Identifying Poor Adherence in Outpatients with Bipolar Disorder: A Comparison of Different Measures

Abstract

Objective Unlike schizophrenia, comparisons of different methods of estimating inadequate adherence in bipolar disorder (BD) are scarce. This study compared four methods of identifying inadequate adherence among outpatients with BD. Materials and Methods Two self-reports, the Morisky Medication Adherence Questionnaire (MAQ) and the Drug Attitude Inventory (DAI-10), clinician ratings employing the Compliance Rating Scale (CRS), mood-stabilizer levels, and clinic-based pill counts were compared at intake in 106 outpatients with BD and after 6 months of follow-up (n = 75). Statistical Analysis Rates of nonadherence were determined for each method. The ability to detect inadequate adherence was based on sensitivity, specificity, positive and negative predictive values (PPV and NPV), and positive and negative likelihood ratios (LR positive and LR negative). Correlation coefficients and Cohen's kappa values were used to determine the agreement between measures. Correlation coefficients were also used to evaluate the determinants of inadequate adherence Results The MAQ and the DAI-10 (cut-off score of two) yielded higher rates of nonadherence (35–47%) than the other methods. They were better at detecting adherence (specificity, 34–42%; PPV, 40–44%; and LR negative, 0.70–0.96) than other measures and had moderate ability to identify nonadherence compared with them (sensitivity, 63–73%; NPV, 54–70%; and LR positive, 1.02–1.16). They were associated with several established predictors of nonadherence. The MAQ and DAI-10 scores and the MAQ and CRS scores were modestly correlated. Multivariate analysis showed that 20% of the variance in the DAI-10 scores was explained by the MAQ scores. Despite their low yield, serum levels had a high sensitivity (88%) and higher accuracy (55%) in identifying inadequate adherence. CRS ratings and pill counts had high sensitivity but low specificity to detect inadequate adherence. Conclusion Self-reports appeared to be the most efficient method of ascertaining inadequate adherence among outpatients with BD. However, since none of the measures were adequate by themselves, a combination of different measures is more likely to maximize the chances of identifying inadequate adherence among these patients.

Physical activity influences adherence to pharmacological treatments in patients with severe mental disorders: results from the multicentric, randomized controlled LIFESTYLE trial

“…However, both our and WHO findings highlight the need to improve medication adherence among patients with chronic physical and mental illnesses ( Fernandez-Lazaro et al, 2019 ; Laranjeira et al, 2023 ). The lower adherence rates found in people with severe mental disorders compared to those reported by people suffering from other chronic conditions can be due to the presence of specific symptoms, such as cognitive impairment in schizophrenia ( El-Missiry et al, 2015 ; Mendes et al, 2019 ; Senner et al, 2023 ); inflated mood in bipolar disorder or hopelessness in major depressive disorder ( Chauhan et al, 2021 ). Indeed, in our sample having a psychiatric diagnosis of schizophrenia and/or bipolar disorder did not influence patients’ adherence to treatments, which is partially in line with findings from Ghosh et al (2022) .…”

Direct and Indirect Predictors of Medication Adherence With Bipolar Disorder: Path Analysis

“…A primary limitation of this study is measurement of medication adherence by self-report only. Though the MMAS-8 has been well studied, including BD [ 52 ], adherence is complicated to measure, especially with mental health conditions expressed by affective symptoms rather than objective markers. Further measurement of adherence using other methods (eg, pharmacy records) shoould corroborate self-reported responses.…”

Tercer Consenso Argentino sobre el manejo de los Trastornos Bipolares. Segunda Parte A: Tratamiento integral de los trastornos bipolares en el adulto

“…■ Tener en cuenta que los agentes de salud tienden a sobrestimar la adherencia a la medicación (Chauhan et al, 2022;Osterberg y Blaschke, 2005).…”