Research report
Medication treatment perceptions, concerns and expectations among depressed individuals with Type I Bipolar Disorder

https://doi.org/10.1016/j.jad.2008.10.002Get rights and content

Abstract

Background

Subjective experience of illness affects outcomes among populations with bipolar disorder (BD). This cross-sectional study combined qualitative and quantitative approaches to evaluate perceived treatment effects, concerns and expectations among 90 individuals with BD.

Methods

Adults with Type I BD, mean age 36.6 years, 51% women, completed a semi-structured interview that was audio taped, transcribed, coded and analyzed along emergent themes. Quantitative scales measured depressive symptoms (Hamilton Depression Scale/HAM-D), psychopathology (Clinical Global Impression/CGI), and insight and treatment attitudes (Insight and Treatment Attitudes Questionnaire/ITAQ).

Results

Individuals had moderate depression and psychopathology with good insight into need for treatment. Drug treatment was perceived as beneficial, by “stabilizing” or “balancing” mood (42%, N = 38), decreasing anxiety/depressive symptoms (19%, N = 17) and improving sleep (10%, N = 9). While 39%, (N = 35) of individuals denied medication concerns, nearly 29%, (N = 26) feared possible long-term effects, particularly diabetes or liver/kidney damage. Media stories and advertisements contributed to medication fears. Hopes and expectations for treatment ranged from those that were symptom or functional status-based, such as desiring mood stabilization and elimination of specific symptoms (23%, N = 21), to more global hopes such as “being normal” (20%, N = 18) or “cured” (18%, N = 16).

Limitations

Limitations include relatively small sample, lack of a comparator, inclusion of only depressed individuals and those willing to discuss their illness experience.

Conclusions

While individuals with BD appreciate the effects of medications, concerns regarding adverse effects and discrepancy between actual and hoped-for outcomes can be substantial. Subjective experience with medications using qualitative and quantitative methods should be explored in order to optimize treatment collaboration and outcomes.

Introduction

While recent years have seen a proliferation of effective treatments for Bipolar Disorder (BD), residual symptoms and illness relapse remain all too common (American Psychiatric Association, 2002). It is perhaps not surprising that many patients become frustrated with treatment, and treatment non-adherence is known to occur in approximately 40% of individuals with BD (Lingam and Scott, 2002). A number of theoretical models have been developed to explain an individual's response to illness (Becker and Maimon, 1975, Leventhal et al., 1984, Horne, 2003), with most generally putting heavy emphasis on how the individuals cognitively and emotionally interpret illness, and the costs and benefits of treatment. Research in the area of chronic illnesses, including BD, have demonstrated that how individuals perceive illness and treatment is important in shaping illness behavior (Scott and Pope, 2002).

Mixed-methodologies utilizing qualitative, narrative techniques combined with traditional quantitative methods more typically seen in experimental medicine, in which data on human beings is condensed to averages or numerical statistics, have gained increasing acceptance among social scientists (Sherman and Strang, 2004). A limited but growing literature suggests that patient-focused, qualitative methods can add valuable insights on patient beliefs about BD treatment (Clatworthy et al., 2007).

The current study was a cross-sectional, exploratory, pooled, quantitative and qualitative analysis to evaluate attitudes and perceptions of medication treatment among 90 individuals with BD. Specific topics evaluated were perceived effects of medications, fears or concerns regarding possible medication effects, and perceived best-case hopes/expectations of what medications might do for individuals with BD.

Section snippets

Methods

This analysis pooled data from three research studies by this group of investigators (Study 1/K-23 National Institute of Mental Health (NIMH) MH065599 PI Sajatovic, Study 2/Ohio Department of Mental Health (ODMH), 06.1223 PI Sajatovic, Study 3/Fairview Lutheran Hospital Foundation PI Muzina) all using the same semi-structured qualitative instrument, the Subjective Experience of Medication Interview (SEMI, Jenkins et al., 2005), in a population of patients with Type I BD and similar

Quantitative findings

Table 1 illustrates demographic and clinical characteristics of the study sample. Mean age of the group was 36.5 years, SD = 11.1, range 18–62 years. The sample was nearly evenly split between men and women. Mean age of BD onset was 26.5 years, SD = 11.0, range 5–46 years. The majority (N = 66, 73%) were Euro-American, while approximately 16% (N = 14) were African-Americans. Mean years of education was 13.4 years, SD = 12.5, range 8–18 years. Overall, the group was moderately depressed with HAM-D-17 mean

Discussion

This mixed-methods analysis of medication treatment perceptions, concerns and hopes/expectations for treatment among 90 individuals with BD demonstrates surprisingly consistent responses among groups of individuals from diverse treatment settings. Based upon the results of quantitative psychiatric rating scales, individuals in this sample all had substantial bipolar depressive symptoms and moderately severe global psychopathology in spite of being prescribed medication to treat their BD. Along

Conclusions

While individuals with BD appreciate the mood-stabilizing and anti-depressant effects of medications, concerns regarding long-term adverse effects and discrepancy between actual effects of medications and hoped for outcomes can be substantial. Subjective experience with medications, and mixed methodologies that combine qualitative and quantitative assessments should be further explored in order to optimize treatment collaboration and outcomes.

Role of funding source

This study was supported by NIMH K 23-MH0655997 (Dr. Sajatovic), a grant from the Ohio Department of Mental Health (Dr. Sajatovic), and a grant from the Fairview/Lutheran Foundation (Dr. Muzina). The funding sources had no further role in data collection, data analysis, data interpretation or the decision to submit the paper for publication.

Conflict of interest

None of the authors have a conflict of interest to report in relation to this study.

Acknowledgements

Special thanks and acknowledgments are in order for key individuals that assisted with study implementation, data collection and data interpretation: Douglas Smith MD, Northcoast Behavioral Healthcare, Northfield, Ohio, Omar Fattal MD, MPH, Lutheran Hospital, Cleveland, Ohio, Beth Singer BA, Northcoast Behavioral Healthcare, Northfield, Ohio, Jane A. West BA, Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio, Elisa Colangelo BS, Department of

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Portions of this data were presented at the American Psychiatric Association (APA) annual meeting on May 5, 2008 in Washington D.C. and the NCDEU annual meeting on May 28, 2008 in Phoenix, Arizona.

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