Factors Associated With Prospective Long-Term Treatment Adherence Among Individuals With Bipolar Disorder

Sajatovic, Martha; Biswas, Kousick; Kilbourne, Amy K.; Fenn, Howard H.; Williford, William O.; Bauer, Mark S.

doi:10.1176/ps.2008.59.7.753

Cited by 54 publications

(23 citation statements)

References 45 publications

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“…Age, gender, and race have been found to be associated with adherence status in some studies [8,22] but did not differ statistically between categories of patients who were generally adherent versus nonadherent in other studies [23]. One study found marriage to be positively associated with adherence to medication [24].…”

Section: Demographic Factorsmentioning

confidence: 99%

REVIEW: Patient, Treatment, and Systems‐Level Factors in Bipolar Disorder Nonadherence: A Summary of the Literature

Busby

Sajatovic

2010

CNS Neuroscience & Therapeutics

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This is a review of adherence determinants in bipolar disorder based on published prospective studies. Patient, treatment, and systems-level adherence determinants are summarized. The review concludes with recommendations on approaches that may minimize nonadherence. MEDLINE, PsychINFO, and the Cochrane Database were searched using key terms of adherence, compliance, or persistence, combined with terms of bipolar disorder, bipolar depression, or mania. Publications were filtered for randomized clinical trials (RCTs). Due to low yields of RCTs, we additionally included prospective nonrandomized clinical and epidemiologic studies, and prospective studies of severe mental illness that had a focus on adherence as an outcome and reported data separately for bipolar disorder. A targeted review of the broader bipolar literature provided background for concluding remarks. Twenty-two publications were identified describing RCTs with a specific population of bipolar disorder and a measure of adherence. Additional prospective nonrandomized studies were also identified. Studies identified three major categories of factors important to adherence: patient, treatment, and systems-associated factors. Patient factors include selected demographic features, symptom severity and phase of illness, presence of past suicide attempts, psychiatric comorbidity, illness and treatment duration, and relationship with providers. Treatment factors include type and intensity of pharmacotherapy and psychotherapy. Systems-level factors include differential levels of care access and costs. There is an overall lack of RCTs, and few prospective studies, on patient and systems-related determinants of adherence. Treatment-related determinants of adherence have the most evidence to date; however, would benefit from larger studies with diverse populations. Careful assessment of treatment adherence (including partial adherence) should be included in all prospective bipolar treatment studies, and studies should be conducted to prospectively evaluate interventions to minimize nonadherence.

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Section: Demographic Factorsmentioning

confidence: 99%

REVIEW: Patient, Treatment, and Systems‐Level Factors in Bipolar Disorder Nonadherence: A Summary of the Literature

Busby

Sajatovic

2010

CNS Neuroscience & Therapeutics

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“…In order to obtain a real-world generalizable sample of patients with bipolar disorder, we established minimal exclusion criteria (inability to provide informed consent and inability to be rated on psychiatric rating scales), similar to prior randomized controlled trials of collaborative care management models (14,17). The study was approved by the local institutional review board.…”

Section: Methodsmentioning

confidence: 99%

“…Interestingly, clinical characteristics usually associated with poor outcome, such as substance abuse, have not been reported to correlate with diminished LGP participation or success. Moreover, collaborative chronic care management models that have been adapted for bipolar disorder and that include LGP have shown significant improvements in clinical outcome (14–17), function (15), and quality of life (15) in long-term, multisite, randomized controlled trials.…”

mentioning

confidence: 99%

“…Previously published trials have used LGP within the context of a combined care approach (14–17), and there are no published data on how LGP may specifically affect treatment adherence in populations of persons with bipolar disorder. A randomized controlled, multicomponent intervention study (that included LGP among the multiple components) conducted in a managed care setting did not specifically evaluate medication adherence (16).…”

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confidence: 99%

“…A randomized controlled, multicomponent intervention study (that included LGP among the multiple components) conducted in a managed care setting did not specifically evaluate medication adherence (16). A randomized, controlled collaborative care model (CCM) study by the Department of Veterans Affairs that included LGP as one of the multiple components and evaluated medication adherence as a secondary outcome did not find a difference between the CCM group and the control group (17), but because the CCM study had several components it was not possible to separate effects of LGP from those of other activities, such as nurse care management (14,15). To the best of our knowledge, there are no previous studies using a controlled methodology that tested LGP as a stand-alone intervention.…”

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confidence: 99%

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A Comparison of the Life Goals Program and Treatment as Usual for Individuals With Bipolar Disorder

Sajatovic¹,

Davies²,

Ganocy³

et al. 2009

Psychiatric Services

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Objective This randomized controlled study of 164 outpatients with bipolar disorder in a community mental health center who received standardized psychoeducation (Life Goals Program [LGP]) or treatment as usual sought to determine whether there were differences between the groups in medication adherence attitudes and behaviors. Methods Patients were randomly assigned to treatment as usual (N=80) or treatment as usual plus LGP (N=84) and were assessed at baseline and at the three-, six-, and 12-month follow-up. Primary outcomes were change in score from baseline on the Drug Attitude Inventory (DAI) and on self-reported treatment adherence behaviors (SRTAB). Results At baseline, there were no significant differences between the two groups. Slightly less than half (N=41, 49%) of the LGP group participated in most or all (four to six) LGP sessions, 14% (N=12) participated in one to three sessions, and 37% (N=31) did not participate in any sessions. At the 12-month follow-up there was improvement among all patients, with no significant differences between the two groups, in DAI scores, SRTAB, symptoms, psychopathology, and functional status. Greater depressive severity at baseline was associated with more negative attitudes toward treatment over time, although this finding was not significant (p=.056). Secondary analysis of persons in the LGP group found that compared with those who did not go to any LGP sessions, those with partial or full participation in LGP sessions had improved attitudes toward medication at the three- and six-month follow-up, but no difference was found between the three LGP subgroups by the 12-month follow-up. Conclusions There were no differences between two groups in treatment attitudes at the 12-month follow-up. Low attendance rates mitigated effects on primary outcomes. Effects of LGP may become lost over time without ongoing intervention, and individuals with depression may have reduced response to LGP.

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PTSD and Bipolar Disorder: Approaches to Pharmacology, Psychotherapy, and Psychoeducation

Bajor¹,

Lucero²,

Melguizo³

et al. 2016

Comprehensive Guide to Post-Traumatic Stress Disorders

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Factors Associated With Prospective Long-Term Treatment Adherence Among Individuals With Bipolar Disorder

Cited by 54 publications

References 45 publications

REVIEW: Patient, Treatment, and Systems‐Level Factors in Bipolar Disorder Nonadherence: A Summary of the Literature

REVIEW: Patient, Treatment, and Systems‐Level Factors in Bipolar Disorder Nonadherence: A Summary of the Literature

A Comparison of the Life Goals Program and Treatment as Usual for Individuals With Bipolar Disorder

PTSD and Bipolar Disorder: Approaches to Pharmacology, Psychotherapy, and Psychoeducation

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