Reasons for Nonadherence to Psychiatric Medication and Cardiovascular Risk Factors Treatment Among Latino Bipolar Disorder Patients Living in Puerto Rico: A Qualitative Study

Abstract

Latinos with bipolar disorder (BD) have a high rate of nonadherence to psychiatric medication and treatment for other medical conditions such as cardiovascular disease (CVD) risk factors than non-Latinos with BD. The aim of this study is to identify patients' perspectives on the reasons for nonadherence to psychiatric medication and for CVD risk factors conditions in outpatients with BD. Three focus group sessions were held for a total of 22 adults ranging from 23 to 60 years old. Participants had BD, Type I/II and CVD risk factors. Audio-recordings of focus groups were transcribed and a content analysis was performed. Reasons identified as barriers to adherence were somewhat different for BD medications in comparison to CVD risk factors suggesting the need for integrated interventions targeting these barriers to adherence for both BD and CVD risk factors.

Mapping modifiable determinants of medication adherence in bipolar disorder (BD) to the theoretical domains framework (TDF): a systematic review

“…A majority of the studies (64%) were focused purely on BD. Of the 57 included studies, 33% (Arvilommi et al, 2014 ; Baldessarini et al, 2008 ; Bauer et al, 2013 ; Fleck, Corey, Strakowski, & Keck, 2005 ; Grover, Ghosh, Sarkar, Chakrabarti, & Avasthi, 2014 ; Hajda et al, 2015 ; Johnson et al, 2007 ; Jonsdottir et al, 2013 ; Jose, Bhaduri, & Mathew, 2003 ; Manwani et al, 2007 ; Nagesh, Kishore, & Raveesh, 2016 ; Pope & Scott, 2003 ; Ralat, Depp, & Bernal, 2018 ; Roe, Goldblatt, Baloush-Klienman, Swarbrick, & Davidson, 2009 ; Scott & Pope, 2002 ; Stentzel et al, 2018 ; Vieta et al, 2012 ) explicitly focused on exploring barriers to adherence. Table 2 describes the quality of the included studies.…”

Mapping of modifiable barriers and facilitators of medication adherence in bipolar disorder to the Theoretical Domains Framework: a systematic review protocol

“…However, the comprehensive nature of the TDF should enable identification of all determinants relevant to behaviour change and any determinants that cannot be mapped to a TDF domain will still be extracted and mapped to new domains if appropriate 34. A further benefit of mapping determinants to the TDF is its linkage to behaviour change techniques 17. This approach was successfully applied by Allemann and colleagues to match adherence interventions to determinants of patient adherence 27.…”

“…The determinants of adherence may be different among patients taking lithium relative to other antipsychotics due to a variety of factors including regular blood test requirements of lithium, dietary restrictions and significant interactions with other medications. Thus, a systematic review without the date limits of the previous systematic review14 is warranted to better represent the mood stabilisers that were the mainstay of treatment in the earlier decades and not included in the previous review and to identify emerging research 17…”

Development of a Psychosocial Intervention to Promote Treatment Adherence in Patients with Bipolar Disorder at Risk of Cardiovascular Disease

“…The goal of this stage 1a was to draft the treatment protocol of a psychosocial intervention based on the input of the focus groups formed, in our earlier study, of BD patients at risk of CVD and thus create a manual [13]. We chose participants with BD because the literature reveals that Latinos with BD living in the continental United States are more likely to be nonadherent to psychiatric medication and to such medication as may be required for other medical conditions than are Euro-Americans [4,10].…”

“…See Table 1. Figure 1 shows the barriers to and facilitators of adherence to BD and CVD medications as determined by an earlier study [13]. The topic and organization of the manual was discussed with several members of the team.…”