Use of Complementary and Alternative Medicine Among Women With ...

6 downloads 88 Views 233KB Size Report
Complementary and Alternative Medicine, Columbia University, New York City. ... and alternative medicine in general included being employed, being sin-.
Use of Complementary and Alternative Medicine Among Women With Depression: Results of a National Survey Ping Wu, Ph.D. Cordelia Fuller, M.A. Xinhua Liu, Ph.D. Hsin-Chien Lee, M.D., M.P.H. Bin Fan, M.D. Christina W. Hoven, Dr.P.H. Donald Mandell, Ph.D. Christine Wade, M.P.H. Fredi Kronenberg, Ph.D.

Objective: This study examined patterns of and reasons for use of complementary and alternative therapies among women with depression, focusing in particular on three popular types of complementary and alternative therapies—manual therapies (for example, chiropractic treatments, massage, and acupressure), herbs, and vitamins. Methods: The multiethnic sample consisted of 220 women with depression who were assessed as part of a nationally representative telephone survey of 3,068 women. Results: Fifty-four percent of these women with depression reported past-year use of complementary and alternative medicine. African-American women were less likely to use complementary and alternative therapies in general, compared with non-Hispanic white women. Other factors significantly associated with use of complementary and alternative medicine in general included being employed, being single, and having self-perceived poor health. The relationships between the sociodemographic factors and use of each of the three individually examined types of therapies differed from their relationships with use of complementary and alternative medicine in general. Participants’ most commonly cited reasons for use of these therapies were wanting treatments to be based on a “natural approach,” wanting treatments to be congruent with their own values and beliefs, and past experiences in which conventional medical therapies had caused unpleasant side effects or had seemed ineffective. Conclusions: It is important for mental health and other health professionals to increase their own awareness of the types of complementary and alternative therapies that their patients may be using and to improve communication with their patients about the benefits and potential risks of these therapies. (Psychiatric Services 58:349–356, 2007) Dr. Wu and Ms. Fuller are affiliated with the Department of Psychiatry, Columbia University, 1051 Riverside Dr., Unit 43, New York, NY 10032 (e-mail: [email protected]). Dr. Wu and Dr. Hoven are with the Department of Epidemiology and Dr. Liu is with the Department of Biostatistics, Columbia University. Dr. Lee is with the Department of Psychiatry, Taipei University Hospital, Taipei, Taiwan, and with the Department of Psychiatry, School of Medicine, Taipei Medical University. Dr. Fan, Dr. Hoven, and Dr. Mandell are with the Department of Child Psychiatry, New York State Psychiatric Institute, New York City. Ms. Wade and Dr. Kronenberg are with the Rosenthal Center for Complementary and Alternative Medicine, Columbia University, New York City.

PSYCHIATRIC SERVICES

♦ ps.psychiatryonline.org ♦ March 2007 Vol. 58 No. 3

D

epression is one of the most prevalent mental disorders in the general population, and it is especially prevalent among women (1–7). Depression is also often comorbid with many other psychiatric and physical illnesses (2,5,6,8). Previous studies have shown that depression tends to be seriously undertreated, although effective treatments have been available for decades (9). Results from the National Comorbidity Survey Replication, for example, indicate that, in 2001– 2003, only 37.5% of people with major depression received adequate conventional treatment for their disorder (10). The cost to individuals, families, and society of this undertreatment is substantial (9,11,12). Although use of complementary and alternative medicine is prevalent in the general population, with more than one-third of Americans having used this medicine in any given year since 1990 (13–17), its use is even more common among people with depression (13,14,16–20). A nationally representative survey done in 1997 found that 53.6% of people reporting severe depression used complementary and alternative medicine (18). A number of community studies have been conducted concerning the factors affecting use of complementary and alternative medicine (13,14,16, 17,21,22), and many of these have 349

found that sociodemographic factors—such as age (17,20,22–24), race or ethnicity (15,22,23,25–29), education (19,20,24,26–28,30), marital status (23), and geographic region (19, 24,26,31)—as well as having poor physical health or one or more longterm medical conditions (19,20,23, 26,29) are associated with use of complementary and alternative medicine in general (15,17,19,20,22–31). Few of these studies, however, have specifically examined the relationships between use of complementary and alternative medicine and particular types of health conditions, such as psychiatric problems (18,24,32). Research on women with depression is particularly important because of their high rate of use of complementary and alternative medicine (18). Some studies have also inquired about users’ own perceptions of their reasons for using complementary and alternative therapies. Astin (16) found that a major motivating factor was having the sense that complementary and alternative therapies were in harmony with the users’ values and “philosophical orientations towards health and life”; Unützer and colleagues (19) found high rates of use of complementary and alternative medicine among individuals who were relatively dissatisfied with conventional health care services, including mental health care services. In these studies, however, the particular types of complementary and alternative therapies these users chose for themselves were not examined in relation to these motivational factors. This study examined the types of complementary and alternative therapies used by women with depression and examined the use of these various types of therapies in relation to sociodemographic factors and reasons or motivations for using these therapies. We aimed to enhance knowledge about the patterns of use of complementary and alternative medicine among women with depression, so that mental health professionals employing conventional methods may better understand the health-related practices of their patients and improve their communication with these patients about the benefits and the potential risks associated with al350

ternative therapy use, either alone or in conjunction with conventional medical treatments.

Methods Sample and data The data used in our analyses are from a cross-sectional telephone survey of women aged 18 and older living in the United States (33). The study was designed to provide nationally representative data on women’s use of complementary and alternative medicine within the past year, as well as on use of complementary and alternative medicine among women in several specific ethnic minority groups. The study design and methodology are described elsewhere (33–35). The interviews were conducted in 2001 in English, Spanish, or Chinese (Mandarin or Cantonese), according to respondents’ preferences. Data were weighted to account for each respondent’s probability of being selected given the number of potential respondents in her household. The unweighted sample consisted of 3,068 women (33). The weighted sample size of the total sample is 3,921; of these women, 19% were non-Hispanic white, 28% were African American, 27% were Mexican American, and 26% were Chinese American. For this article, a subsample consisting of the 220 women who reported past-year medically diagnosed depression was used in the analyses (weighted N=282). Measures Use of complementary and alternative medicine. Respondents were asked about their use, for a particular health problem or concern, of any of a number of categories of complementary and alternative therapies, during the past year. Of the nine major categories of complementary/alternative therapies covered, the three most popularly cited (each cited by 15% or more of the sample) were chiropractic or other manual therapies (such as massage or acupressure), medicinal herbs and teas, and vitamins and nutritional supplements. For the purposes of the study reported here, specific dichotomous variables covering each of these three popular types of complementary and PSYCHIATRIC SERVICES

alternative therapies are used in our analyses. We also used a dichotomous summary variable, “any use,” indicating whether respondents used any of the nine major categories of complementary and alternative therapies in the past year; these nine categories include the three mentioned above and the six less popular categories, which were techniques such as yoga, meditation, or tai chi; acupuncture; remedies or practices associated with a particular culture, such as Chinese medicine, Ayurveda, Native American healing, or curanderismo; a special diet such as a whole foods, macrobiotic, or other vegetarian diet; homeopathic remedies; and energy therapies like Reiki or therapeutic touch. Although the respondents also cited, fairly frequently, another category of complementary and alternative therapies, namely “spirituality, religion or prayer for health reasons” (34), it has been excluded from our analyses, because this study aimed to examine complementary and alternative therapies other than religion or prayer. Reasons for use. Respondents who reported use of complementary and alternative medicine were asked about their reasons for use. The response options offered in the questionnaire included four related to respondents’ experiences with conventional treatment: “I couldn’t afford conventional treatment,” “I tried a conventional medical treatment and it did not work,” “I tried a conventional medical treatment and it had side effects that I did not like,” and “My doctor recommended it.” The response items also offered four more general reasons: “Using these types of remedies and treatments is consistent with my beliefs,” “I wanted a natural approach to treatment,” “When I was growing up family members or other people who were close to me used these types of remedies,” and “I read something or heard something on TV or on the radio that convinced me to use them.” Demographics and socioeconomic status. Respondents were asked about their age, employment status, marital status, years of education, and total household income in the past year. Information was also recorded on race or ethnicity and geographic region. Other measures. Respondents were

♦ ps.psychiatryonline.org ♦ March 2007 Vol. 58 No. 3

Table 1

Sociodemographic characteristics and other characteristics of women with depression, by use of complementary and alternative medicinea Any use (N=151) Characteristic Age 18–24 25–34 35–49 ≥50 Race or ethnicity White African American Mexican American Chinese American Education Less than high school High school College Employment Unemployed Employed Income Greater than $20,000 $20,000 or less Marital status Single Married or cohabiting Divorced or widowed Birth place In the United States Outside the United States Region Northeast Midwest South West Self-perceived health status Fair or better Poor a

Manual therapy (N=73)

Herbs (N=56)

Vitamins (N=46)

Total N

N

%

N

%

N

%

N

%

23 64 102 93

14 30 55 52

61 47 54 56

3 10 32 28

13 16 31 30∗

2 13 21 20

9 20 21 22

1 7 19 19

4 11 19 20

87 89 92 14

55 39 47 10

63 44 51 71∗

35 19 12 7

40 21 13 50∗∗∗

11 11 30 4

13 12 33 29∗∗

20 12 13 1

23 13 14 7

84 151 46

39 80 32

46 53 70∗

13 42 18

15 28 39∗∗

22 23 11

26 15 24†

8 24 14

10 16 30∗∗

146 136

67 84

46 62∗∗

26 47

18 35∗∗

36 20

25 15∗

20 26

14 19

170 112

99 52

58 46†

52 21

31 19∗

36 20

21 18

33 13

19 12†

61 140 81

35 69 47

57 49 58

16 31 26

26 22 32

9 32 15

15 23 19

11 19 16

18 14 20

205 77

106 45

52 58

53 20

26 26

26 30

13 39∗∗∗

36 10

18 13

37 49 106 90

22 30 50 49

59 61 47 54

15 16 18 24

41 33 17 27∗

8 10 9 29

22 20 8 32∗∗∗

10 7 16 13

27 14 15 14

223 59

114 37

51 63

52 21

23 36†

37 19

17 32∗∗

32 14

14 24†

Sample sizes and Ns reported are weighted. Overall chi square tests were conducted for each variable. †p