TY - JOUR
T1 - Identifying the underlying factors associated with patients’ attitudes toward antidepressants
T2 - Qualitative and quantitative analysis of patient drug reviews
AU - Zolnoori, Maryam
AU - Fung, Kin Wah
AU - Fontelo, Paul
AU - Kharrazi, Hadi
AU - Faiola, Anthony
AU - Wu, Yi Shuan Shirley
AU - Stoffel, Virginia
AU - Patrick, Timothy
N1 - Funding Information:
This research was supported by the Intramural Research Program of the National Institutes of Health, National Library of Medicine and Lister Hill National Center for Biomedical Communications. The authors would like to thank Jiaxi Zhu, MPH; Soo Kyung Park, MPH; and Margaret Downs, MS, for their significant contribution to preparing the dataset of this study. The authors also thank their colleagues from National Library of Medicine and University of Wisconsin-Milwaukee who provided insight and expertise that greatly assisted this research project.
Publisher Copyright:
© Maryam Zolnoori, Kin Wah Fung, Paul Fontelo, Hadi Kharrazi, Anthony Faiola, Yi Shuan Shirley Wu, Virginia Stoffel, Timothy Patrick.
PY - 2018/10
Y1 - 2018/10
N2 - Background: Nonadherence to antidepressants is a major obstacle to deriving antidepressants’ therapeutic benefits, resulting in significant burdens on the individuals and the health care system. Several studies have shown that nonadherence is weakly associated with personal and clinical variables but strongly associated with patients’ beliefs and attitudes toward medications. Patients’ drug review posts in online health care communities might provide a significant insight into patients’ attitude toward antidepressants and could be used to address the challenges of self-report methods such as patients’ recruitment. Objective: The aim of this study was to use patient-generated data to identify factors affecting the patient’s attitude toward 4 antidepressants drugs (sertraline [Zoloft], escitalopram [Lexapro], duloxetine [Cymbalta], and venlafaxine [Effexor XR]), which in turn, is a strong determinant of treatment nonadherence. We hypothesized that clinical variables (drug effectiveness; adverse drug reactions, ADRs; perceived distress from ADRs, ADR-PD; and duration of treatment) and personal variables (age, gender, and patients’ knowledge about medications) are associated with patients’ attitude toward antidepressants, and experience of ADRs and drug ineffectiveness are strongly associated with negative attitude. Methods: We used both qualitative and quantitative methods to analyze the dataset. Patients’ drug reviews were randomly selected from a health care forum called askapatient. The Framework method was used to build the analytical framework containing the themes for developing structured data from the qualitative drug reviews. Then, 4 annotators coded the drug reviews at the sentence level using the analytical framework. After managing missing values, we used chi-square and ordinal logistic regression to test and model the association between variables and attitude. Results: A total of 892 reviews posted between February 2001 and September 2016 were analyzed. Most of the patients were females (680/892, 76.2%) and aged less than 40 years (540/892, 60.5%). Patient attitude was significantly (P<.001) associated with experience of ADRs, ADR-PD, drug effectiveness, perceived lack of knowledge, experience of withdrawal, and duration of usage, whereas oth age (F4,874=0.72, P=.58) and gender (χ24=2.7, P=.21) were not found to be associated with patient attitudes. Moreover, modeling the relationship between variables and attitudes showed that drug effectiveness and perceived distress from adverse drug reactions were the 2 most significant factors affecting patients’ attitude toward antidepressants. Conclusions: Patients’ self-report experiences of medications in online health care communities can provide a direct insight into the underlying factors associated with patients’ perceptions and attitudes toward antidepressants. However, it cannot be used as a replacement for self-report methods because of the lack of information for some of the variables, colloquial language, and the unstructured format of the reports.
AB - Background: Nonadherence to antidepressants is a major obstacle to deriving antidepressants’ therapeutic benefits, resulting in significant burdens on the individuals and the health care system. Several studies have shown that nonadherence is weakly associated with personal and clinical variables but strongly associated with patients’ beliefs and attitudes toward medications. Patients’ drug review posts in online health care communities might provide a significant insight into patients’ attitude toward antidepressants and could be used to address the challenges of self-report methods such as patients’ recruitment. Objective: The aim of this study was to use patient-generated data to identify factors affecting the patient’s attitude toward 4 antidepressants drugs (sertraline [Zoloft], escitalopram [Lexapro], duloxetine [Cymbalta], and venlafaxine [Effexor XR]), which in turn, is a strong determinant of treatment nonadherence. We hypothesized that clinical variables (drug effectiveness; adverse drug reactions, ADRs; perceived distress from ADRs, ADR-PD; and duration of treatment) and personal variables (age, gender, and patients’ knowledge about medications) are associated with patients’ attitude toward antidepressants, and experience of ADRs and drug ineffectiveness are strongly associated with negative attitude. Methods: We used both qualitative and quantitative methods to analyze the dataset. Patients’ drug reviews were randomly selected from a health care forum called askapatient. The Framework method was used to build the analytical framework containing the themes for developing structured data from the qualitative drug reviews. Then, 4 annotators coded the drug reviews at the sentence level using the analytical framework. After managing missing values, we used chi-square and ordinal logistic regression to test and model the association between variables and attitude. Results: A total of 892 reviews posted between February 2001 and September 2016 were analyzed. Most of the patients were females (680/892, 76.2%) and aged less than 40 years (540/892, 60.5%). Patient attitude was significantly (P<.001) associated with experience of ADRs, ADR-PD, drug effectiveness, perceived lack of knowledge, experience of withdrawal, and duration of usage, whereas oth age (F4,874=0.72, P=.58) and gender (χ24=2.7, P=.21) were not found to be associated with patient attitudes. Moreover, modeling the relationship between variables and attitudes showed that drug effectiveness and perceived distress from adverse drug reactions were the 2 most significant factors affecting patients’ attitude toward antidepressants. Conclusions: Patients’ self-report experiences of medications in online health care communities can provide a direct insight into the underlying factors associated with patients’ perceptions and attitudes toward antidepressants. However, it cannot be used as a replacement for self-report methods because of the lack of information for some of the variables, colloquial language, and the unstructured format of the reports.
KW - Antidepressive agents
KW - Attitude
KW - Chronic disease
KW - Community networks
KW - Data mining
KW - Depression
KW - Framework method
KW - Internet
KW - Medication adherence
KW - Patient-centered care
KW - Perception
KW - Social media
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U2 - 10.2196/10726
DO - 10.2196/10726
M3 - Review article
C2 - 30287417
AN - SCOPUS:85055260616
VL - 5
JO - JMIR Mental Health
JF - JMIR Mental Health
SN - 2368-7959
IS - 10
M1 - e10726
ER -