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Stigma Predicts Treatment Preferences and Care Engagement Among Veterans Affairs Primary Care Patients with Depression

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Whereas stigma regarding mental health concerns exists, the evidence for stigma as a depression treatment barrier among patients in Veterans Affairs (VA) primary care (PC) is mixed.

Purpose

This study tests whether stigma, defined as depression label avoidance, predicted patients’ preferences for depression treatment providers, patients’ prospective engagement in depression care, and care quality.

Methods

We conducted cross-sectional and prospective analyses of existing data from 761 VA PC patients with probable major depression.

Results

Relative to low-stigma patients, those with high stigma were less likely to prefer treatment from mental health specialists. In prospective controlled analyses, high stigma predicted lower likelihood of the following: taking medications for mood, treatment by mental health specialists, treatment for emotional concerns in PC, and appropriate depression care.

Conclusions

High stigma is associated with lower preferences for care from mental health specialists and confers risk for minimal depression treatment engagement.

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Acknowledgments

This project was funded by the Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Service and the VA Quality Enhancement Research Initiative (QUERI) (Project nos. MHI 99-375, MNT 01-027, MHQ 10-06). The authors acknowledge the contributions of the study participants who made this work possible. A portion of this work was presented at the 35th Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine, Philadelphia, PA.The views expressed here are those of the authors and do not necessarily represent the position or policy of the Department of Veterans Affairs, the United States Government, and the authors’ other institutions.

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Correspondence to Duncan G. Campbell PhD.

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Authors’ Statement of Conflict of Interest and Adherence to Ethical Standards

Authors Campbell, Bolkan, Lanto, Zivin, Waltz, Klap, Rubenstein, and Chaney declare that they have no conflict of interest. The research described in this manuscript was conducted in accord with ethical principles for the treatment of human subjects. All study procedures were approved by the institutional review boards of the participating study sites and the primary study administrative site.

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Campbell, D.G., Bonner, L.M., Bolkan, C.R. et al. Stigma Predicts Treatment Preferences and Care Engagement Among Veterans Affairs Primary Care Patients with Depression. ann. behav. med. 50, 533–544 (2016). https://doi.org/10.1007/s12160-016-9780-1

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