Medication Beliefs Mediate Between Depressive Symptoms and Medication Adherence in Cystic Fibrosis
Medication Beliefs Mediate Between Depressive Symptoms and Medication Adherence in Cystic Fibrosis
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DOI：
10.1037/hea0000136
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发表时间：
2015-05-01
影响因子：
4.2
通讯作者：
Riekert, Kristin A.
中科院分区：
文献类型：
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作者：
Hilliard, Marisa E.;Eakin, Michelle N.;Riekert, Kristin A.
目的：抑郁症是慢性疾病坚持治疗方案的已知障碍。尽管囊性纤维化症患者的抑郁率升高，并接受复杂的治疗方案，但人们对抑郁症状和囊性纤维化症坚持之间的关系知之甚少。一种可能性是，抑郁症状扭曲了人们对药物的看法，这可能会影响服药依从性。方法：青少年和成人(N=128；平均年龄=29+/-11岁，范围为16-63岁，93%为高加索人)报告抑郁症状和药物信念(与服药相关的自我效能、动机、感知重要性和结果预期)。用药依从性通过药房再灌装数据进行客观评估。横截面结构方程模型将用药信念作为抑郁症状和用药依从性之间的中介进行评估。结果：23%的参与者抑郁症状超过临床临界值。参与者服用了不到一半的肺部处方药(平均依从率=44.4+/-26.7%)。抑郁症状与服药依从性相关(r=-0.22，p<；0.05)，服药信念(b=-0.13，95%CI[-0.24，-0.03])显著中介这种关系。较高的抑郁症状与较不积极的用药信念相关(b=-0.27，p<；.01)，与较低的服药依从性相关(b=0.49，p<；.01)。结论：抑郁症状与对CF药物的信念和坚持有关。在常规的CF护理中监测抑郁症状和用药信念可能有助于识别不坚持的风险，并促进干预以减少抑郁，适应用药信念，并最终改善坚持和CF管理。
Objective: Depression is a known barrier to regimen adherence for chronic conditions. Despite elevated depression rates and complex regimens for people with cystic fibrosis (CF), little is known about associations between depressive symptoms and CF adherence. One possibility is that depressive symptoms distort beliefs about medications, which may influence adherence. Method: Adolescents and adults (N = 128; mean age = 29 +/- 11 years, range = 16-63, 93% Caucasian) with CF reported on depressive symptoms and medication beliefs (self-efficacy, motivation, perceived importance, and outcome expectancies related to taking medications). Medication adherence was assessed objectively through pharmacy refill data. Cross-sectional structural equation models evaluated medication beliefs as a mediator between depressive symptoms and medication adherence. Results: Twenty-three percent of participants exceeded clinical cutoffs for depressive symptoms. Participants took less than half of prescribed pulmonary medications (mean adherence rate = 44.4 +/- 26.7%). Depressive symptoms were correlated with adherence (r = -.22, p < .05), and medication beliefs (b = -0.13, 95% CI [-0.24, -0.03]) significantly mediated this relation. Higher depressive symptoms were associated with less positive medication beliefs (b = -0.27, p < .01), which were associated with lower medication adherence (b = 0.49, p < .01). Conclusions: Depressive symptoms are related to beliefs about and adherence to CF medications. Monitoring depressive symptoms and medication beliefs in routine CF care may help identify risks for nonadherence and facilitate interventions to reduce depression, adaptive medication beliefs, and ultimately improve adherence and CF management.