Factors Associated with Medication Adherence among Patients with Schizophrenia in Mekelle, Northern Ethiopia

Abstract

BackgroundNon-adherence to antipsychotic medication has a negative impact on the course of illness resulting in increased risk of relapse, rehospitalization and suicide, and increased costs to healthcare systems. The objective of this study was to investigate factors associated with medication adherence among patients with schizophrenia at Ayder Referral Hospital and Mekelle Hospital in Mekelle, Tigray region, Northern Ethiopia.MethodsThe study was a cross-sectional survey in which sociodemographic characteristics, drug attitudes, insight and side effects were measured and explored in terms of their relationship with medication adherence. A structured questionnaire as a data collection tool was used. Data were analyzed with the help of SPSS Version 20.0.ResultsA total of 393 patients participated, 26.5% were non-adherent to their antipsychotic medication. The factors significantly associated with better adherence were positive treatment attitudes (AOR = 1.40, 95% CI: 1.26, 1.55), fewer side effects (AOR = 0.97, 95% CI: 0.94, 0.99), awareness of illness (AOR = 1.44, 95% CI: 1.12, 1.85) and the ability to relabel symptoms (AOR = 1.57, 95% CI: 1.19, 2.07). However, khat chewers (AOR = 0.24, 95% CI: 0.09, 0.68), being illiterate (AOR = 0.13, 95% CI: 0.03, 0.47) and older age group (AOR = 0.03, 95% CI: 0.01, 0.16) were associated with less medication adherence.ConclusionsA high prevalence of medication non-adherence was found among patients with schizophrenia. Intervention strategies focused on educating the patients to better understand the illness, medications and their potential side effects might be useful in improving adherence to antipsychotic medication treatment.

Why do psychiatric patients stop antipsychotic medication? A systematic review of reasons for nonadherence to medication in patients with serious mental illness

“…An Ethiopian study found that negative attitude toward medication was significantly associated with nonadherence in patients with schizophrenia 35. A Chinese study in first-episode schizophrenia found a similar association,45 as did a study in US veterans with bipolar disorder 44.…”

“…Experiencing greater side effects was significantly associated with worse adherence in Ethiopian patients with schizophrenia 35,39. In another study of patients with schizophrenia, having side effects was among 3 independent variables included in a model that predicted nonadherence of patients in Australia 50.…”

“…A brief summary of results from each of the studies is provided in Tables 1 and 212,19–34 (prospective and post hoc analyses) and Tables 3 and 435–53 (cross-sectional). Most of the studies were conducted in patients with schizophrenia or schizophrenia-like disorders (75%, 27/36).…”

Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments

“…Consistent with this, Misdrahi et al 18 and Lincoln et al 19 found that persons with poor insight were more likely to refuse to take antipsychotic medication, while others have found that groups with lower levels of adherence across cultures have consistently tended to have poorer clinical insight [20][21][22][23] .…”

Medication-related factors of non adherence among patients with schizophrenia and bipolar disorder: Outcome of a cross-sectional survey in Maiduguri, North-eastern Nigeria

“…The principal treatment-related correlates of non-adherence are attributable to the medications used in the treatment of most of these disorders. These medication-related factors include dosing regimen, side effect profiles, fear of addiction potentials, and concerns about drug-drug interactions (Weiden and Miller, 2001;DiBonaventura et al, 2012;Higashi et al, 2013;Caldeira et al, 2014;Eticha et al, 2015). Most studies conducted in subSaharan that addressed nonadherence among patients with psychiatric disorders principally assessed patientrelated and socio-economic factors, with little or no attempt made at looking at the medication-related factors as significant correlates of nonadherence.…”