Adherence, Explicit and Implicit Associations, and Shared Decision Making
Investigators: Patrick W. Corrigan, Nev Jones, Patrick J. Michaels, Natalie Gela, Karina J. Powell, and Andrea Bink
Treatment non-adherence is a significant public health concern. Consequences may include symptom exacerbation, rehospitalization, continued disabilities that undermine life goals, and diminished quality of life. To further understand non-adherence, this study’s purpose is to investigate psychiatric medication treatment discontinuation and, conversely, treatment engagement, by assessing a person’s opinions regarding psychiatric medication treatment and also by evaluating the influence of Shared Decision Making (SDM). Previous research has shown that treatment discontinuation and engagement are impacted by explicit (conscious/planned) and implicit (unconscious/unplanned) cognitive processes. Prior SDM research has shown SDM to be an effective engagement strategy that assists the consumer with weighing the costs and benefits of health care choices. In brief, this longitudinal study’s purpose is to monitor psychiatric medication use among mental health consumers to assess the impact of attitudes on adherence behaviors.
One hundred people with serious mental illness will be recruited for this study from Heartland Health Outreach and Thresholds Psychiatric Rehabilitation Centers in Chicago. Eligible participants will concurrently use psychiatric medication and/or other mental health treatments. Serious mental illness is defined as DSM-IV Axis I diagnoses in the schizophrenia, anxiety, or affective disorder spectrum. Given its prominence, people with concurrent substance use disorders will be included.
The study consists of four visits occurring at baseline, 1-day, 1-week, and 1-month; this selected schedule longitudinally assesses treatment decisions and behaviors to evaluate how such decisions change over time. We will cross-validate self-report with examination of the person’s medical records. For this study, participants will undergo a diagnostic interview, complete symptom assessments, and report on psychiatric hospitalization history. Questionnaires and a computer task will be used to assess attitudes on treatment adherence and mental illness stigma. To assess adherence behaviors during the study, data on pill counts and missed appointments will be obtained. Analyses will be conducted to evaluate the relationships between explicit and implicit attitudes, treatment adherence, and shared decision making.