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TODAY news for Thursday, March 17, 2008

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LLU professors study poor mental health, medication adherence

Mark G. Haviland, PhD (left), and Jim E. Banta, PhD, are participants in the mental health research project.
Mark G. Haviland, PhD (left), and Jim E. Banta, PhD, are participants in the mental health research project.
Forest Laboratories, Inc., has awarded Mark G. Haviland, PhD, professor of psychiatry, a $50,000 research grant to study the effects of poor mental health and binge drinking on adherence to anti-hypertension and asthma control medications. Jim E. Banta, PhD, MPH, assistant professor, School of Public Health, is a co-principal investigator. 

Loma Linda University collaborators include Donald L. Anderson, MD, and Peter Przekop, DO, PhD, from the department of psychiatry in the School of Medicine, and Leonard S. Werner, MD, from the School of Medicine dean’s office and department of internal medicine.

Collaborators from the University of California, Riverside, are M. Robin DiMatteo, PhD, and Summer L. Williams, MA; and from Texas State University, Kelly B. Haskard, PhD, is participating.

The complex behaviors required for effective disease management can be challenging, and depression, substance abuse, social disconnection, and stress inhibit commitments to behavioral change and adherence to prescribed treatments. In few studies, however, are researchers able to control for the many health status, socio-demographic, social support, economic resource, and health care access variables also associated with adherence. 

To address the substantive issue, as well as the methodological challenges, this research team used data from a large population survey to evaluate the effects of poor mental health and binge drinking (five or more drinks at one time) on medication adherence among Californians with hypertension and with asthma.

Data were from the adult 2003 California Health Interview Survey <www.ucla.chis.edu>.  This is the largest state health survey ever carried out in the United States and is a population-based, random-digit dial telephone survey of California households. The 42,044 completed responses are representative of all 25.6 million California adults living in households.

Among adult Californians with hypertension, poor mental health was a significant predictor of medication nonadherence (after covariate adjustment in a multivariable logistic regression analysis), whereas binge drinking was not. Other factors associated with nonadherence were reporting very good or excellent health, being 18-44 years of age, being Latino, having less education, having no usual source of care, being uninsured, and being a non-citizen. Factors associated with adherence were medical comorbidity, reporting fair or poor health, being 65 years of age or older, being African American, having more education, not working, and having prescription insurance coverage. 

Among adult survey respondents with symptomatic asthma, binge drinking was a significant predictor of medication nonadherence, but poor mental health was not. Other factors associated with nonadherence were being overweight, being 18 to 44 years of age, having some college education, being a current smoker, and having no usual source of care. Factors associated with adherence were being 76 years of age or older, increasing frequency of asthma symptoms, having asthma-related ER/urgent care visits or missed workdays, being African American, and not working.

Despite the limits of studies of this kind (notably, these were secondary analyses and self-report data), given the size and scope of the survey, the researchers have recommended that those responsible for the care of patients with hypertension be particularly attentive to medication use/non-use patterns among individuals with poor mental health. They recommended in the asthma study that those caring for asthma patients attend to their patients’ binge drinking/excessive alcohol use, as appropriate.

Results from the hypertension study were presented at the Academy Health meeting in June by Dr. Banta, and the full manuscript has been accepted for publication in the American Journal of Health Behavior. Preliminary asthma analyses were presented at the American Psychiatric Asso­ciation meeting in May by Dr. Anderson, and the manuscript is scheduled for publication in a forthcoming issue of the Journal of Asthma.

Drs. Banta, Haviland, and Przekop have continued their research on binge drinking with data from the 2005 CHIS survey, and a manuscript titled “Mapping estimated county-level income and binge drinking among California men” was published in the February 2008 issue of the journal, Psychiatric Services. This research was highlighted in the February 19, 2008, edition of “Alcohol Reports,” available at <www.alcoholreports.

blogspot.com>. They presented other binge drinking research findings last year at the West Coast College of Biological Psychiatry meeting and will again this April.

William G.C. Murdoch, MD, interim chair of psychiatry, is particularly appreciative of the cross department, school, and university collaborations, as well as the broad appeal of the group’s specific findings.

“Among the many serious problems associated with having a mental or addictive disorder is poor self care,” he says. “This outstanding research team has demonstrated this, and their recommendations are especially useful. I am delighted with the broad appeal of these investigations and that they have been received so well in psychiatry, health psychology, general medicine, and public health.”

Contributed Report

TODAY news for Thursday, March 17, 2008