Influences on social workers' approach to informed consent regarding antidepressant medications

Psychotropic medications have become an increasingly frequent aspect of mental health treatment, and social workers are uniquely poised to have insight to a client's experience of medication treatment as well as to observe and process with the client the way that medications are working or not working. They are also obligated to support clients with a meaningful informed consent process. This study adopts the Theory of Planned Behavior (Ajzen, 1988) as a lens through which to better understand the factors related to clinical behavior around informed consent when social workers are working with those who are using or considering antidepressant medications. Using quantitative cross sectional survey data collected from 77 practicing Master of Social Work clinicians in New York State, the study asked the following questions: Are attitudes, subjective norms and self-efficacy associated with changes in quality of informed consent? Which of the domains theorized to influence practitioner behavior (attitudes, subjective norms, self-efficacy, personal experience, professional norms, and contextual influences of pharmaceutical marketing and the biomedical model) are significantly associated with informed consent related to antidepressants? Are personal experience, professional norms, and contextual influences of pharmaceutical marketing and the biomedical model associated with antidepressant attitudes, subjective norms and self-efficacy? The outcome variable "Quality of informed consent" was found to be significantly associated to a professional norm "regarding randomized control trials as useful": all respondents who regarded randomized control trials as useful and all respondents who were neutral about randomized control trials fell into the "not best practice" category describing quality of informed consent. The study also found significant associations between the independent variables: pharmaceutical marketing has a significant impact on social workers' attitudes and subjective norms; the bio-medical model is significantly associated with social workers self-efficacy and subjective norms. A social workers' satisfaction with their personal experience taking antidepressants were associated with all three Ajzen domains, subjective norms, attitude and self-efficacy. Professional norms, including the importance of evidence based practice and regarding randomized controlled trials as useful were also significantly associated with all three Ajzen domains. Implications for social work practice, policy and research are discussed.