Aspects of patient and clinician language predict adherence to antidepressant medication

High-quality patient-clinician communication is associated with better medication adherence, but the specific language components associated with adherence are poorly understood. We examined how patient and clinician language may influence adherence.

We audio-recorded primary care encounters from 63 patients newly diagnosed with depression and prescribed an antidepressant medication. We rated clinicians' language (motivational interviewing-adherent statements [MIAs], reflections, and global ratings of empathy and "motivational interviewing spirit") along with patients' "change talk" (CT) demonstrating motivation to take medication. Filling a first prescription and an estimate of overall adherence, the proportion of >180 days covered (PDC) (primary outcome), were measured based on pharmacy records.

Fifty-six patients (88.8%) filled an initial prescription, and mean (standard deviation) PDC across all subjects was 45.2% (33.6%). MIAs, complex reflections, and empathy were associated with more CT (for all: rs ≥0.27; P < .05). Two or more and 0 or 1 CT statements were associated with 63.0% and 36.6% PDC, respectively. Empathy, motivational interviewing spirit, and CT were associated with filling the first prescription (for all: rs ≥0.25; P < .05). In an adjusted analysis, empathy (t = 2.3; P = .027) and ≥2 CT statements (t = 2.3; P = .024) were associated with higher PDC.

Clinician empathy, reflections, and MIAs may elicit patient CT, whereas empathy and CT seem to enhance filling an initial prescription and PDC.