Depression, anxiety could cause noncompliance
Depression, anxiety could cause noncompliance
When a patient fails to comply or adhere to medical treatment regimens, one of the first causes a provider should explore is depression. Both depression and anxiety are common in patients. And depression, particularly, bears a strong relationship to poor outcomes. Compared with nondepressed patients, those suffering from depression are three times less likely not to adhere to treatment recommendations. The associations between anxiety and noncompliance were weaker.
The findings come from a study which also reminds clinicians that about 50% of all medical patients in this country fail to adhere to their doctors’ recommendations for prevention or treatment of acute or chronic conditions. The treatments reviewed were recommended by nonpsychiatrist physicians to patients not being treated for anxiety, depression, or psychiatric illness.
Investigators explain that depression and anxiety lead to diminished health status, lower health-related quality of life, and increased utilization of health care services. Since depression also leads to severe limitations in daily functioning, it could explain the high correlation between the condition and noncompliance:
Findings from the study include the following points:
1. Positive expectations and beliefs in the benefits of treatment increase adherence. Since hopelessness is typical of depression, it would be difficult or impossible for a depressed patient to see the any worth in following a medical regimen.
2.Support from family and a social network aid in compliance. However, depressed people often withdraw from such bonds.
3. Depression might be associated with reduced cognitive function, impairing the ability to remember and implement treatment recommendations.
The researchers encourage clinicians to look for depression as a causal factor in noncompliance. Conversely, clinicians might anticipate that compliance will be an issue for those known to have a history of depression.
The authors observe, "Although it remains to be determined whether treating depression will result in improved patient adherence, the recognition of depression as a significant risk factor for noncompliance with medical treatment carries the potential to improve medical practice, reduce patient disability, enhance patient functioning, and improve health care outcomes."
(According to figures released by the Agency for Healthcare Research Quality, depression is one of the top 10 conditions treated at short-term hospitals in the United States. See Data Watch.)
Related reading
• DeMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: Meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med 2000; 160:2,101-2,107.
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