Twenty-two subjects were enrolled in the study during the 4-month period: 21 women and 1 man aged 24 to 77 years (mean age = 45 years). Twenty subjects were white; 2 were African American.
The interview questions were developed by investigators who brainstormed about important topics that would relate to the decision to use SJW. Two initial open-ended questions led people to reflect on their decision-making process, mood, and situation at the time of first use. Each open-ended question was followed by a series of probes used to address specific topics if these topics were not already mentioned by the participant. Key factual questions about other treatments, seeking primary care physician or pharmacist advice, dosage, side effects, and recommendations to others were subsequently asked.
Each session was audio-recorded. Two subjects were excluded because of faulty recordings (2 white women). The remaining 20 sessions were transcribed verbatim, reviewed by 2 independent analysts who extracted substantive quotes from the responses to each interview question. Extracted quotes were discussed in 3 group meetings by at least 4 investigators who reviewed each interview and aggregated categories and frequencies of responses. Theme categories evolved from the data and were agreed on by the investigators as interviews were discussed.
Transcription and quotation extraction was performed concurrent with subsequent interviews to permit better recall of interview nuances of importance. After the transcription was complete themes were developed and derived for each interview question and later combined into overall interview themes in the following areas: aspects of decision making, characteristics of the acute emotional crisis, previous history and perceptions of treatments for depression, previous history and perceptions of the use of alternative medicine in general, perceptions of conventional providers, views about alternative treatments, and effectiveness and side effects of SJW.
Results
Themes
Interviewees reported many reasons for choosing SJW. Four decision-making themes emerged: personal health, depressed mood, perceptions of disease seriousness, and accessibility to care issues.
Personal Health Care Values. This theme included the interviewee’s history of use of medical services and alternative treatments. Respondents reported prior use of alternative remedies, and concurrent use of other herbs, vitamins, and other supplements. The reports of prior use were positive and were often presented in a zealous fashion. Often the subjects’ parents were proponents of alternative therapies, and they were likely to express a belief in such type of care, sometimes even reflecting a faith in divine healing through natural treatments.
Alternative medications were seen as appropriate treatments for all problems. Respondents believed that herbal methods were purer and safer than prescriptions and reported a corresponding mistrust of modern medicines because of their increased potency, increased side effects, and the fear that medicine can cause more harm than good or be addictive in nature. They expressed a willingness to experiment and try new things, almost a sense of adventure in the herbal arena and the belief that it is “cool” to take herbal medicines. One study subject explained, “I’m into the natural stuff anyway. I’m Christian, and I believe God supplied in nature what we need for the most part. I felt like if I could help myself by taking a natural product…also, we had done some research on Prozac, and I didn’t really want to go that route because of the side effects and the dangers there. I felt better about taking something natural.”
The belief that a person should be in control of his or her own treatment was evident in this group. Borrowing from the concept of health locus of control, these are people who believe that they are responsible for their health and their health care. This belief came from a history of failed attempts with medical providers and also from a family or cultural idea that “you are to take care of yourself,” especially your emotional problems. A great advantage to SJW is that a prescription is not necessary; the patients could experiment with SJW on their own.
Mood. All patients in this sample reported depressed mood, sometimes characterized by agitation and sometimes by lethargy. All participants recognized depression as the reason for their use of SJW, and most reported an acute crisis in their lives that led to the decision to self-treat.
The primary emotional descriptors were sadness or depressed mood, hopelessness, suicidal ideation, and lack of energy. Some interviewees reported confused thinking, the inability to make decisions, and an increasing desire to be alone. Others reported feeling irritable or overwhelmed and stressed out. Finally, a small but consistent theme connected depressed mood to menstrual or menopausal changes.