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Hospital-based prevalence of adherence ( N = 239 ).
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Non-adherence to depression treatment is a common clinical problem globally. However, limited research is available from India. This cross-sectional study aimed to assess non-adherence to prescribed treatment among patients with unipolar depression at a psychiatric out-patient department (OPD) of a tertiary hospital in Kolkata, India. The Morisky M...
Citations
... The profound impact of consistent adherence on the treatment trajectory of MDD is undeniable. While antidepressants hold substantial potential for symptom relief and improved functioning, their effectiveness is closely tied to consistent adherence (Banerjee and Varma 2013). ...
Major Depressive Disorder (MDD) is a global mental health concern, with treatment often involving antidepressant (AD) medications. However, adherence to these medications remains a significant challenge. This study aims to investigate the factors influencing medication adherence among individuals with MDD in Erbil, Iraq. This study was conducted at Erbil Psychiatric Hospital, a leading mental healthcare facility in Erbil city. Participants aged 18 to 65, diagnosed with MDD as per the DSM-5 criteria, were treated with antidepressants. The recruitment of 106 participants was facilitated by their treating psychiatrists at the hospital. Data analysis was conducted using SPSS version 22, standard for social science research. Out of the 106 participants, 64.2% were females, and 35.8% were males. The largest age group was 35–45, comprising 33% of the sample. A vast majority (99.1%) were under regular follow-up, with only 0.9% experiencing relapse. The primary antidepressant used was selective serotonin reuptake inhibitors (SSRIs) (72.6%). Most participants (61.3%) reported very high medication adherence. The notable barriers included treatment duration (13.4%), forgetting to take antidepressants (11.9%), frequent medication refills (17.9%), cultural and religious beliefs (19.3%), stigma (19.3%), travelling issues (42.9%), and lack of hospitals and clinics (30.8%). Healthcare facilitators such as effectiveness of antidepressants (27.5%), patient-provider relationship such as trusting healthcare providers (50.7%), and reminders such as keeping pills in visible places (65.9%) were prominent facilitators aiding adherence. Future research should focus on culturally tailored interventions and collaborative efforts among stakeholders. By addressing socio-cultural nuances and enhancing mental health support, more effective strategies can be developed to tackle medication adherence challenges in Erbil’s unique context.
... Previous studies showed that approximately 30%-60% of patients with depressive disorders discontinued their medical treatment without the consent of their doctor [14,15]. In a study conducted by Banerjee and Varma, out of a total of 239 patients with unipolar depressive disorder, 66.9% (n=160) were non-adherent and 33.1% (n=79) were adherent to therapy [16]. ...
... years, which was consistent with the results of a previous study by Banerjee and Varma, where the mean age of the participants was 40.0±11.0 years [16]. Out of a total of 883 recruited patients, the majority (60.6%; n=535) were male, and 39.4% (n=348) were female. ...
... The existing literature on this issue lacks uniformity. Similar to our results, a study by Banerjee and Varma, found that women exhibited a greater rate of treatment non-adherence as compared to males [16]; another study also documented higher treatment compliance among male participants [35]. However, other studies have reported conflicting results, where males were more likely to terminate therapy without a doctor's approval [15,36]; and other studies from India also documented that women were more consistent in their treatment, with a lower dropout rate compared to men [5,19]. ...
Introduction: The success of any medical intervention, including mental health treatment, depends largely on patient adherence to the prescribed regimen. In psychiatric illnesses, one of the biggest problems is getting people to adhere to their treatment schedule, representing a treatment gap that increases the burdens of patients, families, communities, and countries. Globally, it has become necessary for community health organizations to actively work towards reducing this gap and treatment non-adherence. Therefore, in this study, we aimed to examine treatment non-adherence patterns among patients with mental illness.
Materials and methods: This work used a retrospective study design and consecutive sampling. The data source was secondary data obtained from the healthcare records of patients registered in the outpatient department of the District Mental Health Care Center, India, from January 2022 to December 2022.
Results: Out of a total of 883 patients recruited for the study, 35.7% (n=315) were on regular follow-up over a duration of more than one year. Among patients with severe mental illness, 46% (n=46) had regular follow-ups and were compliant with therapy. About 49% of patients (n=433) discontinued their treatment after the initial contact with the therapist, with the highest rate among those with substance use disorders (77.0%; n=57). The remaining 15.3% (n=135) of recruited patients discontinued their follow-up appointments over a duration of 1 week to 12 months. Overall, 64.3% (n=568) of the recruited patients discontinued their treatment within one year.
Conclusion: There was considerable early treatment dropout among patients with mental illness. However, this treatment discontinuation can be avoided because the individual identities of these patients are well-known to the therapist or facility, as they have had at least one interaction with the therapist. In order to improve treatment adherence, patients with mental illnesses must receive consistent support through community outreach programs, home visits, and new strategies to promote treatment compliance.
... 10 Premature discontinuation of medication leads to significantly poorer clinical outcomes such as higher levels of depression, 15 increases emergency department (ED) visits and hospitalizations, 16,17 and impacts the overall health care utilization rate. 18 Unfortunately, patients with depression have poor medication adherence, with 50%-70% of patients not being compliant, 16,19,20 which is one of the main reasons for the limited treatment of depression and the failure of depression management. 21 Therefore, it is necessary to develop and improve medication management strategies to improve medication adherence in patients with depression. ...
... Previous studies have confirmed that 50% to 70% of patients with depression are not adherent to their medication, 70 which leads to worse clinical outcomes. 16,19,20 Incorporating patient preferences into clinical decisions can improve adherence. A study explored the barriers and facilitators of adherence to antidepressants in depression patients, but did not weigh the relative importance of these factors, nor did it survey the preferences of depression patients. ...
Introduction
Depression threatens people’s lives and imposes huge economic burden. Antidepressant therapy is the first-line treatment for depression, and patient adherence to medication is the key to successful treatment. Depression patients have poor medication adherence, which leads to failure of depression management and significantly poorer clinical outcomes. Incorporating patient preferences into clinical decisions can improve uptake rates, optimize treatment adherence. A discrete choice experiment (DCE) can elicit and quantify individual preferences. Previous DCE studies were conducted in developed countries and ignored the influences of factors other than the medication. This paper outlines an ongoing DCE that aims to (1) explore medication-management-related characteristics that may affect depression patients’ adherence to antidepressant, (2) elicit how depression patients consider the trade-offs among different medication managements.
Methods
The six attributes and their levels were developed through a literature review, semi-structured interviews and experts and focus group discussions. A fractional factorial design in the software Ngene 1.2 version was used to generate 36 choice sets, and they were divided into 3 blocks. A mixed logit model will be used to explore the patients’ preferences, willingness to pay and uptake rate of depression patients for medication management attributes.
Results
The final questionnaire consists of three parts. The first is the introduction, which introduces the purpose of the study and the requirements of completing the questionnaire. This was followed by a general information questionnaire, which included sociodemographic characteristics. The last part is DCE tasks, which include 13 DCE choice sets, and each choice set include two alternative and one “opt-out” option. The pilot-test results showed the questionnaire was easy to understand and could be used in formal surveys.
Conclusion
Our study shows how the development process of the study can be conducted and reported systematically and rigorously according to the theoretical foundation and design principles in DCE.
... This was consistent with the results of many studies that reported a higher non-adherence percent to antidepressant therapy. The reasons for nonadherence to antidepressants were forgetting to take drugs, side effects of antidepressants, a stigma among individuals with mental illness, and the higher cost of the medication [21,22]. It was recently discovered that one-quarter of depressed patients has excessive immune system activation [23]. ...
Background
Differentiating unipolar depression from bipolar depression is clinically important. The identification of biomarkers that characterize the pathophysiology of each disorder may provide biological targets for treatment. The objective of the study was to demonstrate a relationship between CRP level and the severity of depressive symptoms and see if C-reactive protein (CRP) levels can be used as a biomarker to distinguish between unipolar and bipolar depression. A convenience sample of 90 individuals was consecutively recruited from the psychiatry outpatient clinic at Beni-Suef University Hospital, Egypt. They were divided into three equal groups: patients with major depressive disorder (MDD) (group 1), bipolar depression (group 2), and a healthy volunteer group (group 3). Patient groups were assessed using semi-structured interviews, and CRP levels were measured.
Results
Patients with bipolar depression and MDD showed a significantly higher score on the Beck Depression Inventory scale than the control group (32.97 ± 2.4 vs. 31.93 ± 2.3 vs. 8.00 ± 2.3 in all groups respectively) ( P -value < 0.001). Patients with bipolar depression and MDD showed a significantly higher serum CRP level than the control group (134.96 ± 16.45 vs. 133.86 ± 17.59 vs.56.04 ± 26.71 vs. in all groups respectively) ( P -value < 0.001). In all studied groups, elevated plasma CRP levels have a significant linear correlation with the severity of depression as measured by the Beck Depression Inventory (BDI) ( r = 0.887, P -value < 0.001).
Conclusions
Serum CRP levels are significantly higher in MDD and BD patients when compared to controls. Individuals with higher CRP levels had more severe depression, and this finding was significantly higher in women than in men.
... Only two Indian studies were included in the previous review. Banerjee and Varma [7] reported a prevalence of 66.9% MNA in patients with unipolar depression. Female gender and lower internal locus of control were reported to predict MNA in this population. ...
... The flowchart for study selection and inclusion in the review has been presented in Figure 1. A total of 42 studies [7][8][9][10][11] with a pooled sample size of 6,268 patients were included in the systematic review. Among them, 32 studies [7][8][9][10][11]15,17,18,[20][21][22][24][25][26]28,29,32,[34][35][36][37][38][39][40][41][42][45][46][47][48][49][50] with a pooled sample size of 4,964 were included in the meta-analysis. ...
... A total of 42 studies [7][8][9][10][11] with a pooled sample size of 6,268 patients were included in the systematic review. Among them, 32 studies [7][8][9][10][11]15,17,18,[20][21][22][24][25][26]28,29,32,[34][35][36][37][38][39][40][41][42][45][46][47][48][49][50] with a pooled sample size of 4,964 were included in the meta-analysis. ...
Medication nonadherence (MNA) poses a significant challenge in the management of major psychiatric disorders. The present study was undertaken to determine the prevalence of MNA among patients with psychiatric disorders in India and to identify the factors associated with MNA. The following databases were searched systematically: PubMed, Directory of Open Access Journals, and Google scholar. Articles originating from India published in peer reviewed English language journals before May 15, 2021 reporting the prevalence of MNA and associated factors among patients with psychiatric disorders were retrieved and the relevant data were abstracted. The pooled prevalence of MNA was calculated using the inverse variance method. Factors associated with MNA were synthesized and described. A total of 42 studies (pooled N = 6,268) were included in the systematic review. Among these, 32 studies (pooled N = 4,964) reported the prevalence of MNA and hence were eligible for meta analysis. The pooled prevalence of MNA was 0.44 (95% confidence interval [CI] 0.37-0.52). The pooled prevalence of MNA for psychotic disorders, bipolar disorders, and depressive disorders were 0.37 (95% CI, 0.28-0.46), 0.47 (95% CI, 0.23-0.72), and 0.70 (95% CI 0.60-0.78), respectively. Negative attitude toward medications, polypharmacy, greater severity of illness, lack of insight, and cost of medications were associated with MNA. Quality appraisal of the included studies revealed that most studies did not categorize and address nonresponders and did not provide any information on nonresponders. To conclude, about half of the patients with psychiatric disorders in India are nonadherent to their psychotropic medications. Evidence based interventions to improve medication adherence in these patients need to be developed and implemented proactively keeping in mind the factors associated with MNA.
... In this study, female clients were 4.7 times more likely not to adhere to clinic appointments than males. This study agrees with the ndings of a study in India's Kolkata Hospital, which found that women were 2.7 times more likely than men to be non-adherent (Banerjee & Varma, 2013). Sociocultural factors may be to blame for the disparity in reported ndings. ...
Background: Individuals who are non-adherent to treatment have higher rates symptom recurrence, higher hospital readmission and poor quality of life.
Methods: A cross-sectional analytical study was conducted at Nkhoma Mission Hospital, Lilongwe Malawi. Survey approach and total population sampling were used. MARS was used to assess medication adherence.
Results: The prevalence of non-adherence to clinic appointment and medication was 64% (n=58) and 46.2% respectively. Females were 4.7 times more likely to miss clinic appointments than males (B =-1.555, Exp (B)=0.221, p=0.029), clients not married were 15 times more likely not to adhere to clinic appointments (B=2.722, Exp(B)=25.12, p=0.002) and clients who visited a mobile clinic were more likely to miss appointments (B =-1.762, Exp (B)=0.172, p=0.020). Psychotic patients had a higher adherence to medication (B=1.753, t=2.041, p=0.044).
Conclusion:It is important to address factors that influence non-adherence to avoid relapse.
... Epilepsy and schizophrenia still seen in most countries of the world as an evil spirit --although twothirds of patients can become seizure-free with adequate treatment, poor adherence to proper guidelines is a major problem for effective recovery [57,58]. In a study conducted in India, 60% of the patients believed in luck and superstition with regard to illnesses [59]. Superstitions also reported in close to 40% men and 70% women in Northern Germany [60]. ...
To cure any disease, proper use of medicine or taking medicine in the correct order is required. Even patients from developed countries struggle to maintain their drug compliance. There is an odd parallel between underdeveloped, emerging nations and the so-called developed world in the West when it comes to improper medicine use. The understanding and perception of the disease is the most important factor influencing whether patients stick to their treatment plan.
... Sources: References [12][13][14][15][16][17][18][19][20] Educational Status: Five of the included studies examined the effect of educational status on non-adherence to anti-depressant medications. Two studies in the pooled analysis showed no significant difference in the odds of no education or primary education between patients who adhered to and non-adhered medications (OR: 1.67, 95% CI: 0.43-6.44), ...
... as shown in Figure 3. Moderate heterogeneity was reported among the study results (I-square: 53%). A study conducted by Slaughter [19], Marasine et al. [16], and Banerjee [14] did not demonstrate any significant impact of educational status on non-adherence to anti-depressant medications. ...
The present meta-analysis has been conducted to review currently available literature to examine the factors associated with adherence to anti-depressant medications in adults. This meta-analysis and systematic review followed the MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines. According to this analysis, the three most important electronic resources for research were CINAHL, EMBASE, and Medline. Google Scholar was used to supplementing the articles already available for review. Keywords used to find relevant articles included "predictors," "non-adherence," "anti-depressants," and "adults." Medical subject headings (MeSH) terms and Boolean operators ("AND" and "OR") were used in the search strategy to refine the search further. Studies included in this meta-analysis had information on factors associated with non-adherence to anti-depressant medication. The study evaluated samples of adult participants over 18 years with a diagnosis of depression and who had been prescribed anti-depressants.
In conclusion, this meta-analysis examined the relationship between demographic factors and non-adherence to anti-depressant medications. The findings revealed that gender, educational status, income level, marital status, and area of residence did not significantly predict non-adherence to anti-depressants. However, older age and polypharmacy were significant predictors of adherence to anti-depressants. The study also found that individuals living in urban areas were more likely to adhere to anti-depressants, but the difference was not statistically significant.
... Improving adherence to antidepressant medication is therefore a critical aspect in the management of MDD [4,6] Previous studies have reported that a significant proportion of individuals with MDD, ranging from 60.0-70.0%, have poor medication adherence [7,8]. ...
... Understanding MDD and its treatment may have a significant impact on adherence to antidepressants [9]. Factors that contribute to poor medication adherence include high severity of illness, self-stigma, and negative attitudes among patients and caregivers towards MDD [8,10]. This is due to the fact that individuals with MDD may experience distress from rejection and discrimination, leading to reduced self-esteem and life satisfaction [10]. ...
... and 60.0% of the general population had poor knowledge of MDD and prejudice attitudes toward MDD, respectively [11,25]. In addition, 60.0-70.0% of individuals with MDD were reported to be medication non-adherent [7,8]. Then the researcher used these towards the sample size calculation to estimate the proportion in this study. ...
Background
Depression is a common disease and the relapse of depression can cause functional impairment. Good medication adherence and relapse prevention should be targeted to achieve normal functioning. This study aimed to evaluate the levels of knowledge, attitude toward depression, and medication adherence among individuals with depression.
Methods
A cross-sectional study surveyed Thai individuals with depression at the psychiatric outpatient clinic of Songklanagarind Hospital; from April to August 2022. The questionnaires inquired about:1) demographic information, 2) knowledge and attitude toward depression questionnaire, 3) the medication adherence scale in Thais (MAST), 4) the Patient Health Questionnaire-9 (PHQ-9), 5) the stigma questionnaire, 6) a patient-doctor relationship questionnaire (PDRQ-9), and 7) the Revised Thai Multidimensional Scale of Perceived Social Support (rMSPSS). All data were analyzed using descriptive statistics. Chi-square or Fisher’s exact test, and Wilcoxon rank sum test were used.
Results
Of all 264 participants, the majority of them were female (78.4%). The overall mean age was 42.3 ± 18.3 years. Most participants had good knowledge and a positive attitude regarding any relationship problems, childhood trauma or bad memories, or having a chemical imbalance in the brain as one of the main causes that result in depression (86.4, 82.6, 77.3%, respectively). They disagreed with common stereotypical assumptions towards individuals with depression. Most of them had good medication adherence (97.0%), low or no level of stigma (92.5%), high perceived social support from family (64.4%), and good doctor-patient relationships (82.2%). Due to most participants reporting having good medication adherence, then an attempt to indicate the factors associated with medication adherence could not be established in this study. This study found that individuals reporting residual symptoms of depression had higher levels of knowledge and perceived stigma, but lower levels of family support compared to those without residual symptoms.
Conclusion
Most participants reported good knowledge and a positive attitude toward depression. They exhibited good medication adherence, a low level of stigma, and a high level of social support. This study revealed a correlation between the presence of residual symptoms of depression and increased levels of knowledge, perceived stigma, and reduced family support .
... 59 Superstitions also reported in close to 40% men and 70% women in Northern Germany. 60 In Africa, 70% of people turn to indigenous treatments such as charms and witchery to treat their illness. 61 Surprisingly, more than 40% of Americans be-lieve in spiritual treatments and researchers found that 73% of addiction treatment programs in the USA include a spirituality-based element. ...
Introduction and aim. To cure any disease, proper use of medicine or taking medicine in the correct order is required. Even patients from developed countries struggle to maintain their drug compliance. There is an odd parallel between underdeveloped , emerging nations and the so-called developed world in the West when it comes to improper medicine use. The understanding and perception of the disease is the most important factor influencing whether patients stick to their treatment plan. Material and methods. Prioritized databases for public health topics included PubMed, ALTAVISTA, Embase, Scopus, Web of Science, and the Cochrane Central Registers. Along with other online sources, journals from Elsevier, Springer, Willey Online Library, and Wolters Kluwer were thoroughly searched. Analysis of the literature. There is a thorough discussion of medication non-adherence issues and a few adherence-improving methods. Conclusion. Adherence to treatment guidelines is essential in the treatment of any disease.
