Exploring beliefs, attitudes, and behavioural intentions towards long-term antidepressant use in the management of people with depression in primary care: a mixed methods study

Abstract

Over the last two decades, antidepressant prescribing in the UK has increased considerably. The rate of antidepressant prescribing increased from 15.8% to 16.6% between 2015 and 2018, with 7.3 million people prescribed antidepressants in 2017/18, at an annual cost of approximately £266 million. Evidence suggests that the increase in the number of antidepressant prescriptions is due to patients staying on treatment for longer. While between a third to a half of patients may no longer be clinically indicated to continue antidepressant treatment, some are prepared to do so due to a fear of relapse or withdrawal symptoms during the discontinuation process.
This PhD aimed to explore beliefs, attitudes, and behavioural intentions towards long-term antidepressant use in the management of people with depression in primary care. A critical interpretive synthesis found that beliefs and attitudes towards depression and antidepressant use influenced patients’ decisions to stop or continue long-term antidepressant treatment. The findings from the synthesis were considered along with existing theoretical models of health behaviour to develop a questionnaire to measure patients’ beliefs, attitudes, and behavioural intentions towards long-term antidepressant use. A sample of 10 participants took part in cognitive interviews to test the understanding and acceptability of the questionnaire before its use in a mixed methods study.
Two hundred and seventy-seven participants took part in The Attitudes and Preferences of People regarding Long-term Antidepressant Use for Depression (APPLAUD) Study, and 16 participants took part in the nested qualitative interview study. The findings from the questionnaire and interviews were interpreted together using a complementarity approach.
The findings showed that patients’ beliefs and attitudes towards depression and long-term antidepressant use predicted intentions to start to come off antidepressants; however, most participants had little to no intention to stop. The qualitative findings showed that participants’ understanding of depression and long-term antidepressant use was multi-factorial and complex. Furthermore, participants rarely attended antidepressant review consultations with their GP, which meant little opportunity for conversations around potential antidepressant discontinuation. As uncertainty is a concept within patients’ representations and understanding of the role of antidepressants in managing depression, having more frequent review consultations with the GP
may be crucial in discussing beliefs around the necessity of antidepressants, and in turn, facilitate conversations around safe and gradual antidepressant discontinuation.

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Identifiers

ORCID for Rachel Dewar-Haggart: orcid.org/0000-0002-3757-1152

ORCID for Anthony Kendrick: orcid.org/0000-0003-1618-9381

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