Treatment Beliefs Research Articles

An Evaluation of the Attitudes and Beliefs of Physicians and Pharmacists towards Complementary and Alternative Medicine Based on CAMBI and another Instrument

Aims: To investigate the attitudes and beliefs of physicians and pharmacists towards Complementary and Alternative Medicine (CAM) using two instruments: the Complementary and Alternative Belief Inventory (CAMBI) and the Attitudes to Alternative Medicine.
 Study Design: This was a cross-sectional study of registered physicians and pharmacists attending their conferences or Continuing Pharmacy Education (CPE) sessions in Guyana.
 Place and Duration of Study: Pharmacists attending their first CPE for 2015 and physicians at their annual Medical Conference participated.
 Methodology: A pre-tested, self-administered questionnaire was used and 274 persons (140 physicians and 134 pharmacists) participated. One section of the questionnaire, utilised the CAMBI to measure three constructs: beliefs in holistic health, natural treatments, and participation in treatment. The other section focused on attitudes to Alternative Medicine. Confirmatory Factor Analysis (CFA) and structural equations modelling were employed in the analysis of the data.
 Results: For the CAMBI, a final model was obtained following the removal of several items that lacked validity and statistical significance. Most of the participants (56%) were 20-30 years old and most (52%) of them had 5 years or less professional experience. Overall, the participants were not closed to the use of CAM but there was some scepticism. Physicians believed more strongly in holistic health than pharmacists, but the latter group showed a more positive attitude to involvement in the CAM environment. Attitudes were not affected by age nor area of practice but were influenced by profession, gender, ethnicity, years of professional service and whether or not they attended the local university.
 Conclusion: The CAMBI performed poorly and would have to be revised to suit the local context in future studies. Overall, most participants had some reservations about CAM. Emphasis on holistic health and CAM should be prioritised in any training at the undergraduate level or any continuing education sessions.

Complementary and alternative medicine beliefs in type 2 diabetes: The Fremantle Diabetes Study Phase II

Complementary medicine (CM) treatment beliefs of people with type 2 diabetes were assessed using a validated three-domain questionnaire. Belief in holistic health, but not natural treatments or participation in treatment, was independently associated with CM use (P = 0.003). Strong holistic health beliefs could identify present/future CM use, with potential management implications.

Clinicians' views of treatment types for first episode psychosis delivered in a randomised controlled trial (MAPS).

BackgroundClinicians’ treatment beliefs could affect the feasibility of delivering different treatments in a randomised controlled trial (RCT). In MAPS (Managing Adolescent first Episode Psychosis: a feasibility Study), adolescents with first episode psychosis (FEP) were randomly allocated to receive either antipsychotic medication (AP), psychological intervention (cognitive behavioural therapy [CBT] and family intervention [FI]), or both. We conducted a nested qualitative study to investigate clinicians’ views of these treatments.MethodsPurposive sampling identified seventeen clinicians from CAMHS and Early Intervention services with prescribing responsibilities for 14-18 year olds at three participating MAPS sites. Individual participants were interviewed to examine their views of treatments in the MAPS trial. Interview transcripts were analysed using inductive Thematic Analysis.FindingsClinicians viewed the decision to refer adolescents to the MAPS trial as requiring careful clinical judgement. Assessment complexity and diagnostic uncertainty had to be balanced against the urgency for treatment to reduce risk and distress. Underlying influences including duty of care and treatment beliefs underpinned decisions. Clinicians consistently valued AP as the primary treatment for FEP, with CBT and/or FI seen as helpful secondary treatment options. Nevertheless, the potential harms of prescribing AP, or not, to such a young population were highlighted as being of concern in treatment decision-making, and fostered reluctance to refer into a RCT.InterpretationThe design and delivery of RCTs involving young people experiencing FEP should consider the views of responsible clinicians, recognising that perceived treatment urgency, limitations in diagnostic precision, and existing treatment beliefs may influence trial processes.FundingNIHR HTA programme (project number 15/31/04).

Self-reported psychological distress among caregivers of patients with cancer: Findings from a health facility-based study in Vietnam 2019.

In Vietnam, little is elucidated in scientific literatures about the mental health of caregivers of people with cancer. We conducted a cross-sectional study to report the situation and correlates of self-reported psychological distress among caregivers of cancer patients in Vietnam in 2019. Multiple logistic and linear regression analyses were performed. A total of 16.5% of the study participants had psychological distress. Respondent’s mean score of negative emotion was 7.6 ± 2. Educational level and type of support were significantly associated with having psychological distress among caregivers. Gender, occupation, financial difficulty, treatment belief and social support significantly correlated to psychological distress level of caregivers.

Race and cultural factors in an RCT of prolonged exposure and sertraline for PTSD

The efficacy of treatments for posttraumatic stress disorder (PTSD) among African Americans is less clear given underrepresentation in clinical research. Additionally, intervention research examining race has typically not considered within-group heterogeneity, such as acculturation, ethnic identity, and cultural attitudes. In a randomized controlled trial, African American (n = 43) and Caucasian (n = 130) individuals received prolonged exposure (PE) or sertraline for PTSD, comparing: treatment response, retention, and treatment beliefs and preferences. Indirect effects of cultural variables were also examined. African Americans reported stronger ethnic identity (d = 0.71), less positive attitudes toward other groups (d = 0.36), and less acculturation (d = 0.51) than Caucasians. Noninferiority analyses indicated clinically equivalent PTSD outcomes for African Americans and Caucasians in both treatments. Groups showed comparable improvements in depression and functioning, and similar treatment preferences and beliefs. African Americans attended fewer sessions in PE (d = 0.87) and sertraline (d = 0.53) than Caucasians. Indirect effects analyses indicated positive cultural attitudes toward other ethnoracial groups were consistently associated with better treatment outcome and retention. Despite no differential effectiveness, findings may highlight the need to target retention among African Americans. Within-group cultural aspects of race may be an informative complement to basic, categorical conceptualizations.

Omunanamwengu (The Mad One): A Multiple Case Study of Individual and Familial Experiences of Madness Among the Northern Namibian Aawambo

To understand mental illness in cultural contexts, research should focus on locally informed concepts of illness and the lived experiences of such conditions. Understanding mental illness, its prevalence, and its influence on people’s lives in Namibia represents one such context where attention to the lived experience of mental illness remains understudied. The purpose of the current study was to build upon ethnographic findings about mental illness as madness ( eemwengu) among the Namibian Aawambo. To that end, a multiple case study design was used to explore the lived experience of being omunanamwengu (the mad one). Data were collected from four cases that were bound by the experience of mental illness. Within each case, the individual experiencing illness ( omunanamwengu), family members, and both omunanamwengu and family members were interviewed formally (via a semi-structured interview protocol) or informally due to participants’ preferences for not being recorded. Using Stake’s suggested approach to multiple-case study cross-case analysis, each individual case is described and cross-case themes (Development and Symptoms of Mental Illness; Marginalization and Omunanamwengu; Family Roles in the Lives of the Distressed and Eemwengu; Belief in Treatment) were identified. Findings are discussed in light of the role of beliefs in treatment as well as family involvement, the potential influence of discrimination on mental illness, and implications for practice and cross-cultural psychology.

Dental health care workers’ attitude towards patients with substance use disorders in medically assisted rehabilitation (MAR)

Objective To assess knowledge, beliefs and attitudes related to treatment of MAR patients among dentists and dental hygienists. Secondly, to investigate to what extent dental health care professionals’ attitudes associate with their treatment experience and beliefs regarding MAR patients. Material and Method We conducted a cross-sectional study, involving a census of dental hygienists and dentists in the public dental health care services in Hordaland and Rogaland counties in Norway. Data were collected by electronically administered questionnaires. Results The response rate was 187/344, 54% (26% dental hygienists and 74% dentists). A majority of both professional groups did not find it difficult to understand information on oral health and drug use. Although they confirmed familiarity with guidelines on good dental practice, they had received little information about oral health aspects of substance use. Both groups had slightly negative attitudes towards treatment of MAR patients. Beliefs that completion of treatment is often unsuccessful and that information on drug use and oral health is difficult to interpret associated with negative attitudes towards treatment. Conclusions The findings suggest that promotion of information to dental care personnel to extend their knowledge and improve their skills regarding oral health aspects of substance use might contribute to positive attitudes and improved utilisation of the free dental care offered to MAR patients.

Medication beliefs in first-line and second-line treated multiple sclerosis patients

Background: Immune treatments of multiple sclerosis (MS) can be classified in first-line and second-line approaches. While in both treatment efficacy is often not easy to assess in the short-term, treatment and illness beliefs may differ in first-line and second-line treated patients. The current study aimed to assess differential beliefs about medicine and illness perception between these groups based on the hypothesis that they are closely connected to adherence behaviour.Methods: An online survey through the website of the German MS Society was performed investigating beliefs about immune treatments as well as the patients’ illness perceptions with validated questionnaires. Demographic factors, disability and self-reported adherence rates were studied as moderator variables.Results: In total, 630 patients participated. Data of 433 first-line treated and 192 second-line treated patients with MS (PwMS) were analysed. Necessity beliefs and also concerns beliefs were significantly higher in second-line treated PwMS (MANCOVA p =.001 and p =.006) and generally in patients with higher disability, while illness perception did not differ between groups. Self-assessed adherence rates were around 70% for oral treatments and injectables irrespective of first-line or second-line. Nonadherence was below 5% for infusion treatments. However, most patients reported only single omissions.Conclusion: The current study reveals differential behavioural attitudes between first-line versus second-line-treated PwMS. However, follow-up studies are needed to further unravel the relationship between behavioural attitudes and treatment adherence.

Can the Pain Attitudes and Beliefs Scales be adapted for use in the context of osteoarthritis with general practitioners and physiotherapists?

BackgroundConservative, first-line treatments (exercise, education and weight-loss if appropriate) for hip and knee joint osteoarthritis are underused despite the known benefits. Clinicians’ beliefs can affect the advice and education given to patients, in turn, this can influence the uptake of treatment. In New Zealand, most conservative OA management is prescribed by general practitioners (GPs; primary care physicians) and physiotherapists. Few questionnaires have been designed to measure GPs’ and physiotherapists’ osteoarthritis-related health, illness and treatment beliefs. This study aimed to identify if a questionnaire about low back pain beliefs, the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT), can be adapted to assess GP and physiotherapists’ beliefs about osteoarthritis.MethodsThis study used a cross-sectional observational design. Data were collected anonymously from GPs and physiotherapists using an online survey. The survey included a study-specific demographic and occupational characteristics questionnaire and the PABS-PT questionnaire adapted for osteoarthritis. All data were analysed using descriptive statistics, and the PABS-PT data underwent principal factor analysis.ResultsIn total, 295 clinicians (87 GPs, 208 physiotherapists) participated in this study. The principal factor analysis identified two factors or subscales (categorised as biomedical and behavioural), with a Cronbach’s alpha of 0.84 and 0.44, respectively.ConclusionsThe biomedical subscale of the PABS-PT appears appropriate for adaptation for use in the context of osteoarthritis, but the low internal consistency of the behavioural subscale suggests this subscale is not currently suitable. Future research should consider the inclusion of additional items to the behavioural subscale to improve internal consistency or look to develop a new, osteoarthritis-specific questionnaire.Trial registrationThis trial was part of the primary author’s PhD, which began in 2012 and therefore this study was not registered.

Determinants of health-related quality of life: a cross-sectional investigation in physician-managed anticoagulated patients using vitamin K antagonists

BackgroundLiterature has paid little attention in describing the specific contribution of each modifiable and non-modifiable characteristics on health-related quality of life (HRQoL) in physician-managed anticoagulated patients using vitamin K antagonists (VKAs). To describe how patients’ treatment-specific knowledge, health literacy, treatment beliefs, clinical, and socio-demographic characteristics influence HRQoL in Italian physician-managed anticoagulated patients using VKAs.MethodsCross-sectional multicentre study with a consecutive sampling strategy, enrolling 164 long-term anticoagulated patients. Clinical and socio-demographic characteristics were collected from electronic medical records. Valid and reliable questionnaires were used to collect patients’ treatment-specific knowledge, health literacy, beliefs about VKAs, physical and health perceptions.ResultsObtaining and understanding health information (i.e., communicative health literacy) positively predicts both adequate mental (ORadjusted = 10.9; 95%CI = 1.99–19.10) and physical (ORadjusted = 11.54; 95%CI = 1.99–34.45) health perceptions. Conversely, the ability to perform proper health decision making (i.e., critical health literacy) was associated with lower rates of adequate mental health perception (ORadjusted = 0.13; 95%CI = 0.03–0.63). Further, age negatively predicted physical health perception (ORadjusted = 0.87; 95%CI = 0.81–0.93).ConclusionsHealth literacy plays an interesting role in predicting HRQoL. The relationship between critical health literacy and mental health perception could be influenced by some psychological variables, such as distress and frustration, which could be present in patients with higher levels of critical health literacy, as they could be more inclined for self-monitoring. For this reason, future research are needed to identify the most suitable patients’ profile for each OAC-management model, by longitudinally describing the predictive performance of each modifiable and non-modifiable determinant of HRQoL.

Does improving appropriate use of malaria medicines change population beliefs in testing and treatment? Evidence from a randomized controlled trial.

A major puzzle in malaria treatment remains the dual problem of underuse and overuse of malaria medications, which deplete scarce public resources used for subsidies and lead to drug resistance. One explanation is that health behaviour, especially in the context of incomplete information, could be driven by beliefs, pivotal to the success of health interventions. The objective of this study is to investigate how population beliefs change in response to an experimental intervention which was shown to improve access to rapid diagnostic testing (RDT) through community health workers (CHWs) and to increase appropriate use of anti-malaria medications. By collecting data on individuals' beliefs on malaria testing and treatment 12 and 18 months after the experimental intervention started, we find that the intervention increases the belief that a negative test result is correct, and the belief that the first-line anti-malaria drugs (artemisinin-based combination therapies or ACTs) are effective. Using mediation analysis, we also explore some possible mechanisms through which the changes happen. We find that the experience and knowledge about RDT and experience with CHWs explain 62.4% of the relationship between the intervention and the belief that a negative test result is correct. Similarly, the targeted use of ACTs and taking the correct dose-in addition to experience with RDT-explain 96.8% of the relationship between the intervention and the belief that the ACT taken is effective. As beliefs are important determinants of economic behaviour and might guide individuals' future decisions, understanding how they change after a health intervention has important implications for long-term changes in population behaviour.

Knowledge, attitude and practices on cholera in an arid county, Kenya, 2018: A mixed-methods approach.

BackgroundCholera remains a public health problem in Kenya despite increased efforts to create awareness. Assessment of knowledge, attitude and practice (KAP) in the community is essential for the planning and implementation of preventive measures. We assessed cholera KAP in a community in Isiolo County, Kenya.MethodsThis cross-sectional study involved a mixed-methods approach utilizing a questionnaire survey and focus group discussions (FGDs). Using multistage sampling with household as the secondary sampling unit, interviewers administered structured questionnaires to one respondent aged ≥18 years old per household. We created knowledge score by allotting one point for each correct response, considered any total score ≥ median score as high knowledge score, calculated descriptive statistics and used multivariate logistic regression to examine factors associated with high knowledge score. In FGDs, we randomly selected the participants aged ≥18 years and had lived in Isiolo for >1 year, conducted the FGDs using an interview guide and used content analysis to identify salient emerging themes.ResultsWe interviewed 428 participants (median age = 30 years; Q1 = 25, Q3 = 38) comprising 372 (86.9%) females. Of the 425/428 (99.3%) who had heard about cholera, 311/425 (73.2%) knew that it is communicable. Although 273/428 (63.8%) respondents knew the importance of treating drinking water, only 216/421 (51.3%) treated drinking water. Those with good defecation practice were 209/428 (48.8%). Respondents with high knowledge score were 227/428 (53.0%). Positive attitude (aOR = 2.88, 95% C.I = 1.34–6.20), treating drinking water (aOR = 2.21, 95% C.I = 1.47–3.33), age <36 years (aOR = 1.75, 95% C.I = 1.11–2.74) and formal education (aOR = 1.71, 95% C.I = 1.08–2.68) were independently associated with high knowledge score. FGDs showed poor latrine coverage, inadequate water treatment and socio-cultural beliefs as barriers to cholera prevention and control.ConclusionsThere was a high knowledge score on cholera with gaps in preventive practices. We recommend targeted health education to the old and uneducated persons and general strengthening of health education in the community.

Patient preferences for symptom-driven or regular preventer treatment in mild to moderate asthma: findings from the PRACTICAL study, a randomised clinical trial.

Symptom-driven low-dose inhaled corticosteroid-formoterol is safe and effective in mild asthma and has been recommended as one of the preferred treatment regimens at steps 1 and 2 in the 2019 update of the Global Initiative for Asthma. However, there are no data on patient preferences for this regimen.A subgroup of participants in the PRACTICAL study (ACTRN12616000377437), a randomised controlled trial comparing symptom-driven budesonide-formoterol with maintenance budesonide plus as-needed terbutaline completed a survey on treatment preferences, satisfaction, beliefs and experience at their final study visit.306 (75%) out of 407 eligible participants completed the survey. Regimen preference was strongly associated with randomised treatment, as were preferences for and beliefs about preventer inhaler use. Combination preventer and reliever as-needed therapy was preferred by 135 (90%, 95% CI 85.2-94.8%) out of 150 who were randomised to as-needed budesonide-formoterol, and by 63 (40%, 95% CI 32.7-48.1%) out of 156 who were randomised to maintenance budesonide. By contrast, twice-daily preventer inhaler with a reliever inhaler as required was preferred by 15 (10%) out of 150 of those randomised to as-needed budesonide-formoterol and 93 (60%) out of 156 of those randomised to maintenance budesonide. Satisfaction with all study inhalers was high. Of patients randomised to as-needed budesonide-formoterol 92% (n=138) were confident using it as a reliever at the end of the study.Although most participants preferred the regimen to which they had been randomised, this association was much stronger for those randomised to budesonide-formoterol as needed, indicating that most patients preferred as-needed corticosteroid-formoterol therapy if they had experienced it.

Should All Violent Offenders Be Treated Equally? Perceptions of Punishment and Rehabilitation for Violent Offenders with Varying Attributes

ABSTRACTResearch finds that, while people are pragmatic in response to crime control, individuals are more punitive toward violent than nonviolent offenders. This endeavor examines individuals’ simultaneous support for punishment and rehabilitation – balanced justice – for violent offenders with varying attributes. Using a convenience sample of 575 criminology and criminal justice students, this study examines if treatment beliefs and respondent demographic characteristics relate to sanctioning preferences. Findings indicate a balanced justice sanctioning preference for violent drug offenders, those with mental health issues, and veterans, while individuals support punishment-oriented sanctions for domestic violence offenders. Policy implications and directions for future research are discussed.

"It's been like a miracle": Low-income Arkansans and access to health care services following Medicaid reform.

This article reports qualitative results from a mixed-methods evaluation of the Arkansas Health Care Independence Program. Qualitative data was collected using telephone interviews with 24 low-income Arkansans newly enrolled in Medicaid or a Qualified Health Plan in 2014. We used methods developed for rapid qualitative assessment to explore a range of general barriers and facilitators to accessing health care services. Secondary analysis guided by the most significant change technique aided in the construction of case summaries that permitted insights into participants’ experiences of managing their health over time. Barriers to accessing health care services included treatment costs, beliefs and values related to health, limited health literacy, poor quality health care, provider stigma, and difficulties that made travel challenging. For 1 participant who was no longer eligible for Medicaid or a QHP, lacking health care coverage was also problematic. Facilitators included having health care coverage, life experiences that re-enforced the value of prevention, health literacy, and enhanced health care services. Low-income Arkansans experiences accessing health care elucidate access as multi-dimensional, involving not only the availability of affordable services, but treatment effectiveness and patient experiences interacting with providers and clinic staff. We use these findings to formulate recommendations for programs and policies aimed at further increasing access to high-quality health care as a strategy for reducing health disparities.

Causal attributions for somatic symptom disorder

ObjectivesTwo research questions will be addressed: (1) What does the German public think about possible causes of somatic symptom disorder (SSD) and are there differences in causal attributions according to symptom and course of SSD? (2) Are causal attributions associated with beliefs about treatment and stigmatizing attitudes? MethodsTwo vignettes with symptoms of SSD were used in a national telephone survey in Germany (N = 1004). Vignettes differed regarding main type of symptom (pain vs. fatigue) and existence of an earlier somatic disease (yes vs. no). Respondents were asked about their agreement with five causal beliefs (broken home, heredity, lack of willpower, work stress, and misinterpretation of body signals). ResultsAbout 90% of the respondents agreed that work stress is a possible cause of the SSD symptoms. Agreement was significantly more pronounced in case of a person with fatigue and an earlier severe somatic disease. A quarter endorsed lack of willpower as a possible cause. Lack of willpower was associated with a significant increase of desire for social distance in both vignettes. Work stress was associated with a significantly increased likelihood of positively evaluating the effectiveness of psychotherapy in both cases of SSD. ConclusionsPublic beliefs about causes of SSD are associated with stigma and treatment beliefs. Emphasising work stress as a cause may promote the belief that psychotherapy is effective for treatment of SSD.

Initial evaluation of a brief pharmacy-led intervention to modify beliefs about medicines and facilitate adherence among patients hospitalised with acute coronary syndrome

ObjectivesMedication non-adherence is common among patients with acute coronary syndrome (ACS) and is associated with poor clinical outcomes. To date, pharmacists have been underutilised in the delivery of adherence interventions....

Addressing causal beliefs in treatment: insights from mental health practitioners in Australia

ABSTRACT Mental health practitioners' beliefs about the causes of mental illness may influence their approach to treatment and impact therapeutic outcomes. There has been limited research on this topic. This study explores mental health practitioners' views and experiences of addressing causal beliefs in treatment. A thematic framework guided the analysis of semi-structured interviews with 17 mental health practitioners. Participants stated that their causal beliefs impact their approach to treatment, and clients' causal beliefs influence how clients approach treatment. Participants thought that it was important to discuss causes with clients and identified several barriers to, and consequences of, doing so. Participants identified that addressing causal beliefs in treatment influenced factors such as practitioner empathy, therapeutic alliance, engagement in treatment and clients' self-blame.

Experience of family function, family involvement, and self-management in adult patients with type 2 diabetes: A thematic analysis.

To describe the patient's experience of family function and its importance in diabetes-related self-management. Many patients fail to reach the targeted glycemic level due to low self-management adherence. Knowledge is needed regarding the impact of family function on diabetes self-management. A qualitative descriptive design. A purposive sample of 20 patients with type 2 diabetes. Data were collected in March-June 2017 via audio-recorded semi-structured interviews, field notes and Eco-maps. Analysed using thematic framework matrix and thematic analysis. Four themes were identified: (1) Downplaying disease. The disease was trivialized creating a barrier to family involvement; (2) Second guessing. When diabetes was not discussed, patient and family made their own assumptions; (3) Going it alone. The participants preferred sole disease responsibility to maintain usual family life; (4) No regrets. The participants managed their disease with medications only to maintain family cohesion and 'the good life'. The participants in our study downplayed the consequences of type 2 diabetes and chose to control their disease medically rather than by lifestyle changes. They renounced family involvement to maintain their lifestyle and promote family cohesion. During clinical check-ups, patients should be encouraged to involve their family in lifestyle changes. Healthcare professionals need to recognize illness- and treatment beliefs and the impact of family function in disease management.

Men's views of antidepressant treatment for depression, and their implications for community pharmacy practice.

Men with depression can express and navigate their condition differently to women. Understanding this population's needs, and experiences, can help healthcare professionals better support these patients. There is a lack of knowledge in this area, and no studies have explored men's depression in the context of community pharmacy. Explore views of men around their medication for the treatment of depression and the role of community pharmacy in their treatment. United Kingdom (UK) primary care. Semi-structured in-depth interviews were conducted. Eligible participants were male, aged 18-65 years, and treating depression with antidepressants. Participants were recruited through 5 UK pharmacies (via the pharmacist or poster recruitment) and a UK University (poster recruitment). A thematic approach was used for analysis. 14 men aged 26-61 years, predominantly of white ethnicity were interviewed. Key themes were found. The theme 'Antidepressant's attributions to benefits' highlighted all men noticed benefits when taking antidepressants, but held uncertainty on what extent their antidepressants caused this. The themes 'Views of pharmacist's role influences engagement', and 'Influence of cognitive state upon healthcare interactions' demonstrated men were not inclined to discuss concerns with the community pharmacist. These men didn't see this as the pharmacist's role, nor had these men given cognitive space to evaluate their treatment beliefs or information needs. Yet the theme 'Reflection of support and information needs' shows men did have unmet information and support needs. This also links into the 'Hegemonic Masculinity and taking antidepressants' theme, where taking antidepressants could challenge ones masculinity. Community pharmacists should create opportunities for men to engage in conversations around their antidepressants and wider support. Men, as a requisite for engagement, will need to see such interactions as within the community pharmacists' remit, and as part of a collaborative healthcare system.