STIGMA, INITIAL SATISFACTION AND TREATMENT ADEQUACY AMONG YOUNG AND OLDER ADULT OUTPATIENTS WITH DEPRESSION

Abstract

Aim: This study was designed to compare young and older outpatients with major depression on perceived stigma and attitudes towards care as predictors of medication adequacy and treatment adherence. Method: A two-stage sampling design was used to identify and follow 68 outpatients age 25–64 and 31 patients age >65 with SCID-diagnosed major depression seeking outpatient mental health treatment. Instruments were administered to assess perceived stigma, need for treatment and satisfaction with clinic upon admission. At 3 months, patients were reinterviewed about their treatment, service use, and depressive symptoms. Adequate antidepressant treatment was operationalized as 4 weeks at a therapeutic dose as defined by a standardized measure of antidepressant intensity (CAD). Results: Although older patients reported lower levels of stigma (t=2.34, df=95, P= 0.02), higher stigma predicted discontinuing treatment among older and not younger outpatients even after controlling for depression severity (OR= 0.77, P= 0.05). Despite lower stigma, older adults reported less need for treatment (t=2.52, df=97, P= 0.01) and less concern about the impact of the depression (t=3.72, df=97, P< 0.001). Satisfaction with the clinic at admission was predictive of “adequate” antidepressant treatment in both age groups at the 3-month follow-up (OR=1.33, P= 0.007). Conclusions: Patients' perceptions of care at the initiation of treatment impact on both treatment adherence and medication adequacy. Early detection of age-related patient barriers to care (stigma, dissatisfaction, and not acknowledging the need for treatment) and active interventions to overcome them may maximize the likelihood of adequate antidepressant treatment.