Table 3.
Reasons for nonadherence to antipsychotic medication in patients with SMI: summary of methods used in cross-sectional observational studies
| References | Reason(s) | Design/patients | Measurement
|
|
|---|---|---|---|---|
| Adherence | Reasons | |||
| Eticha et al35 | • Attitude toward medication • Insight • Side effects • Substance abuse |
• Ethiopia • SZ, consecutive patients (N=393) |
Modified MARS | Attitude toward medication: DAI; insight: ISP; side effects: a list of 16 items rated by patients |
| Na et al36 | • Cognition • Depression • Insight |
• Korea • Chronic SZ (N=104) |
MARS (Korean version) | Cognition: a panel of tests; depression: GDS; functioning: GAF; insight: SUMD; symptom severity: PANSS |
| Jonsdottir et al37 | • Insight • Substance abuse |
• Consecutive outpatients, Norway • SZ (n=166) or BPD (n=114) |
Medication serum concentration at study entry; self-reported adherence during past week | Insight: BIS; substance abuse: a specific questionnaire; symptom severity: PANSS, YMRS |
| Dibonaventura et al38 | • Side effects | • Survey (online or paper), United States • SZ, self-report (N=876) |
4-item MMAS, adherence defined as responding “no” to all 4 items | Side effects: self-report |
| Alene et al39 | • Forgetfulness • Side effects • Substance abuse |
• Ethiopia • SZ, SZD, mood disorder with psychotic features, or unspecified psychosis, consecutive patients (N=336) |
Patient self-report using a structured questionnaire and pharmacy refill record | Patient structured questionnaire (same as for adherence) |
| Adelufosi et al40 | • Family and friend support | • Nigeria • SZ, outpatients (N=313) |
4-item MMAS | Social support from family and friends: self-report SCPQ; symptom severity: BPRS |
| McCabe et al41 | • Therapeutic alliance | • 6 European countries • SZ or related psychotic disorders, outpatients (n=507) and their clinicians (n=134) |
Clinician-rated: good (≥75%), average (25%–75%), poor (<25%) based on knowledge of the patient during past 3 months | Symptom severity: PANSS; therapeutic alliance: HAS-P and HAS-C |
| Magura et al42 | • Self-efficacy in drug avoidance • Side effects • Social support and stability |
• United States • MDD, SZ, BPD, anxiety, and substance abuse history, outpatients (N=131) |
Modified MARS | Friends’ support for abstinence: SNIS; readiness to change: RCQ; recovery support: SSRS; recovery-promoting behaviors: PCQ; self-efficacy for mental health recovery: MHCS; self-efficacy in drug avoidance: DASES; side effects: 16 items; symptom severity: CSI |
| Sajatovic et al43 | • Forgetfulness • Personal, sociocultural, economic factors • Side effects |
• United States • BPD I and II, poorly adherent outpatients (N=20) |
Poor adherence defined as missing ≥30% of medication based on TRQ during past week or month; also assessed by pill counts | Patient factors, environmental/social factors, provider/system factors, health beliefs, costs/burdens associated with treatment: SEMI TAD BD; symptom severity: HAMD, YMRS, BPRS, CGI-BP |
| Zeber et al44 | • Access to specialist • Attitude toward medication • Substance abuse • Therapeutic alliance |
• United States • BPD or SZD-bipolar subtype, VA patients from CIVIC-MD study, N=435 |
Morisky 4-item scale and independent assessment of missed medication in the last 4 days | Access to specialist: 1 item from Cunningham survey; attitude toward medication: ITM; binge drinking: 1 item from AUDIT; therapeutic alliance: HCCQ |
| Wong et al45 | • Attitude toward medication • Insight • Side effects (weight gain) |
• China • First-episode SZ, schizotypal and delusional disorders (N=160) |
Self-report CRS to assess adherence in the past 2 weeks; patient and caregiver interview | Attitude toward medication: DAI-30; insight: SRIS; objective weight measure: BMI; subjective weight perception: FRS and cognitive attitude toward body size; symptom severity: SAPS and SANS |
| Beck et al46 | • Attitude toward medication • Insight |
• Switzerland • SZ or SZD outpatients (N=150) |
Subscale “medication adherence” of the SES; BARS | Attitude toward medication: BMQ; insight: SUMD (2 items only: awareness of illness and awareness of social consequences of illness); symptom severity: PANSS |
| Dassa et al47 | • Duration of untreated psychosis • Insight • Therapeutic alliance |
• France • SZ or SZD consecutive outpatients (N=291) |
10-item DAI | Insight: SUMD; therapeutic alliance: self-report PSQ; symptom severity: CGI |
| Acosta et al48 | • Insight | • Spain • SZ, consecutive outpatients (N=74) |
Electronic monitoring with MEMS; estimates of adherence by psychiatrists, patients, and relatives | Insight: 3 items on AIS; symptom severity: PANSS |
| Baldessarini et al49 | • Affective comorbidity • Side effects • Substance abuse |
• Questionnaire of psychiatrists and their patients, United States • BPD, consecutive patients (n=429); prescribing psychiatrists (n=131) |
Patient self-report: missed doses during past 10 days | Symptoms and severity of BPD and its personal impact, patients’ expectations of treatment: patient self-report and physician questionnaire |
| McCann et al50 | • Access to psychiatrist • Side effects • Social support • Stigma |
• Australia • SZ, nonprobability sample (N=81) |
Adherence and reasons (insight, substance use, significant other support, stigma, side effects, HCP support, access to medication): self-report using a 68-item F INMTS | |
| Rummel-Kluge et al51 | • Insight • Stigma |
• Survey of psychiatrists (n=699), Germany • SZ (n=5,729) |
Adherence and reasons: 10-item physician survey questionnaire assessing 10 patients per physician | |
| Pratt et al52 | • Insight • Medication complexity • Social functioning |
• Study within an RCT comparing intervention strategies, United States, United Kingdom • SZ, SZD, BPD, MDD, older outpatients (age >50 years; N=72) |
Pill counts, self-reported adherence (0%−100%), MARS, 1-item informant rating, a composite of 4 method scores | Insight: SUMD; medication complexity: calculated as a complexity score; social functioning: ILSS-SR, Multnomah; symptom severity: EBPRS, SANS |
| Elbogen et al53 | • Depression • Social stability and living conditions • Substance abuse |
• Patient subset of a risk behavior study, United States • SZ and related disorders (N=528) |
Self-report (questionnaire) | Depressive symptoms: self-report; functioning: GAS; living stability: changing residences in the past 30 days (excluding hospitalization and/or arrests); social environment: various domains, including financial stability, homelessness, and transportation; substance abuse: DALI |
Abbreviations: AIS, Amador Insight Scale; AUDIT, Alcohol Use Disorders Identification Test; BARS, Brief Adherence Rating Scale; BIS, Birchwood Insight Scale; BMI, body mass index; BMQ, Beliefs about Medication Questionnaire; BPD, bipolar disorder; BPRS, Brief Psychiatric Rating Scale; CGI, Clinical Global Impression; CGI-BP, CGI for Bipolar Disorder; CIVIC-MD, Continuous Improvement for Veterans in Care-Mood Disorders; CRS, Compliance Rating Scale; CSI, Colorado Symptoms Index; DAI, Drug Attitude Inventory; DALI, Dartmouth Assessment of Lifestyle Instrument; DASES, Drug Avoidance Self Efficacy Scale; EBPRS, Expanded Brief Psychiatric Rating Scale; FINMTS, Factors Influencing Neuroleptic Medication Taking Scale; FRS, Figure Rating Scale; GAF, Global Assessment of Functioning; GAS, Global Assessment Scale; GDS, Geriatric Depression Scale; HAMD, Hamilton Depression rating scale; HAS, Helping Alliance Scale (C, clinician, P, patient); HCCQ, Health Care Climate Questionnaire; HCP, health care professional; ILSS-SR, Independent Living Skills Survey-Self Report; ISP, Insight Scale for Psychosis; ITM, Insight To Medication; MARS, Medication Adherence Rating Scale; MDD, major depressive disorder; MEMS, Medication Event Monitoring System; MHCS, Mental Health Confidence Scale; MMAS, Morisky Medication Adherence Scale; PANSS, Positive and Negative Syndrome Scale; PCQ, Processes of Change Questionnaire; PSQ, Patient Session Questionnaire; RCQ, Readiness to Change Questionnaire; RCT, randomized controlled trial; SANS, Scale for the Assessment of Negative Symptoms; SAPS, Scale for the Assessment of Positive Symptoms; SCPQ, Sociodemographic and Clinical Profile Questionnaire; SEMI TAD BD, Subjective Experience of Medication Interview Treatment Adherence Bipolar Disorder; SES, Service Engagement Scale; SMI, serious mental illness; SNIS, Social Network Influence Scale; SRIS, Self-Rated Insight Scale; SSRS, Social Support for Recovery Scale; SUMD, Scale to Assess Unawareness of Mental Disorder; SZ, schizophrenia; SZD, schizoaffective disorder; TRQ, tablets routine questionnaire; VA, Veterans Health Administration; YMRS, Young Mania Rating Scale.