Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence.

BACKGROUND: Depression and anxiety are common in medical patients and are associated with diminished health status and increased health care utilization. This article presents a quantitative review and synthesis of studies correlating medical patients' treatment noncompliance with their anxiety and depression. METHODS: Research on patient adherence catalogued on MEDLINE and PsychLit from January 1, 1968, through March 31, 1998, was examined, and studies were included in this review if they measured patient compliance and depression or anxiety (with n>10); involved a medical regimen recommended by a nonpsychiatrist physician to a patient not being treated for anxiety, depression, or a psychiatric illness; and measured the relationship between patient compliance and patient anxiety and/or depression (or provided data to calculate it). RESULTS: Twelve articles about depression and 13 about anxiety met the inclusion criteria. The associations between anxiety and noncompliance were variable, and their averages were small and nonsignificant. The relationship between depression and noncompliance, however, was substantial and significant, with an odds ratio of 3.03 (95% confidence interval, 1.96-4.89). CONCLUSIONS: Compared with nondepressed patients, the odds are 3 times greater that depressed patients will be noncompliant with medical treatment recommendations. Recommendations for future research include attention to causal inferences and exploration of mechanisms to explain the effects. Evidence of strong covariation of depression and medical noncompliance suggests the importance of recognizing depression as a risk factor for poor outcomes among patients who might not be adhering to medical advice.

Pediatricians' knowledge and attitudes concerning diagnosis and treatment of attention deficit and hyperactivity disorders. A national survey approach.

OBJECTIVE: To examine pediatricians' knowledge and attitudes concerning the diagnosis and treatment of attention deficit disorder (ADD) and attention-deficit hyperactivity disorders (ADHD). DESIGN: Cross-sectional survey. SETTING: United States. PARTICIPANTS: Three hundred eighty pediatricians comprising respondents from a random sample of 1000 members of the American Academy of Pediatrics. INTERVENTIONS: None. MEASUREMENTS/MAIN RESULTS: Pediatricians' perceptions of diagnostic modalities, child and family communication concerning ADD and ADHD diagnosis and treatment, and a variety of treatment issues were assessed in this study. Findings indicate that methylphenidate (Ritalin) hydrochloride is the most prescribed medication for treatment of ADD and ADHD. Pediatricians reported common parent and child misperceptions about ADD and ADHD treatment. Results suggest a wide range of reported physician behavior with respect to the diagnosis and treatment of ADD and ADHD. CONCLUSION: Greater attention could be paid to providing accurate information in medical and educator training with respect to the cause, diagnosis, and treatment of ADD and ADHD.

Cesarean childbirth and psychosocial outcomes: a meta-analysis.

A comprehensive literature review with meta-analysis examines the differences between vaginal and cesarean delivery on 23 psychosocial outcomes of childbirth. The most robust findings suggest that cesarean mothers, compared with mothers who delivered vaginally, expressed less immediate and long-term satisfaction with the birth, were less likely ever to breast-feed, experienced a much longer time to first interaction with their infants, had less positive reactions to them after birth, and interacted less with them at home. Some differences were also found between unplanned and planned cesarean sections; none were found between birthing methods for maternal confidence for infant caretaking soon after birth, maternal anxiety in the hospital and at home, maternal stress at home, maternal return to work, and continuation of breast-feeding once begun. Implications of these findings for theory, research, and childbirth practice are discussed.

Modeling long-term parent outcomes of two universal family-focused preventive interventions: one-year follow-up results.

The present investigation extended prior work by R. Spoth, C. Redmond, and C. Shin (1998). These researchers reported findings that 2 universal family-focused preventive intervention programs each had direct effects on a proximal parenting outcome (intervention-targeted parenting behaviors) and indirect effects on 2 global and distal outcomes (parent-child affective quality and general child management) at posttesting. A replication of the previously tested parenting outcome model was conducted with 1-year follow-up data and procedures identical to those used in the earlier study. Results of the present study (N = 404 families) indicate that statistically significant effects on parenting outcomes were sustained through a 1-year period following the posttest.

Facilitation of patient involvement in care: development and validation of a scale.

The authors describe the development and validation of the Facilitation of Patient Involvement Scale, a 9-item measure of the degree to which patients perceive that their physicians actively facilitate or encourage them to be involved in their own healthcare. They first assessed the unidimensionality of the measure, conducting factor analysis in a pilot study of 236 individuals. Subsequently, they assessed the scale's reliability and validity with additional samples of 333, 338, 44, and 84 participants. Reliability of the scale was very high, with average Cronbach's alpha levels of .91. To test the validity of the scale, they used correlational and multiple regression analyses. The findings indicated that patients' satisfaction with their medical encounters was associated with patients' perceptions of facilitation; that perceptions of facilitation were also moderately correlated with general adherence patterns and preferred communication styles; and that patient age, gender, and education level were not relevant to perceptions that healthcare professionals promote patients' involvement in their own care.

Postpartum depression: how much do obstetric nurses and obstetricians know?

Postpartum depression affects 10 to 15 percent of all mothers. A study of 725 obstetric nurses and 204 obstetricians was conducted using a reliable two-factor scale to measure their knowledge and awareness of postpartum depression. Nurses were more aware than physicians of the emotional impact of postpartum depression. Nurses who demonstrated more empathy and who believed education of postpartum depression does not increase a mother's risk were more aware of the postpartum phenomenon than nurses who were less empathic and who did not hold the same belief. Younger and women physicians recognized the psychosocial antecedents to postpartum depression to a greater degree than did older and men physicians. These findings offer potential use in the training of perinatal health care professionals and in the education of pregnant women about postpartum depression.

The physician's role. Views of the public and the profession on seven aspects of patient care.

OBJECTIVES: To determine the importance of various areas of physician competency and to assess the public's ratings of their own physicians. DESIGN: A nationwide household telephone survey. PARTICIPANTS: A random sample of 640 US adults (61% response rate). MAIN OUTCOME MEASURES: Ratings of importance and physicians' competencies in diagnosing and treating illness, communication, ethical conduct, cooperation with other health care professionals, promotion of preventive care, use of technology, and consideration of the cost of care to the patient. RESULTS: Physicians were rated lowest on communication skills and on attention to the costs of the recommended treatment. A comparison of the results with a similar survey of physicians shows that physicians rate their training the lowest in these same areas. Physicians in general practice were rated lower on several competencies than were other physicians. CONCLUSIONS: Health care consumers and physicians share similar values about what is important in the role of a physician. In the areas of communication and attention to the costs of treatment, public needs are not always being met.