PGx in psychiatry: Patients’ knowledge, interest, and uncertainty management preferences in the context of pharmacogenomic testing

Abstract

Objective.

Pharmacogenomic testing (PGx) is expanding into psychiatric care. PGx could potentially offer a unique benefit to psychiatric patients, providing information about patients’ reaction to medications that could reduce the time and financial burdens of drug optimization. The aims of this study were to: (1) examine psychiatry patients’ familiarity and interest in PGx, and (2) explore how Uncertainty Management Theory relates to PGx testing in psychiatry.

Method:

We surveyed psychiatric patients, measuring their PGx familiarity and interest, attitudes toward PGx testing, and preference managing illness uncertainty.

Results:

We analyzed data from 598 patients. Patients’ familiarity of PGx was low, but interest was high. Thirty percent of patients were familiar with the test from communication with their healthcare provider or their own online health information seeking. A preference for seeking information was a significant positive predictor of testing interest (p<.001).

Conclusion:

Psychiatric patients were interested in PGx testing, regardless of their uncertainty management preferences.

Practice Implications:

This study is one of the first to examine psychiatric patients’ perspectives on PGx testing in mental health care. Our findings show that psychiatric patients are interested in the test and are familiar enough with PGx to be included in future research on the topic.

1. Introduction

One in five Americans report suffering from a mental health condition, and yet drug optimization for psychiatric patients is still an unusually long and difficult process [1]. Antidepressants are one of the mostly commonly prescribed medications, but only 55 – 65% of patients have a successful first antidepressant trial [2]. From 2009 to 2011, there was an estimated 89,094 psychiatric medication adverse drug event emergency department visits. Indeed, about 25,000 patients are seen in the emergency department annually in the United States due to antidepressant-induced adverse events [3]. In addition to factors like age, gender, and diet that can affect individual responses to any course of treatment, the success of psychiatric drugs is often limited by patients’ genetic variation [4]. Barring a family history of mental illness, physicians often have little to inform their prescription choice and dosage [5]. The variability of patients’ responses to psychiatric drugs can lead to harmful side effects and untreated symptoms [4, 6, 7]. As result, identifying a successful drug regimen often requires psychiatric patients to undergo an extensive trial and error process, enduring numerous healthcare visits, missed work days, diminished productivity, disability claims, and exorbitant treatment costs [4].

One potential solution to this problem is the implementation of pharmacogenomic (PGx) testing into psychiatric care. PGx testing examines individuals’ ability to metabolize drugs, typically based on their cytochrome P450 enzyme system [8, 9]. A patient’s genetic make-up will determine how effectively this enzyme system will metabolize medications and ultimately how they will respond to the drug [10]. Ideally this additional information minimizes the risks of toxicity and increases drug safety for both individual patients and society as a whole [11]. Widespread implementation of PGx testing in psychiatric care could theoretically reduce the period between diagnosis and drug optimization, allowing physicians to pursue more effective forms of treatment, more precisely tailor dosage, and differentiate between medication side effects and disease symptoms [12].

However, PGx testing has had a slow translation into clinical mental health practice. There are dozens of commercialized PGx tests now available for psychiatric drugs, but PGx has yet to deliver large scale improvements in psychiatric drug treatment and safety [13]. Researchers point to several barriers preventing the integration of PGx into standard care, including the lack of standardization of genetic testing panels [14], clinician education and engagement in testing [15], and a lack of evidence of cost-effectiveness [13]. Additionally, the psychiatric and genetics communities have mixed guidelines on the clinical utility of PGx. In 2018, the FDA argued that there is not yet enough evidence to support the relationship between DNA variations and antidepressant medications, and it advised patients not to alter their medication or dosage based on the results of a genetic test [16]. Further, the broader clinical utility of PGx is uncertain, as current evidence-based guidelines support only four clinically actionable genes [17]. However, other studies suggest testing often leads to a clinically actionable result [16].

Several studies of psychiatrists and mental health providers have been completed in the last decade to determine their perceptions of PGx testing’s effectiveness and utility [18 – 22]. These studies show that psychiatrists believe genetic data would be useful in making pharmaceutical decisions [18, 19, 21 – 23], and that PGx testing will soon be adopted as standard practice [5, 19, 24]. However, to date, only one study has explored psychiatry patients’ perspectives on PGx. Liko et al. [25] conducted interviews with 20 patients who had undergone a pharmacogenomic test to optimize treatment, finding patients’ pre-test expectations and post-test perspectives of its utility to be mixed. Although there are studies about psychiatrists’ [18 – 21] and pharmacists’ attitudes and perspectives [22], there are currently no published studies that have used quantitative analyses to describe a large sample of psychiatric patients’ perspectives. Therefore, we seek to understand what psychiatry patients already know about the use of PGx in psychiatry, as well as their interest in participating in testing. To this end, we ask the following research question (RQ):

RQ1: What are psychiatry patients’ familiarity and interest toward pharmacogenomic testing?

Furthermore, psychiatry patients may face substantial uncertainty in their illness experience. Uncertainty Management Theory (UMT) asserts there is variance in the way individuals manage uncertainty about illness [26, 27]. When faced with uncertainty, individuals first appraise it as positive, negative, or neutral. This appraisal determines their emotional response and ultimately what strategies they will undertake to manage their uncertainty [28]. Those who view uncertainty as a negative or a danger may manage it by seeking information to reduce their uncertainty. Individuals with a positive uncertainty appraisal, who see uncertainty as maintaining hope, may avoid information to maintain or escalate their uncertainty. For patients, uncertainty regarding illness can either be a cause of stress and anxiety or a cause of comfort [29].

There are a number of reasons why a psychiatric patient may avoid information about their illness. Avoiding information allows an individual to maintain hope or denial about the state of their condition by avoiding the possible confirmation of a negative disease state [30]. In some cases, physicians may even encourage patients to maintain uncertainty about their illness in order to remain optimistic and hopeful for their recovery [31]. Avoiding information also protects one from feeling overwhelmed from receiving too much information about their illness or from feeling helpless if there is no course of action available to improve their disease state [32].

Genetic testing is one strategy that patients use to reduce uncertainty [33 – 35] but it can also create new sources of uncertainty [28]. For example, a woman’s desire to reduce uncertainty over her breast cancer risk may motivate her to get a genetic test for the BRCA1/2 gene [36]. However, a positive test result may increase uncertainty about prophylactic treatments or communicating risk to family members, in addition to decreasing uncertainty about her cancer risk [28]. PGx testing is different from genetic testing for a hereditary cancer condition and can reveal distinct information related to medications in the context of psychiatric care. Therefore, it is unclear how uncertainty management preferences may be related to psychiatric patients’ interest in participating in PGx genetic testing. Because PGx testing can help a patient evaluate and compare pharmaceutical treatment options, psychiatric patients with a preference for reducing uncertainty may be more interested in participating in testing than patients with other preferences. However, PGx testing does not yield the same information about disease risk or susceptibility as other types of genetic testing and studies show that patients’ lack knowledge about the test and its results [37], making it unclear how UMT will translate to this context.

Furthermore, the use of genetic testing in the medical context is often criticized for its potential to cause emotional distress in the patient by revealing unwanted information [25, 38]. This argument is especially valid in the context of psychiatric genetic testing, as the results could put patients at an increased risk for discrimination based on their mental illness [20, 39, 40]. Based on previous research findings in other genetic testing contexts, we pose the following research question:

RQ2: How are psychiatric patients’ uncertainty management preferences related to interest in participating in PGx testing?

Psychiatrists’ attitudes toward the use of psychiatric genetic testing have also been shown to have a significant influence on patients’ intent to participate in such a test [38]. Based on these results, patients’ attitudes toward the use of genetic testing in psychiatric care, in addition to their familiarity with PGx and their preferences for managing uncertainty, may likely influence their willingness to participate in PGx testing. In our final research question, we sought to examine the moderating effects of patients’ PGx familiarity and their attitudes toward the use of genetic testing in psychiatry on the relationship between uncertainty management preferences and PGx interest.

RQ3: What are the effects of uncertainty management preferences, psychiatric genetic testing attitudes, and familiarity with PGx on psychiatry patients’ interest in participating in PGx?

2. Method

2.1. Sample

We recruited participants via ResearchMatch, a U.S. national health volunteer registry that was created by several academic institutions and is supported by the U.S. National Institutes of Health as part of the Clinical Translational Science Award program. ResearchMatch has a large population of volunteers who have agreed to be contacted by researchers about health studies for which they may be eligible. To be included in this study, participants had to be 18 years old or older and self-identify that they had received treatment for a mental health condition. Consequently, almost all participants (95.88%) reported that they had taken medication to treat a mental health condition. Although not an original exclusion criterion, we removed participants who had not taken medication to focus specifically on patients who had received psychiatric care.

2.2. Procedure

Participants were sent an email with a recruitment message via ResearchMatch that included a link to an online survey hosted by REDCap. ResearchMatch identified 21,856 volunteers who fit certain health condition filters (e.g., “mental health wellness,” “mood disorder,” “anxiety”). Volunteers who identified interest in the stated health conditions were sent one email with a recruitment message and link to an online questionnaire. The message was sent to 1,500 volunteers who were randomly selected from the population of participants that fit the health condition filters. The message was sent over four months to a total of 11,480 randomly selected volunteers. Potential volunteers answered a screening question to determine if they had ever received treatment for a mental health condition. Review and approval for this study and all procedures was obtained from the Institutional Review Board at the University of Florida.

2.3. Questionnaire

The online questionnaire included 45 questions pertaining to participants’ preferences for uncertainty management, attitudes toward psychiatric genetic testing, familiarity of PGx testing, and their interest in participating in PGx testing (Appendix A).

2.3.1. Uncertainty Preference Scales

Carcioppolo, Yang & Yang’s [31] scales for determining preference for managing illness uncertainty by seeking or avoiding information were adapted for use in this study. The scale includes 16 Likert-type questions from 1 (Strongly Disagree) to 7 (Strongly Agree). Nine questions pertain to participants’ preference for reducing uncertainty by seeking information (α = .83). Seven questions measure participants’ preference for maintaining or escalating uncertainty by avoiding information (α = .87). These preferences are separately measured as two different scales. A higher score on the seeking information scale indicates a stronger preference for reducing uncertainty, and a sample item from this scale is “I tend to avoid information about mental illness because it can be scary to think about.” A higher score on the avoiding information scale indicates a stronger preference for escalating or maintain uncertainty, and items include “I tend to seek out information about mental illness because new information can give me hope about my symptoms.” Because this scale was developed in the context of cancer, the wording of the scale was modified to answer the research questions posed in this study by replacing the word “cancer” with “mental illness.”

2.3.2. Psychiatric Genetic Testing Attitudes Scale

The questionnaire included the Laegsgaard & Mors [38] scale for measuring attitudes and intentions toward the use of genetic testing in psychiatric care. This scale also has 16 Likert-type questions (1 = strongly disagree, 7 = strongly agree) (α = .79). Higher scores indicate more positive attitudes toward the use of genetic testing in psychiatry. Sample items include “Everybody who wants it should have access to psychiatric genetic testing” and “Genetic testing for psychiatric disease should not take place” (reverse scored).

2.3.3. PGx Familiarity & Interest

We asked participants to rate their familiarity with PGx on scale of 1 (Not Familiar at All) to 5 (Extremely Familiar). They were then shown a statement on PGx published by the National Institute of Health ⁴⁰ [31]. This statement provides a plain language description of PGx that allows participants to answer the remainder of the survey questions (Appendix B). We then asked participants if a healthcare provider had ever mentioned PGx to them or if they had sought out information on their own. If participants responded yes to either question, they were directed to open-ended questions to provide further detail. Finally, participants were asked how interested they were in participating in a PGx test on a scale of 1 (Not at all Interested) to 5 (Extremely Interested).

2.4. Analysis

We analyzed descriptive statistics to determine participants’ familiarity, attitudes, and interest in PGx testing. We conducted simple regression analyses to explore the relationship between uncertainty management preferences and PGx interest, while controlling for patients’ demographics (race, gender, age, and education level). Finally, we conducted moderation analyses to determine the direct and indirect effects of uncertainty preferences, psychiatric genetic testing attitudes, and PGx familiarity on patients’ interest in participating in PGx. The analysis was conducted using SPSS 26, and moderation analyses were conducted using the PROCESS macro with 5,000 bootstrapped samples and 95% bias adjusted confidence intervals.

3. Results

A total of 843 participants participated in the survey. We removed 95 participants due to a formatting error that left out a variable in the first round of the survey data collection and 26 who had never received psychiatric care. We removed an additional 117 participants who did not complete 85% of the survey, and seven participants who were under the age of 18. Our final sample consisted of 598 participants. Most participants were white (n= 547, 91.%) and female (n = 490, 81.94%) with a post-high school education (n= 532, 88.96%). Participants were about 40 years old, on average (M = 38 years old, SD = 13.71). Table 1 lists the full demographic information of the participants included in this analysis

Table 1.

Participant demographics

Demographics
Gender
Male	95 (15.7%)
Female	494 (81.7%)
Other	15 (2.5%)
Age, M(SD)	38 (13.8)
Race
White	553 (85.7%)
Black/African-American	30 (4.7%)
Hispanic/Latino	22 (3.4%)
Asian	19 (2.9%)
American Indian/Alaskan Native	10 (1.6%)
Native Hawaiian or Pacific Islander	3 (0.5%)
Other	8 (1.2%)
Highest level of education completed
Less than 8 years	2 (0.3%)
8 through 11 years	13 (2.1%)
High school	51 (8.1%)
Post high school training other than college (vocational or technical)	32 (5.1%)
Some college	178 (28.3%)
College graduate	203 (32.2%)
Postgraduate	151 (24.0%)
Psychiatric medication history
Have taken medication	605 (100%)

3.1. Psychiatry patients’ familiarity and interest toward pharmacogenomic testing

On average, participants indicated a strong interest in participating in PGx treatments (M= 4.16, SD=1.10), despite having relatively low familiarity with PGx (M = 2.09, SD = 1.04). Attitudes toward the general use of genetic testing in psychiatry were also high (M = 4.81, SD = .76). These results are provided in more detail in Table 2.

Table 2.

Descriptive statistics for uncertainty management, PGx knowledge and interest, and genetic testing attitudes.

Variable	Min	Max	M	SD	Variance	⟨
Genetic Testing Attitudes (1–7)	1	7	3.82	.1.4	.59	.80
PGx Knowledge (1–5)	1	5	2.09	1.04	1.08	N/A
PGx Interest (1–5)	1	5	4.16	1.10	1.21	N/A
Avoid information (1–7)	1	7	3.82	1.41	1.99	.87
Seek Information (1–7)	1.56	7	5.34	.94	.89	.83
Treatment dependent (1–7)	1	7	3.35	2.00	4.00	N/A
Treatment notwithstanding (1–7)	1	7	5.42	1.67	2.78	N/A

Ninety-seven patients (16%) indicated that a healthcare provider had discussed PGx with them. Most (n=59) of these participants reported discussing PGx with their psychiatrist; fewer reported discussing with a primary care provider (n=15), a psychologist or therapist (n=9), a nurse practitioner (n=8), or another type of provider (n=5).

About a third of patients (n=210, 34%) indicated that they learned about PGx from a source outside of the healthcare system, citing online sources including ads, social media, support groups, articles, and random searching. Many participants in this group were familiar with PGx through their work or schooling as scientists or medical professionals. Table 3 outlines the most frequently reported sources of information.

Table 3.

Participant identified provider types who discussed PGx

Provider-type
Psychiatrist	59 (60%)
Primary care provider	15 (15.5%)
Psychologist or therapist	9 (9.3%)
Nurse practitioner	8 (8.2%)
Other	5 (5.2%)

3.2. Preferences for uncertainty reduction and interests in PGx

RQ2 sought to examine the relationship between uncertainty management preferences and patients’ interest in participating in PGx. Patients scored higher on the scale indicating a preference of seeking information to reduce uncertainty (M = 5.34, SD = .94) than on the scale indicating a preference for escalating uncertainty by avoiding information (M = 3.80, SD = 1.41) (Table 2). To investigate this research question, we conducted two separate regression analyses to measure the direct effect of each uncertainty preference on PGx interest. All analyses controlled for sex, age, race, and education level. A preference for seeking information to reduce uncertainty was a significant positive predictor of interest in PGx, β = .19, t(555) = 4.43, p < .001. However, a preference for avoiding information was not significantly related to PGx interest, β= −.01, t(566) = −.29, p = .77.

Attitudes toward of the general use of genetic testing in psychiatry was a significant positive predictor of PGx interest, β = .31, t(557) = 7.57, p < .001. When controlling for general genetic testing attitudes, the results remained the same: a preference for seeking information was a significant positive predictor of PGx testing interest (β = .14, t(542) = 3.37, p < .001), but a preference for avoiding information was not (β= −.08, t(552) = −1.90, p = .058).

3.3. The effects of uncertainty management preferences, psychiatric genetic testing attitudes, and familiarity with PGx on psychiatry patients’ interest in participating in PGx

Finally, we conducted a series of multivariate regression analyses to test whether uncertainty preferences interacted with either PGx knowledge or testing attitudes to predict PGx interest. All analyses controlled for age, gender, education, and race. PGx familiarity did not predict PGx interest for patients with a preference for seeking information (β= .14, t(539) = .60, p > .05) or avoiding information (β= .17, t(549) = 1.55, p > .05). There was a significant main effect of general genetic testing attitudes for both the avoiding information (β= .50, t(549) = 3.17, p = .002) and seeking information (β= .63, t(539) = 2.26, p = .024) uncertainty preference, However, neither information-seeking preference predicted PGx interest, nor did it significantly interact with attitudes or knowledge to predict PGx interest. These results are outlined in Table 4.

Table 4.

Most frequently reported sources of PGx information

Information source
Online searching, forums and social media	87 (41.4%)
Work or school	54 (25.7%)
Family or friends	41 (19.5%)
News media	14 (6.7%)
Other genetic services or study participation	10 (4.8%)

4. Discussion and Conclusion

4.1. Discussion

The purpose of this study was to examine psychiatry patients’ knowledge and interest in PGx testing (RQ1), explore the relationship between uncertainty management preferences and PGx (RQ2), and investigate the effects of uncertainty management preferences, psychiatric genetic testing attitudes, and familiarity with PGx on interest in participating in testing (RQ3). Although the integration of PGx into mental health care has been studied extensively, researchers have primarily focused on the perceptions and intentions of providers [19]. Patients’ perspectives on PGx in psychiatry have been largely understudied, despite the fact that public awareness of PGx is increasing [41]. Patients’ lack of familiarity and perception of utility have even been cited as barriers to widespread implementation [42]. If this new information technology is to be successfully adopted as a standard of care in psychiatry, as predicted, both patient and provider perspectives must be explored in order to address the needs of both groups.

UMT has been applied to genetic testing participation, but this theory had not yet been examined in the context of PGx and psychiatric care [27, 34]. We found that a preference for reducing uncertainty was a significant positive predictor of interest in participating in PGx, consistent with previous literature on uncertainty management and genetic testing. However, a preference for avoiding information was not a significant negative predictor of interest. The nature of PGx results, which may be perceived as less precise than other forms of genetic testing, may lead psychiatric patients to believe their uncertainty about their illness will not be reduced by participating in testing. The shifting guidelines, mixed perceptions of clinical utility, general lack of knowledge about PGx from psychiatry patients [37] likely generates uncertainty about PGx, meaning that the test may speak to a different source of uncertainty than other types of genetic testing.

Our results suggest a complex relationship between uncertainty preferences and interest in PGx testing, which differs from genetic testing in other hereditary contexts [43]. UMT asserts that when individuals feel uncertain, they appraise that uncertainty for its meaning (danger, threat, or opportunity) and that appraisal will determine their management behaviors [26, 44]. When individuals appraise uncertainty as an opportunity to maintain hope or avoid negative feelings, they often avoid information to maintain or increase their uncertainty [32]. However, the source(s) of uncertainty may account for the complexity of our results, as PGx testing results provide different information from genetic testing for hereditary cancer or cardiovascular conditions. For example, psychiatric patients may feel uncertainty about the test, uncertainty about whether the results will reveal anything salient to their treatment, and uncertainty about what the results of the PGx test could mean for them and their current treatment plan if they do have actionable findings. These results indicate patient participation in PGx may be affected by patients’ existing opinions toward the safety and utility of genetic testing use in psychiatric care [38]. Attitudes toward the use of genetic testing in psychiatry had a significant impact on participants’ interest in testing for both patients who managed their uncertainty by seeking information and patients who avoided information. Future research needs to identify the different sources of uncertainty for psychiatry patients and examine how each type of uncertainty motivates attitudes and behaviors.

This paper is limited by its sample, as users of ResearchMatch may not reflect the general population of psychiatric patients. By registering for ResearchMatch, study participants are likely more knowledgeable and active than a typical patient. Additionally, by virtue of their participation in this health study with no compensation, ResearchMatch users are more likely to manage uncertainty through seeking information than by avoiding it. The response rate of this study is also low when comparing the number of the participants to the number of ResearchMatch volunteers who received an email with a contact message for the study. However, not all volunteers who received an email fit the criteria for this study, which limits the accuracy of the response rate. The sample is also heavily skewed toward white females with high levels of education, and a number of participants indicated that they worked in science or medical professions. Additionally, measuring patients’ knowledge of PGx rather knowledge of PGx rather than their familiarity and using more extensive measures would have led to more precise results.

Future studies may be able to combat these limitations by recruiting participants directly from psychiatry clinics – thus, providing a sample that is more clinically authentic. Additionally, qualitative interviews should be conducted with this population, in addition to more extensive surveys, to gain a richer, more insightful data the relationship between uncertainty preferences and PGx testing.

4.2. Conclusion

Our findings suggest that UMT may not map onto PGx in the same way it applies to other forms of genetic testing, as patients with differing uncertainty management preferences indicated interest in participating in PGx. PGx provides markedly different information than other types of genetic testing, and because this testing does not reveal disease susceptibility or prognosis, psychiatrists have argued that participating in the test offers a relatively low risk of psychological distress to patients in comparison to other types of genetic testing [20]. PGx results may be helpful to psychiatrist to inform care decisions, but they could also directly impact patients’ well-being as they may reduce their risk of experiencing adverse effects as a result of their medication. Thus, there is less incentive for patients who typically avoid information to maintain or escalate uncertainty to decline participation in order to protect themselves from harmful news.

4.3. Practice Implications

This study is one of the first to examine psychiatric patients’ perspectives on PGx, and the results are consistent with similar studies focused on providers. Our findings show that psychiatric patients are in interested in participating in PGx, and a number of patients are educating themselves about PGx both inside and outside the physician’s office. Our results suggest that patients are familiar enough with PGx to be included in future research on this topic. Researchers who are working to aid in the translation of PGx from bench to bedside should seek incorporate both patient and provider perspectives.

Additionally, this study is the first to examine UMT in the context of psychiatric pharmacological genetic testing. The findings of this paper both support and contradict this theory in comparison to other types of genetic testing, as patients who seek to reduce uncertainty and patients who prefer to escalate uncertainty about their mental illness both expressed their interest in participating in the test. Thus, more research must be done to extend the theory into this context and understand how uncertainty preferences relate to this unique application of genetic testing.

Table 5.

Results of simple linear regression analysis on uncertainty management preferences, psychiatric genetic testing attitudes, and PGx interest.

Variable	B	SE(B)	®	t	p
Seeking Info	.22	.05	.19	4.62	.000***
Avoiding Info	−.01	.03	−.01	−.31	.76
Genetic Ttesting Aattitudes	.49	.06	.33	8.51	.000***

^***p < .001

Table 6.

Results of a multivariate regression analysis examining effect of uncertainty management preferences on PGx interest while controlling for general genetic testing attitudes.

Variable	t	p	®	F	df	p	adj R2 (adj.)
PGx Interest
Overall Model				42.75	2, 572	.000**	.13
Seeking info	3.33	.001**	.13
Genetic testing attitudes	7.82	.000***	.31
PGx Interest
Overall Model				38.82	2, 583	.000***	.12
Avoid info	−.07	.02*	−.09
Genetic testing attitudes	8.80	.000***	.35

^*p < .05

^**p < .01

^***p < .001

Table 7.

Results of simple linear regression analysis on treatment dependent attitudes toward genetic testing and PGx interest.

Variable	B	SE(B)	®	t	p
Treatment dependent	−.12	.02	−.22	−5.60	.000***
Treatment notwithstanding	.31	.02	.47	12.87	.000***

^***p < .001

Table 8.

Results of a multivariate regression analysis examining effect of uncertainty management preferences on PGx interest while controlling for attitudes toward genetic testing with and without existing treatment possibilities.

Variable	t	p	®	F	df	p	adj R2 (adj)
PGx Interest
Overall Model				25.68	2, 583	.000**	.08
Seeking info	4.51	.000**	.18
Treatment dependent	−5.38	.000***	−.21
PGx Interest
Overall Model				16.92	2, 596	.000***	.12
Avoid info	.557	.58	.02
Treatment dependent	−5.81	.000***	−.23
PGx Interest
Overall Model				86.89	2, 583	.000**	.23
Seeking info	3.23	.001**	.12
Treatment notwithstanding	12.13	.000***	.45
PGx Interest
Overall Model				82.17	2, 596	.000***	.21
Avoid info	−.20	.84	−.01
Treatment notwithstanding	12.81	.000***	.47

^**p < .01

^***p < .001

Appendix A

Uncertainty Preference Scales

How much do you agree or disagree with each statement? (Strongly Disagree to Strongly Agree)

“I tend to AVOID information about mental illness because:”

It can be depressing.

I get anxious when I think about mental illness.

Being constantly reminded of it makes me nervous about my own health condition.

It can be scary to think about.

There’s a lot of misinformation out there, so it’s difficult to know which is truthful.

The recommendations are always changing.

The amount of information out there can be overwhelming.

“I tend to SEEK OUT information about mental illness because:”

I want to get a second opinion about a diagnosis.

New information can give me hope about my symptoms.

New information can give me hope about a diagnosis.

Finding new information helps me check my doctor’s diagnosis.

It’s good to be prepared.

It makes me feel equipped to handle difficult situations.

It makes me less fearful.

I try to find all kinds of information I can.

Being knowledgeable can help keep me healthy.

Psychiatric Genetic Testing Attitudes Scale

How much do you agree or disagree with each statement? (Strongly Disagree to Strongly Agree)

Everybody has the right to know about their hereditary characteristics

Everybody has the right to decide they do not want to know about their hereditary characteristics

Everybody has the right to keep their own genetic data confidential

Everybody who wants it should have access to psychiatric genetic testing

Members of families with mental disease should have access to psychiatric genetic testing

Members of families with mental disease should be obliged to psychiatric genetic testing

Genetic testing for psychiatric disease should not take place

Genetic testing for physical disease should not take place

If risk genes for mental disease are detected in a person, close relatives should be informed, even without the agreement of the tested person

The general practitioner should be informed about the results of a psychiatric genetic test, with or without the patients consent

Soldiers called up for recruitment should go through a psychiatric genetic test

Persons occupying highly responsible jobs (e.g., pilots) should go through a psychiatric genetic test

Persons wanting to adopt a child should be able to show a psychiatric genetic certificate

Persons wanting to adopt should be allowed to demand a psychiatric genetic certificate of the child

I would have a psychiatric genetic test only if effective treatment/prevention exists

I would have a psychiatric genetic test notwithstanding treatment possibilities

Familiarity with PGx

How would you rate your knowledge of pharmacogenomic testing?

• Not familiar at all

• Slightly familiar

• Moderately familiar

• Very familiar

• Extremely familiar

Interest in PGx

How interested would you be in participating in pharmacogenomic testing?

• Not at all interested

• Somewhat interested

• Moderately interested

• Very interested

• Extremely interested

Appendix B

Pharmacogenomics uses information about a person’s genetic makeup, or genome, to choose the drugs and drug doses that are likely to work best for that particular person. This new field combines the science of how drugs work, called pharmacology, with the science of the human genome, called genomics.

Depending on your genetic makeup, some drugs may work more or less effectively for you than they do in other people. Likewise, some drugs may produce more or fewer side effects in you than in someone else. In the near future, doctors will be able to routinely use information about your genetic makeup to choose those drugs and drug doses that offer the greatest chance of helping you.

Pharmacogenomics may also help to quickly identify the best drugs to treat people with certain mental health disorders. For example, while some patients with depression respond to the first drug they are given, many do not, and doctors have to try another drug. Because each drug takes weeks to take its full effect, patients’ depression may grow worse during the time spent searching for a drug that helps.