Older primary care patient views regarding antidepressants: A mixed methods approach

Abstract

Background Generally, the efforts to predict antidepressant use from patient demographic factors have not been fruitful. Aim Our objective was to generate hypotheses regarding antidepressant use among older primary care patients. Methods We utilized a mixed methods design that is both hypothesis-testing and hypothesis-generating. Adults aged 65 years and over were recruited from primary care practices and interviewed in their homes. We examined the personal characteristics of older adults according to antidepressant use (hypothesis-testing). Participants taking antidepressants and participants not taking antidepressants were asked open-ended questions about their views on treatment for depression. Themes related to use of antidepressants were examined (hypothesis-generating). Results Older adults taking antidepressants were more likely to be white and have more depression symptoms compared to older adults not taking antidepressants (p < 0.001 and p = 0.004, respectively). Positive and negative themes emerged when participants discussed antidepressant use. We linked quantitative data from the participants with the themes they endorsed to form an emerging theory about older adults’ perceptions about antidepressant use. Conclusion Few personal characteristics were associated with aatidepressant use. An improved understanding of how older adults view antidepressant use, derived from multiple methods, may inform clinical practice.

“You Don't Want to Burden Them”

“…At the same time, recognition of distinct experiences with the health care system across ethnic groups has drawn national attention (Smedley, Stith, & Nelson, 2003). In our work, we acknowledge the importance of individual differences by employing methods that allow respondents to tell us, in their own words, how they view health and health care (Barg et al, 2006; Bogner, Cahill, Frauenhoffer, & Barg, 2009; Gallo, Bogner, Morales, & Ford, 2005; Wittink, Barg, & Gallo, 2006). Consistent with current publications of the National Institutes of Health, (Office of Research on Women's Health, 2000), we use the term Black to include individuals of African, African American, and African Caribbean descent and White to include individuals of European descent.…”

Cognitive behavioural therapy for older adults with depression: a review

“…The World Health Organization (2011) has recommended that if antidepressant treatment is required for older people, tricyclic antidepressants (TCA) should be avoided if possible. Therefore, older people, despite taking medication, continue to experience symptoms and/or disabling adverse effects (Bogner et al, 2009;Candy et al, 2008;Mottram et al, 2006). There is thus a growing need to consider alternative forms of treatment for depression.…”

“…Since the early 1980s, several well-controlled clinical trials have demonstrated that depression in older adults can be treated with psychotherapy, either alone or in combination with antidepressant medication. Several psychological therapies have been studied, but the cognitive-behavioural therapy (CBT) has been most widely investigated in this population (Bogner et al, 2009;Candy et al, 2008;Mottram et al, 2006). CBT, a form of psychotherapy, is regarded as a non-pharmacological intervention that can provide depressed individuals with the skills with which to manage their own illness (Bogner et al, 2009;Lockwood et al, 2004;Ridgway & Williams, 2011).…”

“…Several psychological therapies have been studied, but the cognitive-behavioural therapy (CBT) has been most widely investigated in this population (Bogner et al, 2009;Candy et al, 2008;Mottram et al, 2006). CBT, a form of psychotherapy, is regarded as a non-pharmacological intervention that can provide depressed individuals with the skills with which to manage their own illness (Bogner et al, 2009;Lockwood et al, 2004;Ridgway & Williams, 2011). CBT has no known adverse side effects, unlike antidepressant medications and, has the potential to go on assisting the individual long after the symptoms subside and the therapy ceases.…”

Patient ethnicity and perceptions of families and friends regarding depression treatment

“…Differences in identification and management of depression according to ethnicity have been found to be related to both patient and provider factors (Das et al 2006). Important barriers to mental health care for black patients include perceptions of stigma, beliefs that life experiences are the cause of depression, that problems should not be discussed outside one’s family, mistrust of health care professionals, and concerns about the effects of psychotropic medication (Millet et al 1996, Cooper-Patrick et al 1997, Alvidrez 1999, Bogner et al in press). Black patients may be more likely to exhibit somatic symptoms of depression, which may complicate detection and diagnosis (Fabrega et al 1988, Bogner et al 2005).…”