Pharmaceutical Care in Depression: A Survey of Stigma, Confidence, Attitudes, and Barriers

Figures & data

Table 1 Demographic Information of Pharmacists Surveyed (n=86)

Characteristics	n (%)
Age (year)
<30	30 (34.9)
30–40	34 (39.5)
41–50	18 (20.9)
>50	4 (4.7)
Gender
Male	26 (30.2)
Female	60 (69.8)
Years of practice (year)
<5 years	22 (25.6)
5 to 10 years	26 (30.2)
11 to 20 years	26 (30.2)
>20 years	12 (14.0)
Setting of pharmacy practice
Community pharmacy	43 (50.6)
Hospital pharmacy	26 (30.6)
Other	16 (18.8)
Region of practice
Greater Cairo	28 (32.9)
Alexandria region	17 (20.0)
Delta Region	33 (38.8)
Upper Egypt	8 (9.3)
Highest degree awarded in pharmacy
B Pharm	46 (53.5)
Diploma	17 (19.8)
Pharm D	10 (11.6)
Master	8 (9.3)
PhD	5 (5.8)
Pharmacist received any postgraduate mental health training
No	68 (81.0)
Yes	16 (19.0)
Pharmacist or someone close to him/her suffer from depression
No	40 (46.5)
Yes	46 (53.5)
Pharmacy routinely screen patients for depression
No	83 (96.5)
Yes	3 (3.5)
Estimated percentage of pharmacist’s patients suffering from depression
0 to 25%	49 (59.0)
26% to 50%	25 (30.1)
51% to 75%	9 (10.8)
76% to 100%	0 (0.0)
The pharmacist’s ability to provide pharmaceutical care to depressed patients is affected by pharmacist’s opinions about depression
Definitely	23 (27.1)
Probably	35 (41.2)
Maybe	16 (18.8)
Not at all	11 (12.9)

Table 2 Pharmacists’ Stigma of Patients with Depression (n=86)

Item	Mean ± SD	Response to Each Item, n (%)					Having Negative Opinion, n (%)
		Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
Patients with depression are dangerous to others	3.2 ± 1.1	8 (9.3)	10 (11.6)	34 (39.5)	23 (26.7)	11 (12.8)	18 (20.9)
Patients with depression are unpredictable	2.3 ± 1.0	22 (25.6)	30 (34.9)	21 (24.4)	12 (14.0)	1 (1.2)	52 (60.5)
Patients with depression are hard to talk to	3.2 ± 1.2	7 (8.1)	20 (23.3)	24 (27.9)	21 (24.4)	14 (16.3)	27 (31.4)
Patients with depression feel different	1.7 ± 0.8	39 (45.3)	35 (40.7)	9 (10.5)	2 (2.3)	1 (1.2)	74 (86.0)
Patients with depression have only themselves to blame	4.6 ± 0.7	0 (0.0)	1 (1.2)	6 (7.0)	23 (26.7)	56 (65.1)	1 (1.2)
Patients with depression should pull themselves together	3.4 ± 1.4	11 (12.9)	12 (14.1)	19 (22.4)	20 (23.5)	23 (27.1)	23 (27.1)
Patients with depression are not improved if treated	4.3 ± 1.2	7 (8.1)	2 (2.3)	3 (3.5)	19 (22.1)	55 (64.0)	9 (10.5)
Patients with depression will never recover	4.5 ± 0.7	0 (0.0)	2 (2.3)	5 (5.8)	26 (30.2)	53 (61.6)	2 (2.3)

Notes: The pharmacists responded to each item on a 5-point scale ranging from (1 – strongly agree) to (5 – strongly disagree). The response to each item is classified as “having negative opinions” if the pharmacist scored 1 or 2.

Table 3 Pharmacists’ Confidence About Medication Consultation for Depressive Patients (PCMCD) (n=86)

Item	Mean ± SD	n (%)
		Disagree	Tend to Disagree	Neither Agree Nor Disagree	Tend to Agree	Agree
I can understand the patient’s medical condition	4.1 ± 1.0	3 (3.5)	6 (7.0)	8 (9.3)	33 (38.4)	36 (41.9)
I can perceive change in the patient’s medical condition	4.0 ± 1.2	6 (7.0)	6 (7.0)	8 (9.3)	30 (34.9)	36 (41.9)
I can comprehend the patient’s comorbid illness	4.1 ± 1.1	5 (5.8)	4 (4.7)	7 (8.1)	27 (31.4)	43 (50.0)
I can ease the patient’s anxiety about medication	4.6 ± 0.7	0 (0.0)	3 (3.5)	4 (4.7)	20 (23.3)	59 (68.6)
I can understand the patient’s background and value system.	4.4 ± 0.8	0 (0.0)	3 (3.5)	5 (5.8)	32 (37.2)	46 (53.5)
I can comprehend the patient’s medication adherence status	4.2 ± 1.0	2 (2.3)	5 (5.8)	11 (12.8)	24 (27.9)	44 (51.2)
I can establish a trust relationship with the patient	4.3 ± 1.0	3 (3.5)	2 (2.3)	11 (12.8)	22 (25.6)	48 (55.8)
I can maintain a good trust relationship with the patient	4.3 ± 0.9	2 (2.3)	2 (2.3)	11 (12.8)	24 (27.9)	47 (54.7)
I can tell what to do when a side effect develops	3.9 ± 1.3	7 (8.1)	8 (9.3)	5 (5.8)	30 (34.9)	36 (41.9)
I can provide information on side effects of antidepressants	4.5 ± 0.9	2 (2.3)	1 (1.2)	5 (5.8)	21 (24.4)	57 (66.3)
I can appropriately instruct how to take antidepressants	4.5 ± 0.9	2 (2.3)	2 (2.3)	5 (5.8)	19 (22.1)	58 (67.4)
I can provide guidance to patients with poor medication adherence	4.5 ± 0.6	0 (0.0)	1 (1.2)	4 (4.7)	33 (38.4)	48 (55.8)
Total score	51.4 ± 6.6	–	–	–	–	–

Notes: Each participant responded to each item on a 5-point scale ranging from (1) “total disagreement” to (5) “total agreement” that he/she can perform the task in the item.

Table 4 Pharmacists’ Attitudes Toward Providing Pharmaceutical Care to Patients with Depression and Other Physical Conditions (n=86)

Task	Response, n (%)^†		P value^‡
	Depression	Other Physical Conditions
How confident, comfortable, interested, and likely are you to obtain a medication history?
Much less	2 (2.3)	0 (0.0)	0.0000
Less	5 (5.8)	5 (5.8)
Neutral	25 (29.1)	10 (11.6)
More	39 (45.3)	38 (44.2)
Much More	15 (17.4)	33 (38.4)
How confident, comfortable, interested, and likely are you to screen for pharmacotherapy problems?
Much less	1 (1.2)	0 (0.0)	0.0005
Less	3 (3.5)	4 (4.7)
Neutral	24 (28.2)	12 (14.0)
More	37 (43.5)	37 (43.0)
Much More	20 (23.5)	33 (38.4)
How confident, comfortable, interested, and likely are you to monitor for efficacy and adverse effects?
Much less	3 (3.5)	1 (1.2)	0.57
Less	1 (1.2)	4 (4.7)
Neutral	18 (20.9)	13 (15.1)
More	36 (41.9)	45 (52.3)
Much More	28 (32.6)	23 (26.7)
How confident, comfortable, interested, and likely are you to provide medication counseling?
Much less	0 (0.0)	0 (0.0)	0.003
Less	7 (8.1)	4 (4.7)
Neutral	15 (17.4)	6 (7.0)
More	36 (41.9)	37 (43.0)
Much More	28 (32.6)	39 (45.3)

Notes: ^†Pharmacists responded to each question with “much more”, “more”, “neutral”, “less”, or “much less.” ^‡Attitudes to patients with depression and other physical illnesses were compared using the Wilcoxon signed-rank test. The p-values <0.05 were considered significant.

Figure 1 Barriers to provide pharmaceutical care to patients with depression (n=86).

Figure 2 Pharmacists’ needs for caring for patients with depression (n=86).