0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

Articles   |    
Family Involvement, Medication Adherence, and Depression Outcomes Among Patients in Veterans Affairs Primary Care
Cory R. Bolkan, Ph.D.; Laura M. Bonner, Ph.D.; Duncan G. Campbell, Ph.D.; Andy Lanto, M.A.; Kara Zivin, Ph.D.; Edmund Chaney, Ph.D.; Lisa V. Rubenstein, M.D., M.S.P.H.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200160
View Author and Article Information

Dr. Bolkan is affiliated with the Department of Human Development, Washington State University, 14204 Salmon Creek Ave., Vancouver, WA 98686 (e-mail: bolkan@vancouver.wsu.edu).
Dr. Bonner is with the Veterans Affairs (VA) Puget Sound Health Care System Geriatric Research, Education and Clinical Center and the Health Services Research and Development Northwest Center of Excellence, Seattle, Washington.
Dr. Campbell is with the Department of Psychology, University of Montana, Missoula.
Mr. Lanto and Dr. Rubenstein are with the VA Greater Los Angeles Healthcare System, where Dr. Rubenstein is with the VA Center for the Study of Healthcare Provider Behavior. Dr. Rubenstein is also with the RAND Health Program, Santa Monica, California.
Dr. Zivin is with the National Serious Mental Illness Treatment, Research and Evaluation Center, U.S. Department of Veterans Affairs, and with the Department of Psychiatry, University of Michigan Medical School, both in Ann Arbor.
Dr. Chaney is with the Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle.
A portion of this article was presented at the Gerontological Society of America meeting held November 18–21, 2011, in Boston.

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  Family involvement and social support are associated with recovery from mental disorders. This project explored how family involvement in health care and social support among depressed veterans in primary care related to medication adherence and depression outcomes.

Methods  During a longitudinal telephone survey, 761 Veterans Affairs (VA) primary care patients (mean age=60 years) with probable major depression were asked about depression symptoms, self-reported health, medication adherence, social support, family involvement with care, and satisfaction with clinicians’ efforts to involve the patients’ families in their care. Follow-up interviews at seven and 18 months assessed depression severity and medication adherence.

Results  Most participants lived with others (71%) and reported moderately high social support. Most participants (62%) reported being very likely to discuss treatment of a major medical condition with family, but 64% reported that VA providers had not involved the participants’ family in their care within the prior six months. In multivariate regression analyses, lower depression severity and better medication adherence over time were significantly linked to higher satisfaction with limited efforts by clinicians to involve families in care. Neither social support nor the extent of family involvement by itself was associated with outcomes.

Conclusions  The results suggested a link between patient satisfaction with family involvement by clinicians and clinical outcomes among depressed veterans. In addition, clinician responsiveness to patient wishes may be more important than the amount of family involvement per se. Further research is needed to clarify when and how clinicians should involve a patient’s family in depression treatment in primary care.

Abstract Teaser
Figures in this Article

Your Session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Anchor for Jump
Table 1Characteristics of 761 patients at baseline
Table Footer Note

a Possible scores on the Patient Health Questionnaire–9 (PHQ-9) range from 0 to 27, with higher scores indicating worse symptomatology.

Table Footer Note

b Cutoff score of three positive symptoms in the past month on the Primary Care PTSD Screen for posttraumatic stress disorder (PTSD)

Table Footer Note

c Assessed using eight items (three for tangible support and five for emotional support) from the Medical Outcomes Study Social Support Survey. Possible scores range from 1 to 5, with higher scores indicating more perceived support.

Anchor for Jump
Table 2Satisfaction among 728 patients with providers’ involvement of family, by degree of family involvement in the past six monthsa
Table Footer Note

a χ2=152.6, df=12, p<.001. Results are reported for patients who responded to both questions about providers’ involvement of family.

Anchor for Jump
Table 3Association of measures of social support and family involvement at baseline with severity of depression over 18 monthsa
Table Footer Note

a Multivariate linear regression adjusted for patients’ age, employment, education, self-reported health, primary care site, and posttraumatic stress disorder status (R2=.19; F=9.98, df=13 and 535, p<.001). Depression severity was measured by the Patient Health Questionnaire–9 (PHQ-9) at baseline, seven months, and 18 months, and scores were incorporated into a single model.

Anchor for Jump
Table 4Association of family involvement, social support, and medication adherence over 18 monthsa
Table Footer Note

a The model included measurement of medication adherence at baseline, seven months, and 18 months (except stopped medications, which was not measured at baseline) and controlled for age, education, employment status, health, primary care site, Patient Health Questionnaire–9 score, and posttraumatic stress disorder status. Family involvement and social support were measured at baseline.

+

References

Horowitz  A;  Reinhardt  JP;  Boerner  K  et al:  The influence of health, social support quality and rehabilitation on depression among disabled elders.  Aging and Mental Health 7:342–350, 2003
[CrossRef] | [PubMed]
 
Holahan  CK;  Holahan  CJ:  Self-efficacy, social support, and depression in aging: a longitudinal analysis.  Journal of Gerontology 42:65–68, 1987
[CrossRef] | [PubMed]
 
Travis  LA;  Lyness  JM;  Shields  CG  et al:  Social support, depression, and functional disability in older adult primary-care patients.  American Journal of Geriatric Psychiatry 12:265–271, 2004
[PubMed]
 
Rosland  AM;  Piette  JD;  Choi  H  et al:  Family and friend participation in primary care visits of patients with diabetes or heart failure: patient and physician determinants and experiences.  Medical Care 49:37–45, 2011
[CrossRef] | [PubMed]
 
Glynn  SM;  Cohen  AN;  Niv  N:  New challenges in family interventions for schizophrenia.  Expert Review of Neurotherapeutics 7:33–43, 2007
[CrossRef] | [PubMed]
 
McCorkle  BH;  Rogers  ES;  Dunn  EC  et al:  Increasing social support for individuals with serious mental illness: evaluating the compeer model of intentional friendship.  Community Mental Health Journal 44:359–366, 2008
[CrossRef] | [PubMed]
 
Prince  JD:  Family involvement and satisfaction with community mental health care of individuals with schizophrenia.  Community Mental Health Journal 41:419–430, 2005
[CrossRef] | [PubMed]
 
Murray-Swank  A;  Glynn  S;  Cohen  AN  et al:  Family contact, experience of family relationships, and views about family involvement in treatment among VA consumers with serious mental illness.  Journal of Rehabilitation Research and Development 44:801–811, 2007
[CrossRef] | [PubMed]
 
Pilling  S;  Bebbington  P;  Kuipers  E  et al:  Psychological treatments in schizophrenia: I. meta-analysis of family intervention and cognitive behaviour therapy.  Psychological Medicine 32:763–782, 2002
[PubMed]
 
Cohen  S;  O’Leary  KD;  Foran  HA:  A randomized clinical trial of a brief, problem-focused couple therapy for depression.  Behavior Therapy 41:433–446, 2010
[CrossRef] | [PubMed]
 
Barefoot  JC;  Burg  MM;  Carney  RM  et al:  Aspects of social support associated with depression at hospitalization and follow-up assessment among cardiac patients.  Journal of Cardiopulmonary Rehabilitation 23:404–412, 2003
[CrossRef] | [PubMed]
 
Brummett  BH;  Barefoot  JC;  Siegler  IC  et al:  Relation of subjective and received social support to clinical and self-report assessments of depressive symptoms in an elderly population.  Journal of Affective Disorders 61:41–50, 2000
[CrossRef] | [PubMed]
 
DiMatteo  MR:  Social support and patient adherence to medical treatment: a meta-analysis.  Health Psychology 23:207–218, 2004
[CrossRef] | [PubMed]
 
Lincoln  TM;  Wilhelm  K;  Nestoriuc  Y:  Effectiveness of psychoeducation for relapse, symptoms, knowledge, adherence and functioning in psychotic disorders: a meta-analysis.  Schizophrenia Research 96:232–245, 2007
[CrossRef] | [PubMed]
 
Ramírez García  JI;  Chang  CL;  Young  JS  et al:  Family support predicts psychiatric medication usage among Mexican-American individuals with schizophrenia.  Social Psychiatry and Psychiatric Epidemiology 41:624–631, 2006
[CrossRef] | [PubMed]
 
Tamburrino  MB;  Nagel  RW;  Chahal  MK  et al:  Antidepressant medication adherence: a study of primary care patients.  Primary Care Companion to the Journal of Clinical Psychiatry 11:205–211, 2009
[CrossRef] | [PubMed]
 
Bull  SA;  Hu  XH;  Hunkeler  EM  et al:  Discontinuation of use and switching of antidepressants: influence of patient-physician communication.  JAMA 288:1403–1409, 2002
[CrossRef] | [PubMed]
 
Chaney  EF;  Rubenstein  LV;  Liu  CF  et al:  Implementing collaborative care for depression treatment in primary care: a cluster randomized evaluation of a quality improvement practice redesign.  Implementation Science 6:121, 2011
[CrossRef] | [PubMed]
 
Yano  EM;  Chaney  EF;  Campbell  DG  et al:  Yield of practice-based depression screening in VA primary care settings.  Journal of General Internal Medicine 27:331–338, 2012
[CrossRef] | [PubMed]
 
Kroenke  K;  Spitzer  RL;  Williams  JB:  The PHQ-9: validity of a brief depression severity measure.  Journal of General Internal Medicine 16:606–613, 2001
[CrossRef] | [PubMed]
 
Löwe  B;  Spitzer  RL;  Gräfe  K  et al:  Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians’ diagnoses.  Journal of Affective Disorders 78:131–140, 2004
[CrossRef] | [PubMed]
 
Löwe  B;  Kroenke  K;  Herzog  W  et al:  Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9).  Journal of Affective Disorders 81:61–66, 2004
[CrossRef] | [PubMed]
 
Sherbourne  CD;  Stewart  AL:  The MOS Social Support Survey.  Social Science and Medicine 32:705–714, 1991
[CrossRef] | [PubMed]
 
Rubenstein  LV;  Parker  LE;  Meredith  LS  et al:  Understanding team-based quality improvement for depression in primary care.  Health Services Research 37:1009–1029, 2002
[CrossRef] | [PubMed]
 
Campbell  DG;  Felker  BL;  Liu  CF  et al:  Prevalence of depression-PTSD comorbidity: implications for clinical practice guidelines and primary care-based interventions.  Journal of General Internal Medicine 22:711–718, 2007
[CrossRef] | [PubMed]
 
Zen  AL;  Whooley  MA;  Zhao  S  et al:  Post-traumatic stress disorder is associated with poor health behaviors: findings from the heart and soul study.  Health Psychology 31:194–201, 2012
[CrossRef] | [PubMed]
 
Kronish  IM;  Edmondson  D;  Li  Y  et al:  Post-traumatic stress disorder and medication adherence: results from the Mind Your Heart Study.  Journal of Psychiatric Research 46:1595–1599, 2012
[CrossRef] | [PubMed]
 
Kazis  LE;  Ren  XS;  Lee  A  et al:  Health status in VA patients: results from the Veterans Health Study.  American Journal of Medical Quality 14:28–38, 1999
[CrossRef] | [PubMed]
 
Bliese  PD;  Wright  KM;  Adler  AB  et al:  Validating the primary care posttraumatic stress disorder screen and the posttraumatic stress disorder checklist with soldiers returning from combat.  Journal of Consulting and Clinical Psychology 76:272–281, 2008
[CrossRef] | [PubMed]
 
Prins  A;  Ouimette  P;  Kimerling  R  et al:  The primary care PTSD screen (PC-PTSD): development and operating characteristics.  International Journal of Psychiatry in Clinical Practice 9:9–14, 2004
 
 Stata Statistical Software .  College Station, Tex,  StataCorp, 2009
 
Sherbourne  CD;  Weiss  R;  Duan  N  et al:  Do the effects of quality improvement for depression care differ for men and women? Results of a group-level randomized controlled trial.  Medical Care 42:1186–1193, 2004
[CrossRef] | [PubMed]
 
Hinton  L;  Zweifach  M;  Oishi  S  et al:  Gender disparities in the treatment of late-life depression: qualitative and quantitative findings from the IMPACT trial.  American Journal of Geriatric Psychiatry 14:884–892, 2006
[CrossRef] | [PubMed]
 
Apesoa-Varano  EC;  Hinton  L;  Barker  JC  et al:  Clinician approaches and strategies for engaging older men in depression care.  American Journal of Geriatric Psychiatry 18:586–595, 2010
[PubMed]
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Articles
Books
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 18.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 18.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 33.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 8.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 8.  >
Topic Collections
Psychiatric News
APA Guidelines
PubMed Articles