Utilizing Consumer Health Posts to Identify Underlying Factors Associated with Patients' Attitudes towards Antidepressants

BACKGROUND: Non-adherence to antidepressants is a major obstacle to antidepressants therapeutic benefits, resulting in a significant burden on individuals and the healthcare system. Several studies showed that non-adherence is weakly associated with personal and clinical variables, but strongly associated with patients’ beliefs and attitudes towards medications. Patients’ drug review posts in online healthcare communities may provide a significant insight into patients’ attitudes towards antidepressants and address the challenges of self-report methods such as patients’ recruitment. OBJECTIVE: The primary objective of this study is to use consumer health posts to identify factors affecting the patient’s attitude towards the drugs, which in turn, is a strong determinant of treatment non-adherence. METHODS: We randomly selected 892 patients’ drug reviews from a healthcare forum “askapatient.com”. We used the Framework Method to build the analytical framework containing the themes for developing structured data from the qualitative drug reviews. In the next step, four annotators coded the drug reviews at the sentence level using the analytical framework. To test the hypotheses, we first managed missing values using different imputation methods. Then, we used chi-square and ordinal logistic regression to test and model the association between variables and attitude. RESULTS: Analysis of the sample showed that the drug reviews were posted from February 2001 to February 2016. The majority of the patients (76%; n= 680) were female. Approximately two-thirds of the patients (n=540) were less than 40 years of age. Testing the association between variables and attitude showed that “experience of adverse drug reactions (ADRs)” ( x=¿ 31.11, P= 2.91e-06), “perceived distress from ADRs” ( x=¿ 231.6, P= 2.2e-16), “drug effectiveness” ( x=¿ 548.52, P= 2.2e-16), “complaint about the lack of knowledge” ( x=¿ 59.36, P= 3.96e-12), “experience of withdrawal” ( x=¿ 55.63, P= 2.4e-11), and “duration of usage” (F-value= 43.66, P = 6.76e-11) were significantly associated with patients’ attitudes towards antidepressants. While variables “age” (F-value= 0.72, P = 0.4) and “gender” ( x=¿ 2.7, P= 0.21) were not associated with the patients’ attitudes. Moreover, modeling the relationship between variables and attitudes showed that “drug effectiveness” and “perceived distress from adverse drug reactions” were the two most significant factors affecting patients’ attitude toward antidepressants. CONCLUSIONS: Patients’ self-report experiences of medications in online healthcare communities can provide a unique insight for identifying underlying factors associated with patients’ perceptions and attitudes towards antidepressants. However, it cannot be used as a replacement for self-report methods due to the lack of information for some of the variables, colloquial language, and the unstructured format of the reports.