Relationship Between Depression Literacy and

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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