Adherence to Mental Health Treatment in a Primary Care Clinic

Article Figures & Data

Download figure
Open in new tab
Figure 1.
The health decision model, combining the health belief model and patient preferences, including decision analysis and behavioral decision therapy. [Reprinted from Eraker SA, Kirscht JP, Becker MH. Understanding and improving patient compliance. Ann Intern Med 1984;100:258–68. Copyright © 1984 by the American College of Physicians. Used with permission.]

Table 1.

Factor Items for Three Scales Measuring Attitudes toward Mental Health Treatment (N = 95)

Factors (Chronbach’s Coefficient α)
Benefits of treatment (0.79)
The doctor expressed confidence about the psychiatric medicine/referral^* to me.
Psychiatric medicine/mental health treatment will fix my particular problems.
I understand why psychiatric medicine was prescribed to me/I was referred for mental health treatment.
My doctor told me that the medicine/referral was important to my treatment.
Risks of treatment (0.74)
I am concerned about possible side effects from psychiatric medicine.
I am concerned about becoming addicted to psychiatric medicine.
I would be uncomfortable or embarrassed if others knew I was taking psychiatric medicine/in psychotherapy.
I have a good understanding of how medicine/psychotherapy is supposed to improve psychiatric problems.
I have heard that psychiatric medicine/psychotherapy is helpful.
Readiness for treatment (0.58)
Do you agree with your doctor that you need medicine/mental health treatment for these problems?
I do not have a mental health problem.
I feel poorly, but am not motivated to start treatment right now.
I feel ready to take medication or begin psychotherapy.
Overall attitudes score (3 factors) Chronbach’s Coefficient α = 0.76

* Italics indicate that the wording of the question differed based on treatment group.

Table 2.

Respondent Demographics from a Veterans Health Administration Internal Medicine Clinic (N = 95)

Demographic Characteristics	Frequency (%)
Gender
Male	88 (92.6)
Ethnicity/Race
African American	10 (10.5)
Caucasian	47 (49.5)
Hispanic	32 (33.7)
Other	6 (6.3)
Age
25 to 34	2 (2.1)
35 to 44	10 (10.5)
45 to 54	39 (41.1)
55 to 64	23 (24.2)
65 to 74	10 (10.5)
75–up	11 (11.6)
Marital Status
Single/divorced/separated/widowed	47 (49.5)
Married	48 (50.5)
Education
High school or GED	35 (36.8)
Some college	38 (40.0)
Associates degree and above	22 (23.2)
Prior mental health treatment
Yes	45 (47.4)

Table 3.

Mental Health Treatment Preferences (N = 95)

Preference Category	Frequency (%)
Preferred Treatment
Medicine only	10 (10.5)
Counseling/psychotherapy	4 (4.2)
Medicine & psychotherapy	19 (20.0)
Prefer none	10 (10.5)
Don’t know enough to say	41 (43.2)
Don’t have a preference	11 (11.6)
Preferred Provider
Psychiatrist	18 (19.8)
Psychologist	8 (8.8)
Primary care provider	18 (19.8)
Social worker	6 (6.5)
No preference	38 (41.8)
Other	3 (3.3)
Preferred Provider Characteristics^*	% Endorsing Preference
At internal medicine clinic	24 (25.3)
At mental health clinic	4 (4.2)
Male	16 (16.8)
Female	14 (14.7)
Own ethnicity/race	8 (8.4)
Other ethnicity/race	2 (2.1)
None of the preferences endorsed	47 (49.5)

Table 4.

Short-Term and Intermediate Adherence to an Antidepressant Prescription (n = 47) among Veterans

Variable	Short-Term[No. (%) or Mean (±SD)]		P	Intermediate[No. (%) or Mean (±SD)]		P
Variable	Adherent	Nonadherent	P	Adherent	Nonadherent	P
Treatment preference			.17			.004^*
Medicine	14 (82)	3 (18)		15 (88)	2 (12)
Preference for no medicine	4 (80)	1 (20)		2 (40)	3 (60)
No preference specified	14 (56)	11 (44)		10 (40)	15 (60)
Pharmacy			.04^*			.44
Trouble getting through by phone	8 (100)	0 (0)		6 (75)	2 (25)
No trouble getting through	24 (62)	15 (38)		21 (54)	18 (46)
Travel			.04^*			.01^*
<30 minutes	22 (79)	6 (21)		20 (71)	8 (29)
>30 minutes	9 (50)	9 (50)		6 (33)	12 (67)
Medication Questions
Advised to take daily	23 (61)	15 (39)	.14	19 (50)	19 (50)	.21
Advised 2 to 4 weeks for effect	22 (71)	9 (29)	.71	18 (58)	13 (42)	.00
Advised to continue even if better	21 (68)	10 (32)	.46	16 (52)	15 (48)	.22
Advised don’t stop without calling	12 (57)	9 (43)	.14	10 (48)	11 (52)	.16
Asked about prior experience w/meds	14 (78)	4 (22)	.43	11 (61)	7 (39)	.47
Advised to schedule pleasant activities	6 (46)	7 (54)	.08	6 (46)	7 (54)	.59
Benefits of Treatment	38 (±20)	39 (±14)	.86	33 (±15)	45 (±19)	.04^**
Mental Health Inventory	16 (±4)	15 (±4)	.53	16 (±4)	15 (±4)	.27

* P < .01
** P < .05
χ² analysis used for categorical variables, logistic regression for continuous variables.

Table 5.

Term and Intermediate Adherence to a Mental Health Referral (n = 48) among Veterans

Variable	Short-Term[No. (%) or Mean (SD)]		P	Intermediate[No. (%) or Mean (SD)]		P
Variable	Adherent	Nonadherent	P	Adherent	Nonadherent	P
Negative effects from prior mental health treatment			.14			.04^*
None or mild	16 (84)	3 (16)		12 (63)	7 (37)
Moderate or severe	5 (56)	4 (44)		2 (22)	7 (78)
Overall Attitudes	40 (±12)	51 (±19)	.03^*	40 (±12)	46 (±18)	.16
Readiness for Treatment	39 (±14)	50 (±23)	.05	39 (±14)	45 (±20)	.20
Benefits of Treatment	36 (±17)	54 (±24)	.01^*	38 (±17)	44 (±24)	.32
Participatory decision-making style	62 (±25)	43 (±30)	.04^*	62 (±27)	50 (±27)	.14
Mental Health Inventory	17 (±5)	17 (±4)	.92	16 (±4)	18 (±4)	.34