Psychiatric outpatients' self-reported adherence versus psychiatrists' impressions on adherence in affective disorders

摘要

Objective The objective of this study is to explore correlation between patients' self-reported adherence to medication and their treating psychiatrists' impressions on adherence. Methods During a 9-month period, 140 consecutive psychiatric outpatients with affective disorders attending two community mental health centers, and their treating psychiatrists, took part. Data were collected on socio-demographic, clinical, and therapeutic variables. The Clinical Global Impression-Severity and Improvement scales and the Beck Depression Inventory were used for clinical assessment. Adherence was assessed by the psychiatrist's report and the Morisky scale from patients. In addition, "Drug Attitude Inventory," "Beliefs about Medicine Questionnaire," and "Leeds Attitude towards concordance scale" were applied to all participants. A multivariate analysis of variance (Bonferroni control) and a subsequent stepwise regression were performed. Results The allocation of patients to "adherent" or "non-adherent" categories by the patients themselves and their treating psychiatrists was divergent in more than 40% of the cases. The best agreement appears when treatment is prolonged. There is a better agreement with patients having a positive view of the medicines. When patients consider the medication harmful, this is when psychiatrists perceive more non-adherence. The agreement is also better in mild cases of depression. Conclusions Adherence was principally compromised by patient-related factors, especially their beliefs and attitudes toward their treatment and its duration.