Rural Perspectives Challenging Pharmacotherapy
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troduction Though studies analyzing large national data sets find that rural residents experience depression at similar rates as the general US population,1, 2 studies estimating the prevalence of depression among rural women in smaller primary care-based samples find significantly higher levels of depression, ranging from 33 to 44%,3–6 and higher rates of suicide.7 Compared with urban residents, residents of the most rural areas receive less mental health treatment.8 The depression treatment rural residents do receive is more likely to be pharmacotherapy than psychotherapy,9 disproportionately received from primary care providers due to mental health provider shortages in rural areas.10, 11 Even when rural residents access guideline concordant care, it is not shown to have the same effectiveness as for urban populations.12 Though pharmacotherapy remains the predominant option for rural residents with significant need, little is known about their perceptions of this treatment form. The work was completed at the University of Kentucky College of Medicine. Address correspondence to Claire Snell-Rood, PhD, Division of Community Health Sciences, School of Public Health, University of California, 2121 Berkeley Way #5302, Berkeley, CA 94720, USA. . Ryan Jenkins, BA, MD, Rainbow Babies and Children’s Hospital, Cleveland, OH, USA.
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Journal of Behavioral Health Services & Research, 2020. 1–7. c 2020 National Council for Behavioral Health. DOI 10.1007/s11414-020-09721-5
Rural Perspectives Challenging Pharmacotherapy
JENKINS & SNELL-ROOD
Broadly, research shows that patients prefer psychotherapy to pharmacotherapy, expressing doubt in pharmacotherapy’s adequacy and distrust of its side effects.13, 14 The perceived stigma of using depression medication has been shown to lower adherence to clinician recommendations.15, 16 Consistent with such an approach, recommendations and interventions to improve adherence to pharmacotherapy have focused on changing consumers’ attitudes about medication, combatting stigma, and improving practitioner communication.17, 18 In contrast to this focus on individual decisions about pharmacotherapy consumption, recent anthropology and sociology research has explored how consumers’ perceptions of pharmacotherapy interact with broader factors shaping their lived experience of pharmaceuticals, including healthcare availability, social conditions, and health needs. These studies raise questions about how consumption of psychiatric medication impacts patients’ sense of themselves, and further, how local experiences of pharmaceutical consumption interact with broader social, cultural, and economic processes.19, 20 Attention to the context of decision-making holds great relevance for better understanding the broad factors shaping pharmacotherapy use, and therefore, for pointing toward novel, culturally appropriate strategies to improve treatment access. Guided by this framework, this study examines emergent themes about pharmaceutical use that arose during semi-structured interviews and focus groups in ru
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