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The Journal of the American Board of Family Practice 18:87-96 (2005)
© 2005 American Board of Family Practice

Adherence to Mental Health Treatment in a Primary Care Clinic

Jodi Gonzalez, PhD, John W. Williams, Jr., MD, MHSc, Polly Hitchcock Noël, PhD and Shuko Lee, MS

VERDICT Center of Excellence (PHN, SL), University of Texas Health Science Center at San Antonio
South Texas Veterans Health Care System (JG), University of Texas Health Science Center at San Antonio
Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center and Duke University School of Medicine, Durham, NC (JWW)

Correspondence: Address correspondence to Jodi Gonzalez, Dept. of Psychiatry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900 (e-mail: gonzalezjm1{at}uthscsa.edu)

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.


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Copyright © 2005 by the American Board of Family Medicine.