title: Adherence to mental health treatment in a primary care clinic.
abstract: BACKGROUND
  Patient nonadherence is common for the standard mental health treatments in primary care: antidepressants and referrals to specialty mental health treatment. This is one of few studies to prospectively identify predictors of nonadherence.
  
  
  METHODS
  We observed 95 veterans attending an internal medicine clinic prescribed antidepressant medication or referred to mental health treatment. We collected information on sociodemographic factors, health beliefs, preferences about treatment, past experiences, and treatment knowledge.
  
  
  RESULTS
  At 1 month, medication adherence was greater when patients experienced previous pharmacy trouble and traveled for less than 30 minutes to reach the clinic. Appointment attendance improved when patients were ready for treatment, perceived benefits, and saw their physician as collaborative. At 6 months, medication adherence was greater when patients reported a preference for medicine treatment, traveled for less than 30 minutes, and perceived greater benefits. Fewer negative effects from previous mental health treatment improved adherence to appointments. In multivariate analyses examining adherence to all treatments, greater readiness for treatment predicted 1-month adherence, whereas being unmarried and seeing the physician as more collaborative improved 6-month adherence.
  
  
  CONCLUSIONS
  Adherence to antidepressant medications and to mental health referrals should be examined separately. A brief initial assessment for nonadherence risk factors may identify persons for targeted adherence promoting interventions.
authors.affiliation: VERDICT Center of Excellence, University of Texas Health Science Center at San Antonio, TX 78229-3900, USA. gonzalezjm1@uthscsa.edu
authors.forename: Jodi
authors.initials: J
authors.lastname: Gonzalez
authors.forename: John W
authors.initials: JW
authors.lastname: Williams
authors.forename: Polly Hitchcock
authors.initials: PH
authors.lastname: Noël
authors.forename: Shuko
authors.initials: S
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D037001:Directive Counseling / Q000592:standards*; D005260:Female; D006778:Hospitals, Psychiatric; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000592:standards*; D011446:Prospective Studies; D011787:Quality of Health Care / Q000592:standards; D012017:Referral and Consultation / Q000592:standards; D011795:Surveys and Questionnaires; D014481:United States