Original Paper
DOI: 10.5455/jmood.20161123023646
Relationship Between Depression Literacy and Medication Adherence in Patients with Depression Dushad Ram1, Neetu Benny2, Basavana Gowdappa3
ABSTRACT:
Relationship between depression literacy and medication adherence in patients with depression Objective: To find out the relationship between depression literacy and adherence to medications in subjects with major depressive disorder in remission. Methods: In this cross-sectional hospital-based study, 130 subjects with major depressive disorder were assessed by using socio-demographic data form and clinical proforma designed for this study, Depression Literacy Questionnaire and Medication Adherence Rating Scale. Results: Median scores on D-Lit and MARS were 13.2 and 0.00 respectively. Two patterns of common incorrect responses were regarding the cognitive and treatment aspect of depression. Female gender had statistically significant higher D-Lit score (p=0.025) than male, and Score on D-Lit had statistically significant negative predictive value of score on MARS (R2=0.059, df=5, F=1.55, p=0.020). Conclusion: Cognitive and treatment aspect of depression literacy is lower in patients with depression in India. Depression literacy is more in women and positively associated with medication adherence.
1 Department of Psychiatry, JSS Medical College, Mysore 2 Department of Clinical Pharmacy, JSS Medical Pharmacy College, Mysore 3 Department of Medicine, JSS Medical College, Mysore
Corresponding Author: Dushad Ram, Department of Psychiatry, JSS Medical College, Mysore E-mail address:
[email protected]
Keywords: health literacy, medication adherence, depression
Date of received: September 21, 2016
Journal of Mood Disorders (JMOOD) 2016;6(4):183-8
Date of acceptance: November 23, 2016 Declaration of interest: D.R., N.B., B.G.: The authors reported no conflict of interest related to this article.
INTRODUCTION
medication (5). Poor knowledge about depression may
Depression is a common mental disorder characterized
mediate non-adherence in depression (6). Depression is still not well-understood by health
by sadness, loss of interest or pleasure, feelings of guilt or
professionals, patients, and the public in general
low self-esteem, disturbed sleep or appetite, fatigability,
particularly with regards to etiology, signs and symptoms,
and poor concentration. The World Health Organization
and treatment of depression (7). Thus large proportions of
(WHO) has predicted that major depressive disorder (MDD)
patients with depression may not seek help, may not know
will be second only to ischemic heart disease as a cause of
where to seek help, may have negative attitudes to
disability by the year 2020, and is projected to become the
treatments, or may be fearful of being stigmatized if they
foremost contributor to disease in high income countries by
seek help (7).
2030 (1,2) . It is a leading cause of disability worldwide, and
prevalence in India is 35.9 percent (3). More than half of the
literacy and is defined as the ability to recognize depression
patients with depression do not seek help (4). Among those
and make informed decisions about treatment (8).
who seek treatment, up to 66% will be non-adherent to the
Published literature indicates poor depression literacy
Journal of Mood Disorders Volume: 6, Number: 4, 2016 - www.jmood.org
Depression literacy is a specific type of mental health
183
Relationship between depression literacy and medication adherence in patients with depression
among patients and general population which has a bearing
Any subject who participated in any depression related
on help-seeking behavior (7,9). Treatment or need for
research was excluded from this study. Selected participants
treatment of depression may be under-recognized due to
were further assessed with;
poor depression literacy.
Antidepressants are the major treatment option for
Socio-demographic data and clinical proforma: The
depression. Medication adherence is an important
proforma included socio demographic variables such as
predictor of illness course and therapeutic outcome in
age, gender, occupation, marital status, residence, family
psychiatric illnesses. Adherence to treatment may be
type, socioeconomic status, religion, history of mental
related to knowledge of depression (6). Medication
illness in their family.
adherence usually refers to whether patients take their Depression Literacy Questionnaire: In this study, we
medications as prescribed as well as whether they continue
to take prescribed medications till the course of therapy
have used Depression Literacy Questionnaire, a self-report
ends. Non-adherence to medications is a major barrier for
measure to evaluate literacy of depression in patients (14).
the recovery of depression (10). There is paucity of literature
The questionnaire comprises of 22 questions. It was
that specifically assesses the relationship of depression
translated in different languages and widely used.
literacy and medication adherence. Few attempts have
Chronbach’s alpha coefficient varies from 0.70–0.78, while
been made to address awareness of depression among
test-retest reliability (rr) ranges from 0.7 to 0.91.
students in India, but major limitation being use of Medication Adherence Rating Scale: It measures the
un-standardized tools. One report reveals that only 13.1%
graduate student identified depression, while in other
patient’s attitude in taking medication (15). MARS
reports it increased up to 29.04 percent (11,12). Nigam et al.
comprises of 10 questions related to the administration of
(2013) reported a highest of 45.6% of students who could
medications and attitude towards the medicines. For each
identify symptoms of depression (13).
question, score ranges from 0–1. Higher total score indicate
lower adherence.
In this study, we examined the relationship between
depression literacy and its effect on patient’s adherence to medications, with a hypothesis that depression literacy and
medication adherence are positively associated. In this
Windows. Descriptive statistics were used to express socio-
study, evaluating the relationship between depression
demographic and clinical characteristic. The distribution
literacy and medication adherence, we have used
and normality of the sample was assessed with the
medication adherence rating scale to check the medication
Kolmogorov-Smirnov and the Shapiro-Wilk test and was
compliance and depression literacy questionnaire to assess
found to be significantly skewed. Since analysis required
depression literacy.
comparison of more than two variables, Kruskal-Wallis H
METHODS
The data were analyzed using SPSS Version 16 for
test was used to know the group difference of sociodemographic and clinical variables on the score of different scales and a post-hoc analysis was done (for comparison of
This single centre, hospital-based cross-sectional study
≥ 3 groups). A linear regression analysis was conducted to
was conducted at an outpatient psychiatry department of
know if patients who score on measure of depression
tertiary care centre in the South India. Over a period of
literacy can predict the values of scores on measure of
three months, 142 consecutive patients who came for
medication adherence. The level of statistical significance
follow-up were screened and 130 met study selection
was kept at p