Access factors associated with the use of St. John's wort among adults with depressive symptoms

Chung-Hsuen. Wu

Background: St. John's wort is one of the top 20 selling herbs in the United States. An estimated 4.4 million adults reported using St. John's wort in the past 12 months (Ni, Simile, & Hardy, 2002). Some studies suggest that the rise in the use of Complementary and Alternative Medicine (CAM) including herbal medications like St. John's wort may reflect the increasing lack of access to conventional medical care (Kennedy, 2005; Pagan & Pauly, 2005). However, empirical research on the use of specific herbal remedies such as St. John's wort and its treatment of clinical conditions like depression has not been conducted. Objective: To examine the association between access to conventional healthcare and the use of St. John's wort among adults who report depressive symptoms. Study Design: Secondary analysis of the Complementary and Alternative Medicine Supplement to the 2002 National Health Interview Survey (NHIS). Study Population: Adults who report depressive symptoms and used St. John's wort (sample, n=246) were compared to nonusers (sample, n=5,111). Results: Depressed people who delay their medical care because of cost are more likely to use St. John's wort (8.0% vs. 4.1%, P< 0.001). People who cannot afford needed medical care (7.47% vs. 4.37%, P=0.002) or cannot afford mental health care or counseling (9.26% vs. 4.42%, P=0.003) are more likely to use St. John's wort than those who can. After controlling for various sociodemographic and socioeconomic factors, people who could not afford needed medical care due to cost were nearly two times (OR 1.92, CI 1.38 - 2.67) more likely to use St. John's wort than those who could afford conventional medical care. Conclusion: The growing use of complementary and alternative therapies in the U.S. is widely interpreted as evidence of changing consumer tastes and dissatisfaction with conventional medical treatment for chronic conditions like depression. However, the rising costs of conventional therapies and diminishing access to health insurance may also play a role. Implications for Policy, Delivery or Practice: The growing use of complimentary or alternative therapies like St. John's wort should be viewed in the context of rising costs and shrinking access. From a clinical perspective, self-treatment with herbal preparations is a potentially risky alternative to conventional treatment. Depression is a serious but treatable chronic illness. For patients to make truly informed treatment decisions, access to conventional medical care should also be assured.

Access factors associated with the use of St. John's wort among adults with depressive symptoms

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