This investigation suggests that having a vicarious experience with depression may lead to a more positive attitude towards treatment with antidepressant medications. Specifically, having a family member who had been treated for depression was associated with positive attitudes toward antidepressants for respondents with a history of depression. In contrast, for respondents with no history of depression treatment, having a friend with a history of depression was associated with positive attitudes toward antidepressant medications. These findings support our hypothesis, based on learning and social cognitive theory, that both personal past experiences and the experiences of others can significantly affected attitudes towards treatment.
Patients who have taken antidepressant medication in the past have a highly favorable attitude towards antidepressants. This is consistent with other work which has shown an favorable attitude towards treatment for those who have been prescribed or are currently taking anti-depressants 
,. Prior research suggests that those with positive attitudes towards antidepressants are more likely to be adherent 
and that as treatments more closely match patient preferences, adherence is increased 
Interestingly, we also found that higher scores on the PHQ-9 are associated with more negative attitudes. As past work has shown that those with negative attitudes towards treatment have decreased adherence 
, this suggests that those who might benefit most from treatment, those most depressed 
, might be a group at particular risk for non-adherence. Every effort should be made to engage these patients in evidence based therapies.
Busy clinicians, especially in primary care, often face multiple demands for their time. We feel the ideal time to discuss vicarious experiences with depression treatment with a patient is when a clinician is considering initiation of treatment. This can be incorporated into routine counseling and anticipatory guidance around starting a new medication. Open-ended statements encourage patients to share details about their own experiences. For example, clinicians could say “Do you know anyone who has had depression?” or “Tell me about people you have known with depression”. Once obtained, this information can help identify patients at greater risk for non-adherence and be used to tailor patient-specific education about treatment.
It is curious that patients with a personal history of depression are influenced differently by their vicarious experience compared to those with no personal history. Patients with a personal and family history of depression may view their condition as more attributable to heredity and thus be open to a biomedical perspective, one that views pharmacological treatment favorably. In contrast, a person with no history of depression may see the depression experiences of a friend as being more informative than the experience of a family member. It should be noted, however, that although the association between attitudes toward antidepressant medications and having a family member who had been treated for depression for this group of respondents missed statistical significance, the relationship was in the anticipated direction. How vicarious experience mediates attitudes toward treatment for depressive symptoms is unknown. One possible mechanism may lie through the reduction of stigma. Prior studies of vicarious experience have noted that people who have a friend or family member with depression rate lower on measures of stigma (such as regarding depression as a ‘real’ illness, or feeling that a person with depression could “get better if they wanted”) than those without such an experience 
This study has several limitations. First, our outcome was a psychometric measure of attitudes towards antidepressants derived from survey data. It was not validated or assessed for reliability in other populations, and was not a clinical measure. Thus we cannot be sure how the associated positive regard will translate in the office setting. Second, our data are cross-sectional and thus can demonstrate an association between vicarious experience and treatment attitudes, but not a causal link. Third, compared to the BRFSS survey sample as a whole 
, which is representative of California, our sample was generally older and had higher income than the general population. Although we controlled for age and income in our analysis, this may limit generalizability to other settings.
In summary, patients who lack personal or vicarious experiences with depression tend to have negative attitudes towards antidepressants. Conversely, having such experience may facilitate acceptance of pharmacotherapy. Future research should focus on strategies that utilize knowledge of patient characteristics to boost treatment adherence.