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Research ArticleOriginal Article

Adherence to Mental Health Treatment in a Primary Care Clinic

Jodi Gonzalez, John W. Williams, Polly Hitchcock Noël and Shuko Lee
The Journal of the American Board of Family Practice March 2005, 18 (2) 87-96; DOI: https://doi.org/10.3122/jabfm.18.2.87
Jodi Gonzalez
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John W. Williams Jr.
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Polly Hitchcock Noël
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Shuko Lee
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    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.]

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    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.

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    Table 2.

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

    Demographic CharacteristicsFrequency (%)
    Gender
        Male88 (92.6)
    Ethnicity/Race
        African American10 (10.5)
        Caucasian47 (49.5)
        Hispanic32 (33.7)
        Other6 (6.3)
    Age
        25 to 342 (2.1)
        35 to 4410 (10.5)
        45 to 5439 (41.1)
        55 to 6423 (24.2)
        65 to 7410 (10.5)
        75–up11 (11.6)
    Marital Status
        Single/divorced/separated/widowed47 (49.5)
        Married48 (50.5)
    Education
        High school or GED35 (36.8)
        Some college38 (40.0)
        Associates degree and above22 (23.2)
    Prior mental health treatment
        Yes45 (47.4)
    • View popup
    Table 3.

    Mental Health Treatment Preferences (N = 95)

    Preference CategoryFrequency (%)
    Preferred Treatment
        Medicine only10 (10.5)
        Counseling/psychotherapy4 (4.2)
        Medicine & psychotherapy19 (20.0)
        Prefer none10 (10.5)
        Don’t know enough to say41 (43.2)
        Don’t have a preference11 (11.6)
    Preferred Provider
        Psychiatrist18 (19.8)
        Psychologist8 (8.8)
        Primary care provider18 (19.8)
        Social worker6 (6.5)
        No preference38 (41.8)
        Other3 (3.3)
    Preferred Provider Characteristics*% Endorsing Preference
        At internal medicine clinic24 (25.3)
        At mental health clinic4 (4.2)
        Male16 (16.8)
        Female14 (14.7)
        Own ethnicity/race8 (8.4)
        Other ethnicity/race2 (2.1)
        None of the preferences endorsed47 (49.5)
    • * More than one characteristic could be endorsed

    • View popup
    Table 4.

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

    VariableShort-Term[No. (%) or Mean (±SD)]PIntermediate[No. (%) or Mean (±SD)]P
    AdherentNonadherentAdherentNonadherent
    Treatment preference.17.004*
        Medicine14 (82)3 (18)15 (88)2 (12)
        Preference for no medicine4 (80)1 (20)2 (40)3 (60)
        No preference specified14 (56)11 (44)10 (40)15 (60)
    Pharmacy.04*.44
        Trouble getting through by phone8 (100)0 (0)6 (75)2 (25)
        No trouble getting through24 (62)15 (38)21 (54)18 (46)
        Travel.04*.01*
        <30 minutes22 (79)6 (21)20 (71)8 (29)
        >30 minutes9 (50)9 (50)6 (33)12 (67)
    Medication Questions
        Advised to take daily23 (61)15 (39).1419 (50)19 (50).21
        Advised 2 to 4 weeks for effect22 (71)9 (29).7118 (58)13 (42).00
        Advised to continue even if better21 (68)10 (32).4616 (52)15 (48).22
        Advised don’t stop without calling12 (57)9 (43).1410 (48)11 (52).16
        Asked about prior experience w/meds14 (78)4 (22).4311 (61)7 (39).47
        Advised to schedule pleasant activities6 (46)7 (54).086 (46)7 (54).59
    Benefits of Treatment38 (±20)39 (±14).8633 (±15)45 (±19).04**
    Mental Health Inventory16 (±4)15 (±4).5316 (±4)15 (±4).27
    • * P < .01

    • ** P < .05

    • χ2 analysis used for categorical variables, logistic regression for continuous variables.

    • View popup
    Table 5.

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

    VariableShort-Term[No. (%) or Mean (SD)]PIntermediate[No. (%) or Mean (SD)]P
    AdherentNonadherentAdherentNonadherent
    Negative effects from prior mental health treatment.14.04*
        None or mild16 (84)3 (16)12 (63)7 (37)
        Moderate or severe5 (56)4 (44)2 (22)7 (78)
    Overall Attitudes40 (±12)51 (±19).03*40 (±12)46 (±18).16
    Readiness for Treatment39 (±14)50 (±23).0539 (±14)45 (±20).20
    Benefits of Treatment36 (±17)54 (±24).01*38 (±17)44 (±24).32
    Participatory decision-making style62 (±25)43 (±30).04*62 (±27)50 (±27).14
    Mental Health Inventory17 (±5)17 (±4).9216 (±4)18 (±4).34
    • * P < .05

    • χ2 analysis used for categorical variables, logistic regression for continuous variables.

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The Journal of the American Board of Family Practice: 18 (2)
The Journal of the American Board of Family Practice
Vol. 18, Issue 2
1 Mar 2005
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Adherence to Mental Health Treatment in a Primary Care Clinic
Jodi Gonzalez, John W. Williams, Polly Hitchcock Noël, Shuko Lee
The Journal of the American Board of Family Practice Mar 2005, 18 (2) 87-96; DOI: 10.3122/jabfm.18.2.87

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Adherence to Mental Health Treatment in a Primary Care Clinic
Jodi Gonzalez, John W. Williams, Polly Hitchcock Noël, Shuko Lee
The Journal of the American Board of Family Practice Mar 2005, 18 (2) 87-96; DOI: 10.3122/jabfm.18.2.87
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