title: Factors impacting decisions to decline or adhere to antidepressant medication in perinatal women with mood and anxiety disorders.
abstract: OBJECTIVE
  To identify specific quantitative and qualitative factors that govern the decision to adhere or decline antidepressant medication in antenatal women with moderate-to-severe mood and anxiety disorders.
  
  
  METHODS
  Fifty women (30 adherers, 20 decliners) were recruited between 18 and 34 weeks gestation in a tertiary care clinic for perinatal mothers. They were prospectively monitored 4 weeks apart up to 1-month postpartum on the: Hamilton Anxiety Scale, Hamilton Depression Scale, Mood Disorders Insight Scale, Antidepressant Compliance Questionnaire, Penn State Worry Questionnaire, and NEO Personality Inventory. Qualitative interviews were conducted at baseline. Hierarchical linear modeling determined illness trajectories of the two groups.
  
  
  RESULTS
  Significantly different course of illness was observed in adherers versus decliners. Adherers had healthier attitudes toward depression and compliance with medication (P < .005). Decliners had less illness insight (P < .001) and cited fear of fetal exposure, and thought medication was unwarranted.
  
  
  CONCLUSIONS
  Pregnant women experienced significantly divergent illness trajectories depending on if they accepted antidepressant medication therapy for their illness. Risk perception, attitudes, and illness insight impacted decisions surrounding adherence and decline.
authors.affiliation: Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada; Reproductive Mental Health Program, BC Women's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Shaila
authors.initials: S
authors.lastname: Misri
authors.forename: Andrea B
authors.initials: AB
authors.lastname: Eng
authors.forename: Jasmin
authors.initials: J
authors.lastname: Abizadeh
authors.forename: Ekin
authors.initials: E
authors.lastname: Blackwell
authors.forename: Alicia
authors.initials: A
authors.lastname: Spidel
authors.forename: Tim F
authors.initials: TF
authors.lastname: Oberlander
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000188:drug therapy / Q000523:psychology*; D003866:Depressive Disorder / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D006801:Humans; D010349:Patient Compliance / Q000523:psychology*; D049590:Postpartum Period / Q000187:drug effects / Q000523:psychology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy / Q000523:psychology*; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents
keywords: adherence; antidepressants; anxiety/anxiety disorders; depression; maternal-child; mood disorders; pregnancy and postpartum; treatment resistance