Self-reported medication treatment adherence among veterans with bipolar disorder

Martha Sajatovic, Mark S Bauer, Amy M Kilbourne, Julia E Vertrees, William Williford
Psychiatric Services: a Journal of the American Psychiatric Association 2006, 57 (1): 56-62

OBJECTIVE: Treatment nonadherence has been identified as an understudied, yet frequent, cause of relapse among patients with bipolar disorder. This study evaluated factors related to treatment adherence.

METHODS: This study was a cross-sectional analysis of patient characteristics, features of the patient-provider relationship, and barriers to care as they related to self-reported treatment adherence among veterans with bipolar disorder. Data were collected before patients were randomly assigned to treatment in a multicenter trial. Participants were enrolled in the study from 1997 to 2000.

RESULTS: This analysis found that individuals with bipolar disorder who were adherent to medication (N=113) differed from those who were not (N=71) on patient characteristics and variables related to the patient-provider relationship. Individuals with bipolar disorder who were not adherent to medication were more likely than those who were adherent to have a current substance use disorder. A past substance use disorder was not associated with treatment nonadherence. Adherence to medication was not predicted by symptoms, overall health status, functional level, or gender. Individuals who were adherent to medication took a greater number of different medications than those who were nonadherent.

CONCLUSIONS: Treatment adherence is a multidimensional entity and includes not only patient characteristics but also factors related to patient-provider interactions. Therapeutic approaches that address or incorporate an individual's comorbid conditions and are able to optimize intensity of treatment may have the greatest effect on treatment adherence attitudes and behaviors.

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