Introduction

Effect of Adherence on Psychological Outcomes
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Best practice in healthcare is based on empirically proven treatment modalities. One aspect of treatment that is presumed to yield better outcomes is adherence to treatment. However, this aspect of treatment has been emphasized in medication treatments. Patients across the spectrum of diseases have shown issues with adherence to treatment, calling for a need to investigate the factors that impede this adherence. On the other hand, there has been minimal attention on the health care effects of this adherence. Often, it is presumed that better adherence would yield better outcomes, there is no study indicating the extent of positive outcomes that would be derived from such behavior.
The concept of ‘adherence’ in general medicine has received more attention, unlike in the field of psychology. Gonzalez and Williams (2006) indicated that the limited focus on adherence in psychological treatments is due to the varied approaches that are characteristic of these treatments. Unlike medicine, psychological therapy views adherence in reference to dropouts; yet, medication treatments characterizes adherence in terms of visits; hence, when conducting this study, it is important to operationalize the term adherence. The varied approaches; thus, indicate the different and inconsistent effect of adherence. As a result, there is need to conduct studies that will help to develop a standardized definition of the word. Also, most studies in psychology have examined adherence as an outcome of treatment, unlike the current study that aims to look at adherence as a predictive factor.

There have been various studies that have sought to investigate the effects of adherence on health care outcomes, most of which are old and a few are not specific to psychological disorders. Horwitz and Horwitz (1993) indicated that adherence is associated with positive outcomes but adherence calls for more than taking a particular medication, but it is also associated with “nonspecific therapeutic effects” where mental health might be part (Horwitz & Horwitz, 1993, p. 1863). Depression has been one comorbid that has shown to emerge and coexists with other ailments and especially when the course of treatment is not associated with a good prognosis.
Depression is believed to occur when treatment does not produce beneficial outcomes, but it can occur as an independent entity. Gonzalez and Williams (2006) state that this disorder is associated with low adherence levels to treatment when it coexists with another ailment like diabetes. However, it is unclear whether the disorder would produce similar effects when it exists solely as a psychological ailment. Grenard et al. (2011) have suggested a similar trend due to a myriad of risk factors linked to non-adherence among individuals with coexisting ailments that include depression. There are various studies that indicate various interventions that can be applied to increase adherence among individuals with depression, but it is unclear whether they would produce expected adherence levels as shown in these studies.
There is adequate research on the factors that influence adherence to treatment, and a substantial amount of research investigations have been carried out to develop strategies meant to increase adherence and presumed associated effects. There are limited studies that have focused on adherence interventions in depression which could be due to the various psychological disorders and each seems to require specific interventions. In reference to psychological disorders, individuals have a negative perception about these disorders because patients think that they are being considered “mad/crazy”; hence, they are likely to deviate from the normal course of treatment.
In a more recent study by Hogue et al. (2010), the impact of adherence on treatment outcomes was based on certain predefined outcomes. In addition, the treatments under investigation were cognitive-behavioral therapy (CBT) and multidimensional family therapy (MDFT). This study was conducted among a group of adolescents who had been diagnosed with substance use and abuse. Thereby, the outcomes under investigations were limited to timeline follow-back, eternalizing and internalizing symptoms, and the severity of the substance use problem using a personal experience inventory. However, this study aims at focusing on depression, which has received the least attention in relation to adherence. Also, this study will target the care givers because most of the individuals with depression are not in a position to answer research questions.
It, therefore, follows that adherence is an important aspect of effective treatment, but it has been viewed differently in psychology as opposed to general medicine. Using a more holistic approach to adherence, there is need to carry out a study that examines their effect on depression because this aspect of treatment has rarely been studied in this population. Hence, the purpose of this study will be to determine the effects of adherence on treatment or healthcare outcomes among individuals between 45 and 60 years with depression using a quasi-experimental design. Hence, the guiding research questions will be:
What strategies can be used to promote total adherence to treatment among individuals with depression?
How does adherence improve psychological treatment outcomes?
The hypotheses to be tested will be:
H01: There is no relationship between adherence strategies and depression scores
H02: There is no relationship between adherence and improved treatment outcomes

References
Gonzalez, J., & Williams, J. W. (20016). The effects of clinical depression and depressive symptoms on treatment adherence. In H. B. Boswoth, E. Z. Oddone, & M. Weinberger (Eds.), Patient treatment adherence: Concepts, interventions, and measurement. London: Lawrence Erlbaum Associates.
Grenard, J. L., Munjas, B. A., Adams, J. L., Suttorp, M., Maglione, M., McGlynn, E. A., & Gellad, W. F. (2011). Depression and Medication Adherence in the Treatment of Chronic Diseases in the United States: A Meta-Analysis. Journal of General Internal Medicine, 26(10), 1175–1182.
Hogue, A., Henderson, C. E., Dauber, S., Barajas, P. C., Fried, A., & Liddle, H. A. (2008). Treatment Adherence, Competence, and Outcome in Individual and Family Therapy for Adolescent Behavior Problems. Journal of Consulting and Clinical Psychology, 76(4), 544–555.
Horwitz, R. I., & Horwitz, S. M. (1993). Adherence to treatment and health outcomes. Archives of Internal Medicine, 153(16), 1863-1868.