Conference: 2015 PH Professional Network Symposium
Release Date: 09.17.2015
Presentation Type: Abstracts
File Download: 2015 Symposium Abstract - 1026
File Size: (275 kb)
Download Adobe Acrobat
To determine whether depressive symptoms are associated with decreased motivation and decreased outcome expectancy for medication adherence in pulmonary hypertension.
Pulmonary hypertension (PH) is a progressive disease of the pulmonary vasculature with high morbidity and mortality. Recent advances in therapeutics have improved symptoms, functional capacity, health-related quality of life (HRQoL), and survival in patients. These therapies, however, are often cumbersome, requiring frequent dosing or continuous infusion and have significant side effects. Little is known about patient perceptions of medical therapies in PH or factors that influence medication adherence in PH. Given the high prevalence of depression in this population, we hypothesized that depressive symptoms may be associated with decreased motivation and decreased outcome expectancy for medication adherence in PH.
Subjects were recruited from focus groups examining HRQoL in PH and completed questionnaires assessing impact of disease on activities of daily life, symptom difficulty, self-efficacy, outcome expectancy, medication importance and motivation, treatment adherence, depression, and fatalism. The center for epidemiologic studies depression (CES-D) scale was used to assess depressive symptoms. A CES-D score of ≥ 16 is associated with increased risk of depressive symptoms. Continuous variables were summarized by mean ± SD or median (range). Scores for each domain were summarized and compared across CES-D scores using a cutoff of 16. P-values < 0.05 (2-tailed) were considered significant.
As shown in Table 1, the majority of the 34 patients were white women who were married and had children living in the household; 13 reported living with a spouse or partner. Over 60% of participants completed college and more than half of participants generated more income than the median household income in the US. On a scale from 1 to 10, with 10 being extremely important, patients had a mean medication importance score of 9.3±1.5 and a mean medication motivation score of 8.4±2.6. The mean CES-D score was 7.1±6.4 and of the 34 participants, 5 (15%) had a CES-D score ≥ 16, indicating clinically significant depressive symptoms. Participants at increased risk for depression tended to have lower medication importance scores (p<0.005), lower medication motivation scores (p=0.06), but more positive outcome expectancy beliefs about medications (p=0.03).
In this cohort, PH patients at increased risk for depression tended to view PH-specific therapies as helpful, but were less motivated to take PH-specific medications as instructed and did not view this as particularly important. These findings suggest that depressive symptoms may influence patient medication adherence in PH. Further studies are warranted to examine the relationship between patient-important measures and medication use.