• Mei-Chi Hsu Mei-Chi Hsu

Complementary and Alternative Medicine (CAM) is being increasingly used by consumers to prevent disease and promote health in general. However, the use of CAM by adults with depression remains a largely unexplored area. Little is known about how patients actually use CAM while they are under the care of health professionals and being prescribed conventional medicine. More information is required regarding the impact of CAM on conventional treatment, because such information can have important implications for public health and mental health care. Using a descriptive design, the main aim of the thesis was to identify the prevalence of CAM use in a sample of Taiwanese patients (n = 206). Participants were aged 50 years or over and were hospitalised with a diagnosis of depression. The study also aimed to identify factors associated with CAM use and the influence of CAM use on compliance with antidepressant medication. This study consisted of 2 phases. During Phase 1, participants who were hospitalised and receiving conventional care for depression were surveyed in a face-to-face interview. The survey included (1) CAM use, (2) reasons for use, (3) communication with health professionals about CAM use, and (4) support for CAM use. Attitudes toward and perceived education of nurses about both CAM and antidepressant medication were measured as potential contributing factors to CAM use. The influence of CAM use on adherence to antidepressant medication was also addressed. Phase 2 consisted of a telephone interview conducted one month following discharge. Participants repeated the CAM survey, and the Adherence Attitude Inventory (AAI) was added in this phase. Nearly 70% of participants (69.9%, n = 144) reported using at least one CAM therapy in the past 12 months and 50.2% (n = 101) reported using CAM for one month after discharge. During the past 12 months, around 60% of participants (59.2%, n = 122)had used a combination of CAM and antidepressants to treat depression; 20.4% (n = 42) had used antidepressants exclusively; and 10.7% (n = 22) had used CAM exclusively. One month after discharge, 40.8% (n = 82) reported using CAM and antidepressants; 28.9% (n = 58) had used antidepressants exclusively; and 9.5% (n = 19) had used CAM exclusively. The most commonly used CAM therapies in the treatment of depression were herbal medicines, spiritual healing by others and folk remedies. In Phase 2, the most commonly used CAM were spiritual healing by others, relaxation techniques and herbal medicine. In Phase 1, 'improved feeling of well-being' was reported as the primary reason for using CAM, followed by 'symptom relief' and 'increased energy'. In Phase 2, 'symptom relief' was the main reason participants used CAM for depression. Although some participants sought CAM from licensed therapists, some also sought CAM from non-licensed therapists. A high proportion of participants never discussed their CAM use with psychiatrists or nurses. The most likely users of CAM were women aged 50 - 64 who had higher incomes, higher education, current employment, strong religious beliefs and practice, and a longer duration of depression. There was a statistically significant relationship between CAM use and antidepressant use. Participants had slightly favourable attitudes toward CAM. Many participants (50%, n = 102) expressed that they were willing to try any possible treatment for depression. They believed that CAM helped them to feel better and live a happier life. They disagreed that CAM could be ineffective. However, two thirds of participants (66.5%, n = 137) reported that they have inadequate knowledge of CAM. Most participants were unsure whether CAM assisted with the effects of antidepressants or affected their tolerance of other treatments, or if CAM use conflicted with their antidepressants. Most participants were not satisfied with the health education they received about CAM. Participants also reported receiving low levels of education about antidepressant medication. However, a consistent positive relationship between attitudes toward CAM and reported patient health education about CAM was found both in Phase 1 (&beta = .276, p less than .001) and Phase 2 (&beta = .152, p less than .05). Patient education about CAM was found to be a mediator for the use of CAM in Phase 1, but not in Phase 2. Positive attitudes toward CAM and patient health education accounted for 32% of the variance in the use of CAM. CAM use for depression and its influence on antidepressant medication is an under-explored area and to date no similar research has been conducted in Taiwan. This research is distinctive in that it identified the prevalence of CAM use for depression, the demographic, attitudinal and educational factors that contribute to the use of CAM, and the potential impact of CAM on conventional medicine use. Such findings should prompt not only the exploration of new areas of CAM research and depression management, but also help to determine how CAM can best be used to meet patients' needs, for which culturally appropriate care ultimately leads to better patient treatment options.