Enhancing adherence to prevent depression relapse in primary care

Lin, Elizabeth H.B; Von Korff, Michael; Ludman, Evette J; Rutter, Carolyn; Bush, Terry M; Simon, Gregory E; Unützer, Jürgen; Walker, Edward; Katon, Wayne J

doi:10.1016/S0163-8343(03)00074-4

Next »General Hospital Psychiatry
Volume 25, Issue 5 , Pages 303-310, September 2003

Enhancing adherence to prevent depression relapse in primary care

Elizabeth H.B Lin, M.D., M.P.H.
- Center for Health Studies, Group Health Cooperative, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Corresponding author. Tel.: +1-206-287-4264; fax: +1-206-287-2871.
Michael Von Korff, Sc.D.
- Center for Health Studies, Group Health Cooperative, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
Evette J Ludman, Ph.D.
- Center for Health Studies, Group Health Cooperative, Seattle, WA, USA
Carolyn Rutter, Ph.D.
- Center for Health Studies, Group Health Cooperative, Seattle, WA, USA
Terry M Bush, Ph.D.
- Center for Health Studies, Group Health Cooperative, Seattle, WA, USA
Gregory E Simon, M.D., M.P.H.
- Center for Health Studies, Group Health Cooperative, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
Jürgen Unützer, M.D., M.P.H.
- University of California, Los Angeles Neuropsychiatric Institute, Los Angeles, CA, USA
Edward Walker, M.D., M.P.H.
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
Wayne J Katon, M.D.
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA

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.

Keywords: Adherence, Antidepressant medication, Depression, Relapse prevention, Primary care