Medication nonadherence and its associated factors in psychiatric patients in India: A systematic review and meta-analysis

Abstract

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.

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“…AXIS critical appraisal tool for cross sectional studies/surveys [46][47][48][49][50][51]. This tool is designed to assess the quality of cross-sectional studies or surveys.…”

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“…A review of the literature indicates that treatment adherence is difficult to achieve, and is an obstacle to achieving good clinical outcomes in people with severe mental disorders ( 11 ). Patients with serious psychiatric problems are most likely to fail to adhere to medication due to poor reasoning and lack of knowledge about their illness and treatment ( 8 , 12 , 13 ). In turn, non-compliance with taking psychotropic drugs can lead to exacerbation of the disease, reduce the effectiveness of treatment or make the patient less amenable to subsequent treatment.…”

“…Adherence to treatment recommendations is defined as the patient's acceptance of and compliance with basic health and treatment suggestions; this definition covers various aspects, such as access to treatment, taking medications, and understanding further advice (7)(8)(9). The WHO defines medication nonadherence as "a case in which a person's behavior while taking medication does not conform to the established recommendations of medical personnel" (10).…”