects [OR = 1.10, 95% CI = (1.04, 1.68)]. Among primary care patients at high risk for depression relapse, enhanced attitudes towards antidepressant medicines and higher confidence in managing side effects were key factors associated with greater adherence to maintenance pharmacotherapy.
authors.affiliation: Center for Health Studies, Group Health Cooperative, Seattle, WA, USA. lin.e@ghc.org
authors.forename: Elizabeth H B
authors.initials: EH
authors.lastname: Lin
authors.forename: Michael
authors.initials: M
authors.lastname: Von Korff
authors.forename: Evette J
authors.initials: EJ
authors.lastname: Ludman
authors.forename: Carolyn
authors.initials: C
authors.lastname: Rutter
authors.forename: Terry M
authors.initials: TM
authors.lastname: Bush
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Simon
authors.forename: Jürgen
authors.initials: J
authors.lastname: Unützer
authors.forename: Edward
authors.initials: E
authors.lastname: Walker
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Katon
mesh_terms: D000223:Adaptation, Psychological; D000928:Antidepressive Agents / Q000627:therapeutic use; D001294:Attitude to Health; D003863:Depression / Q000175:diagnosis / Q000517:prevention & control*; D004311:Double-Blind Method; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011314:Preventive Health Services / Q000592:standards*; D011320:Primary Health Care; D012307:Risk Factors; D055502:Secondary Prevention; D012648:Self Care; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D000928:Antidepressive Agents; D005473:Fluoxetine