Perceived stigma and patient-rated severity of illness as predictors of antidepressant drug adherence

Objective: Major depression is undertreated despite the availability of eff ective treatments. Psychological barriers to treatment, such as perceived s tigma and minimization of the need for care, may be important obstacles to adherence to the pharmacologic treatment of major depression. The authors e xamined the impact of barriers that were present at the initiation of antid epressant drug therapy on medication adherence in a mixed-age sample of out patients with major depression. Methods: A two-stage sampling design was us ed to identify adults with a diagnosis of major depressive disorder, as det ermined by the Structured Clinical Interview for Diagnosis, who sought ment al health treatment at outpatient clinics. Additional instruments were admi nistered to 134 newly admitted adults who had been taking a prescribed anti depressant medication for at least a week to assess perceived stigma, self- rated severity of illness, and views about treatment. The patients were rei nterviewed three months later and were classified as adherent or nonadheren t on the basis of self-reported estimates of the number and frequency of mi ssed doses. Results: Medication adherence was associated with lower perceiv ed stigma, higher self-rated severity of illness, age over 60 years, and ab sence of personality, pathology. No other characteristics of treatment or i llness were significantly related to medication adherence. Conclusions: Per ceived stigma associated with mental illness and individuals' views about t he illness play an important role in adherence to treatment for depression. Clinicians' attention to psychological barriers early in treatment may imp rove medication adherence and ultimately affect the course of illness.