Table 1.
Summary of included studies
| Study details | Study design | Study included | Study aims | No. of participants | Country | Non-adherence rate |
|---|---|---|---|---|---|---|
| Agyapong, Nwankwo, Bangaru, and Kirrane (2009) | Cross-sectional survey | BD, schizophrenia, depression | Assessment of associated factors that might influence compliance | 409 | Ireland | Not reported |
| Arvilommi et al. (2014) | Structured Clinical Interviews | BD only | Explored barriers of adherence: to investigate reasons were for treatment discontinuation | 168 | Finland | Not reported |
| Averous, Charbonnier, Lagouanelle-Simeoni, Dany, and Prosperi (2018) | Face to face interview | BD only | To explore associations between illness perceptions and adherence | 38 | France | Not reported |
| Baldessarini et al. (2008) | Survey | BD only | Explored barriers of adherence: risk factors to guide clinical prediction of nonadherence | 429 patients + 131 psychiatrists | USA | 33.8% |
| Bates, Whitehead, Bolge, and Kim (2010) | Web-based cross-sectional survey | BD only | To identify and describe correlates of medication adherence | 1052 | USA | 49.5% |
| Bauer et al. (2013) | Naturalistic study where patient recorded their medication taking in self-reporting software | BD only | Explored barriers of adherence: to investigate regularity in the daily mood stabiliser dosage taken by patient and factors associated with irregularity | 206 | Germany | Not reported |
| Belzeaux et al. (2013) | Cross-sectional survey and interviews | BD only | To explore adherence behaviour and characterise the sociodemographic and clinical factors associated with adherence | 382 | France | 25% of patients exhibited clear poor adherence |
| Bener, Dafeeah, and Salem (2013) | Survey | BD, schizophrenia, depression, anxiety and others | To examine the extent of compliance and non-compliance and examine the factors that affect compliance. | 564 | Qatar | 41.8% |
| Clatworthy et al. (2007) | Semi-structured interviews | BD only | To explore in-depth beliefs about BD and its treatment that are associated with adherence to medication prescribed for BD | 16 | UK | 8 reported non-adherence in the past and 5 reported current non-adherence |
| Clatworthy et al. (2009) | Questionnaire survey | BD only | The utility of the necessity concerns framework for understanding patient attitudes towards and levels of adherence | 223 | UK | 30% |
| Col, Caykoylu, Karakas, and Ugurlu (2014) | Semi-structured interviews | BD only | To determine the factors affecting treatment compliance | 78 | Turkey | 42.3% |
| Copeland et al. (2008) | Cross-sectional survey | BD only | To determine the association of insight and adherence | 435 | USA | 27% had poor adherence based on missed dose and 46% had poor adherence based on Moriskey |
| Correard et al. (2017) | Cross-sectional observational | BD only | To investigate influence of age and neuropsychological functioning on adherence | 353 | France | 47.3% |
| Darling et al. (2008) | Survey/interview | BD only | The influence of family and health stress, level of coping and internal health locus of control upon the life contentment of adherent and non-adherent individuals | 100 | USA | Not applicable as purposive sampling to include 50 adherent and 50 non-adherent patients |
| De Las, Penate, and Sanz (2014) | Survey | Bipolar, depression and dysthymia | To identify potential modelling factors influencing adherence | 145 | Spain | 46.2% |
| De Las, Penate, and Cabrera (2016) | Survey | BD, schizophrenia, depression and others | To examine the role of perceived health control variables in psychiatric patients' adherence to prescribed treatment. | 966 | Spain | A quarter of patients self-reported a high level of adherence; 46.8% medium adherence and 28.2% a low adherence |
| Deegan (2005) | Interviews | BD, schizophrenia, major depression, and others | To understand how people with psychiatric disorders demonstrate the capacity for resilience in the ways they use or do not use psychiatric medications | 29 | USA | Not reported |
| Fleck et al. (2005) | Interviews | BD only | Explored barriers of adherence: to examine rates, self-perceived reasons and attitudes associated with non-adherence | 50 | USA | 45% African American and 50% Whites totally non-adherent |
| Gianfrancesco et al. (2009) | Retrospective analysis of database | BD only | The study investigated monotherapy v. polypharmacy | 3626 | USA | Variable (depending on the medication and combination of medication) |
| Greene et al. (2018) | Retrospective analyses from database | Bipolar and schizophrenia (here we included only bipolar) | To compare differences in medication adherence and discontinuation between those who initiated a long acting injection and those who changed from one oral antipsychotic monotherapy to another | 11 344 | USA | 61.1% in LAIs group and 78.5% in oral group |
| Greenhouse, Meyer, and Johnson (2000) | Survey | BD only | This report hypothesised that acceptance coping would correlate positively, and denial coping would correlate inversely with adherence | 32 | USA | 75% of participants reported perfect adherence during the previous week |
| Grover et al. (2014) | Survey and semi structured interview with the patient and spouse/partner | BD only | Explored barriers of adherence: to evaluate the prevalence of sexual dysfunction in patients with BD receiving lithium and to study the correlates of sexual dysfunction | 100 | India | Varied (used BARS, MAQ) 84% took the prescribed doses of medications |
| Hajda et al. (2015) | Survey | BD only | Explored barriers of adherence: to determine the relationship between current adherence, medication discontinuing in the past and self-stigma | 33 | Czech Republic | Nineteen (57.6%) patients discontinued medication at least once in the past |
| Hibdye, Bekan, Dessalegne, Debero, and Sintayehu (2015) | Survey | BD only | Explored barriers of adherence: to assess the prevalence and factors associated with medication non-adherence among patients with BDs | 410 | Ethiopia | 51.2% |
| Hou, Cleak, and Peveler (2010) | Survey | BD only | To investigate the impact of treatment and illness beliefs on medication adherence | 35 | UK | 54.3% (probably non-adherent) |
| Inder, Lacey, and Crowe (2019) | Interviews | BD only | Analysis of medication adherence | 36 | New Zealand | NA |
| Johnson et al. (2007) | Survey | BD only | Explored barriers of adherence: to investigate factors associated with nonadherence and to assess the effect of patient preference on hypothetical medications | 469 | USA | 23% always adherent, 37% usually adherent, 23% occasionally adherent, 17% rarely adherent |
| Jonsdottir et al. (2013) | Interviews | Bipolar and schizophrenia | Explored barriers of adherence: to investigate potential risk factors for medication nonadherence | 255 | Norway | 13% Nonadherent, 31% partial adherent |
| Jose et al. (2003) | Survey | BD only | Explored barriers of adherence: to identify the reason for non-compliance | 96 | India | Not applicable (purposive sampling) |
| Kamaradova et al. (2016) | Survey | Bipolar, schizophrenia, depression, anxiety disorder and others | Explored barriers of adherence: to examine associations between self-stigma and adherence to treatment and discontinuation of medication in patients from various diagnostic groups | 332 | Czech Republic | 124 patients (37.35%) admitted they had discontinued their medication previously |
| Keck et al. (1996) | Cohort study – patients evaluated at admission and followed up at 6 months | BD only | To identify clinical factors associated with maintenance antipsychotic treatment in patients with BD | 77 | USA | Varied, 41–68% |
| Keck, McElroy, Strakowski, Bourne, and West (1997) | Interviews | BD only | To assess patients' compliance with pharmacotherapy | 140 | USA | 51% |
| Kraemer et al. (2013) | Observational study | BD only | To assess the duration of time on different mood stabilising medications and retention rates in standard clinical care | 761 | Germany | 28.4% |
| Kutzelnigg et al. (2014) | Observational study | BD only | To determine factors associated with better compliance and to assess compliance between patients stabilised on olanzapine monotherapy and those stabilised on combination therapy | 657 | Austria, Romania, Hungary, Korea, Taiwan and Mexico | High levels of compliance (⩾80%) were observed in 67% of patients at baseline, increasing to 80% in study completers |
| Maczka et al. (2010) | Survey | Psychiatrists and patients with BD | An analysis and comparison of patients' and psychiatrists' beliefs regarding the most important aspects of BD treatment. | 100 psychiatrists and 100 remitted patients | Poland | Not applicable |
| Manwani et al. (2007) | Structured Interviews | BD only | Explored barriers of adherence: to examine patterns and reasons of non-adherence | 115 | USA | 17.5% in non-substance users, 34.5% in substance users |
| Morselli and Elgie (2003) | Survey | People with bipolar and non-bipolar (unipolar depression, or dysthymia or atypical depression) | To gain a better understanding of what it is like to live with BD | 1732 | Austria, Finland, France, Hungary, Holland, Italy, Portugal, Russia, Spain, Sweden and UK | 47% |
| Nagesh et al. (2016) | An interviewer-assisted questionnaire-based study | Acute and transient psychotic disorder, borderline personality disorder, major depressive disorder, BD | Explored barriers of adherence: to assess the level of patients' adherence to psychotropic medications and to explore factors associated with non-adherence to medication | 156 | India | Adherence rate varied from low adherence (24.4%) through medium (34%) to high adherence (41.7%) among participants |
| Novick et al. (2017) | Post hoc analysis of 1-year observational study | Bipolar and schizophrenia | To explore non adherence with oro-dispersible v. standard normal tablet of olanzapine | 903 | France, Germany, Greece | Only reported average MARS scores |
| Perron, Zeber, Kilbourne, and Bauer (2009) | Survey | Bipolar, cyclothymia or schizoaffective disorder-bipolar subtype | To examine concurrent and predictive associations between provider support and adherence, access to care and health related quality of life | 433 | USA | Not reported |
| Pope and Scott (2003) | Survey | Patients with BD and their treating clinicians | Explored barriers of adherence: likely reasons for non-adherence identified by patients, the most common concerns of adherent and non- adherent subjects and the similarities and differences between clinicians' perceptions and patient concerns | 72 patients taking lithium and 41 psychiatrists treating them | UK | 46% |
| Ralat et al. (2018) | Focus group | BD only | Explored barriers of adherence: to identify patients' perspectives on the reasons for nonadherence to psychiatric medication | 22 | Puerto Rico | 68% of participants reported nonadherence during the week of recruitment |
| Roe et al. (2009) | Semi-structured interviews | Bipolar and schizophrenia | Explored barriers of adherence: to explore why and how people with a serious mental illness choose to stop taking prescribed medication | 7 | Israel | Not applicable |
| Rosa et al. (2007) | Survey | BD only | To determine plasma and red blood cell lithium concentrations in bipolar patients at the same time as estimating attitudes and knowledge about lithium treatment in adherence scales | 106 | Brazil | 33.06% based on MARS >7 14.4% based on plasma lithium |
| Rosenblat et al. (2018) | Survey | Bipolar depression and Major depressive disorder | Explore factors that impact treatment decisions | 896 | Canada | Bipolar depression and Major depressive disorder |
| Sajatovic, Bauer, Kilbourne, Vertrees, and Williford (2006) | Interview and self-report | BD only | Evaluated factors related to adherence | 184 | USA | 38.6% |
| Sajatovic et al. (2009) | Interviews | BD only | This cross-sectional analysis examined clinical and subjective variables in relation to adherence | 140 | USA | 19.3% |
| Sajatovic et al. (2011) | Interview plus quantitative assessments, adherence behaviour and treatment attitudes | BD only | This mixed-method analysis evaluated factors related to adherence among 20 poorly adherent community mental health clinic patients with BD | 20 | USA | Not applicable |
| Scott and Pope (2002) | Structured clinical interviews | BD (n = 78) and major depressive disorder (n = 20) | Explored barriers of adherence: to explore the prevalence and predictors of nonadherence with mood stabilisers | 98 | UK | Variable (47% had been non-adherent within last 2 years) |
| Sharma et al. (2012) | Survey | BD, schizophrenia and depression | This study examined the rates of medication non-adherence, associated disease, illness, treatment and physician-related factors of compliance | 400 | India | 40.2% |
| Stentzel et al. (2018) | Interviews | BD, schizophrenia, schizotypal and delusional disorder, depression | Explored barriers of adherence: to examine potential determinants of non-adherence for patients with severe mental disorders | 127 | Germany | 54% of the participants reported some kind of non-adherence |
| Teter et al. (2011) | Interviews | BD only | The study examined the impact of substance use disorder history with regards to medication-taking behaviours and attitudes | 54 | USA | Not reported |
| Vargas-Huicochea, Huicochea, Berlanga, and Fresan (2014) | Semi-structured interviews | BD only | To characterise the patients' perceptions and to give information that can help identify some of the factors involved in the treatment nonadherence | 50 | Mexico | Not reported |
| Vieta et al. (2012) | Survey | Psychiatrist treating bipolar patients | Explored barriers of adherence: to canvas the opinions of psychiatrists treating patients with BD and ascertain their perceptions of potential reasons for partial and non-adherence | 2448 | Austria, France, Germany, Italy, Spain, Switzerland, Turkey and UK | Psychiatrists estimated that 57% of their patients were partially or non-adherent |
| Weiss et al. (1998) | Structured interviews | Coexisting BD and substance use disorder | The study examined the pattern of medication compliance and reasons for non-compliance | 44 | USA | Variable and dependent on individual medication |
| Younas et al. (2016) | Interviews | Mental health pharmacists | To explore the views and experiences of UK mental health pharmacists regarding the use of shared decision making in antipsychotic prescribing in people with serious mental illness | 13 | UK | Not applicable |
| Zeber et al. (2008) | Survey | BD, cyclothymia, or schizoaffective disorder-bipolar subtype | The study examined the association between adherence and therapeutic environment perceptions among veterans with BD | 435 | USA | 27% |