Table 1.

Patient, treatment, and systems‐level factors impacting treatment adherence in bipolar disorder

Category	Factor	Finding correlated with poor adherence
Patient Factors	Demographic features
	Age	Younger age
	Gender	Male gender
	Marital Status	Single
	Disability Status	Less likelihood of receiving disability
	Education level	Lower levels of education
	Legal history	Presence of legal history
	Bipolar disorder features
	Illness presentation	BPI, psychosis, rapid cycling, elevated mood, low insight
	Neurocognitive function	Frontal executive impairment
	Illness duration	Longer duration
	Treatment duration	Longer duration
	Past suicide attempts	Presence of past suicide attempts
	Psychiatric comorbidity	Current substance abuse disorder
	Relationship with providers	Possibly, poor relationship and mistrust
	Treatment expectations	Low provider expectation
	Treatment history	Higher number of past irregular hospital discharges
Treatment Factors	Medication factors
	Number of medications	Lower number of different prescriptions
	Intensity of pharmacotherapy	Suboptimal symptom response and
	Side effects	Lower doses of medications
	Psychotherapy factors	Presence or fear of side effects and
	Duration of therapy and aftercare	Negative attitudes toward mood stabilizer
		Effects on adherence may diminish over time
Systems Factors	Level of access to care	Lower access to care
	Availability of resources	Fewer resources