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Beliefs About Depression and Depression Treatment Among Depressed Veterans

Edlund, Mark J. MD, PhD*; Fortney, John C. PhD*†‡; Reaves, Christina M. MPH*; Pyne, Jeffrey M. MD*†‡; Mittal, Dinesh MD*†‡

doi: 10.1097/MLR.0b013e3181648e46
Original Article

Introduction: Because of the misunderstanding and stigmatization of mental health disorders and treatment, health beliefs may be important in treatment seeking for depression. It is important to understand patients’ beliefs about mental health disorders and mental health treatment to improve systems of care.

Methods: We studied beliefs about depression and depression treatment among patients in a randomized trial of a chronic care intervention to improve depression treatment in the Veterans Administration healthcare system (n = 395). The Depression Beliefs Inventory was used to assess beliefs regarding: (1) perceived need for depression treatment, (2) the efficacy of depression treatment, and (3) treatment barriers, including stigma, at baseline and 6 months. We calculated descriptive statistics on patients’ baseline beliefs, and used multiple regression to investigate the extent to which beliefs changed in intervention and treatment as usual patients between baseline and 6-month assessments. We used logistic regression to investigate the relationship between beliefs and antidepressant initiation, adherence and clinical response.

Results: At baseline, 73% of our sample believed that they had depression, and 66% believed that taking antidepressants would be helpful for their depression. However, the depression intervention had few effects on beliefs, and individual beliefs were generally not associated with taking medication or clinical response. However, a summary measure of beliefs was found to have predictive validity with respect to initiating and adhering to antidepressant treatment.

Discussion: Our results highlight the potential difficulty in modifying individuals’ attitudes regarding depression and depression treatment in chronic care models for depression interventions.

From the *Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; †VA Health Services Research and Development (HSR&D), Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas; and ‡VA South Central Mental Illness Research Education and Clinical Center, North Little Rock, Arkansas.

Supported by VA HSR&D Career Award RCD 03-036 (to M.J.E.), VA IIR 00-078-3 grant (to J.C.F.), VA NPI-01-006-1 grant (to J.M.P.), South Central Network Research/Career Development Grant (to D.M.), the VA HSR&D Center for Mental Health and Outcomes Research, and the VA South Central Mental Illness Research Education and Clinical Center.

The study was approved by the Research and Development Committees of the Central Arkansas Veterans Healthcare System in Little Rock, AR, the Overton Brooks VA Medical Center in Shreveport, LA, and the G.V. (Sonny) Montgomery VA Medical Center in Jackson, MS and their affiliated Institutional Review Boards at the University of Arkansas for Medical Sciences and the University of Louisiana Health Sciences Center at Shreveport.

Reprints: Mark J. Edlund, MD, PhD, 5800 W. 10th Street, Suite 605, Little Rock, AR 72204. E-mail: edlundmarkj@uams.edu.

© 2008 Lippincott Williams & Wilkins, Inc.