|Year : 2019 | Volume
| Issue : 2 | Page : 61-66
Medication adherence and its association with subjective well-being among persons with schizophrenia
Angshu Lama1, Arunjyoti Baruah2
1 Ph.D Scholar, Department of Psychiatric Nursing, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam, India
2 Prof, H.O.D. Department of Psychiatric Nursing, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam, India
|Date of Web Publication||21-Jan-2020|
Mrs. Angshu Lama
Department of Psychiatric Nursing, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam
Source of Support: None, Conflict of Interest: None
Background: Medication nonadherence has been associated with persistence of psychotic symptoms, relapse, and hospitalization in persons with schizophrenia. Adherence to antipsychotic drug treatment is a key issue for nurses and treatment team members. Aim: The study was conducted with the purpose to assess the medication adherence and its association with subjective well-being among persons with schizophrenia. Method: The study followed a quantitative nonexperimental descriptive design. Participants of this study included 85 persons diagnosed with schizophrenia according to ICD-0 taking treatment at LGB Regional Institute of Mental Health, Tezpur. Data were collected using the self-structured sociodemographic datasheet, The Medication Adherence Rating Scale, and The WHO Subjective Well-Being Inventory. Results: 34.1% patients were not adherent to medication. Significant association was found between the medication adherence and subjective well-being (χ2= 6.58 P < 0.05). Significant association was also found between the medication adherence and factor 8, i.e., inadequate mental mastery factor of subjective well-being of the patient (χ2= 10.82 P < 0.05). Pearson correlation coefficient between the medication adherence and subjective well-being was 0.343, so there was positive correlation between the patient's medication adherence and their subjective well-being. Conclusion: The findings of this study reveal that there is a significant association of adherence with the subjective well-being of the patient and that there is a significant positive correlation present between the medication adherence and subjective well-being. Proper psychoedu and support can help clients to improve their medication adherence.
Keywords: Medication adherence, persons with schizophrenia, subjective well-being
|How to cite this article:|
Lama A, Baruah A. Medication adherence and its association with subjective well-being among persons with schizophrenia. Indian J Psy Nsg 2019;16:61-6
|How to cite this URL:|
Lama A, Baruah A. Medication adherence and its association with subjective well-being among persons with schizophrenia. Indian J Psy Nsg [serial online] 2019 [cited 2020 Aug 5];16:61-6. Available from: http://www.ijpn.in/text.asp?2019/16/2/61/276349
| Introduction|| |
Schizophrenia has puzzled physicians, philosophers, and general public for centuries. The early onset of the disease and its chronic course makes this a particularly disabling disorder for patients and their families. The social and economic impact of the disorder on society and families is enormous.
Antipsychotics are the foundation of treatment for persons with schizophrenia. Despite their demonstrated ability to reduce symptoms and relapse rates and improve health outcomes, nonadherence to antipsychotic medication is common, averaging 40%–50%.
There is a myth that people with mental disorders comply poorly with treatment. In fact, psychiatric patients are no more likely than patients in other medical specialties to go against the advice of their doctor. However, it is easy to find instances where psychotropic medication is refused by the supposed beneficiary.
The value of neuroleptic treatment in schizophrenia is now widely accepted, and failure to take such treatment is associated with relapse. Relapse may endanger the patient and other people. Despite this, people with schizophrenia frequently fail to take their treatment. One-third of patients leaving a general adult psychiatry ward can be expected to be noncompliant within 2 years.
In two-third of cases, rehospitalization is the result of complete or partial noncompliance. After 1 year of the first hospitalization, 40% of relapse results from nonadherence to medication.
Poor adherence to oral antipsychotic medication leads to relapses, derails the process of recovery, and contributes to the high cost of treating schizophrenia.
Medication adherence is important in determining whether the selected treatment is effective, whether there should be dosage adjustments, and whether concomitant medications should be added. To optimize treatment, adherence is extremely important.
Nonadherence to neuroleptic drug treatment is a key issue for nurses and treatment team members caring for persons who typically are on chronic, progressive disease course. Mental health nurses are in a key position to support improved adherence in persons with schizophrenia through use of practical educational strategies that help patients, family members, and health-care providers better understand and manage treatment.
| Materials and Methods|| |
This study aimed to assess the medication adherence, subject well-being among the persons with schizophrenia, and to find out the association between their medication adherence and sociodemographic variables, subjective well-being. The study followed a quantitative nonexperimental descriptive design. Convenience sampling technique was used. The study was conducted in the LGB Regional Institute of Mental Health, Tezpur. Participants of this study included 85 persons diagnosed with schizophrenia, according to ICD-10, taking treatment at LGB Regional Institute of Mental Health, Tezpur. Both male and female clients diagnosed with schizophrenia according to ICD-10 guidelines with minimum 6 months duration, aged between 18 and 60 years, attending OPD and free from other medical disease were included in the study.
The tools utilized for data collection were self-structured sociodemographic datasheet, the items included in the sociodemographic data sheet, were age, sex, and duration of illness of the patient, religion, education, occupation, marital status, residence, family type, and family income. Clinical variables were also included in the sociodemographic sheet. The items included were patient's diagnosis, duration of illness, mode of onset, family history of psychiatric illness, substance abuse, medication prescribed, route of medication, and regularity of follow-up. The Medication Adherence Rating Scale (MARS),, which is a self-report measure of medication adherence in psychosis. MARS was created by Thompson et al. for assessment of adherence in psychiatric patients. There are ten questions in the scale; patients are compliant if they respond “NO” to questions 1–6 and 9–10 and “YES” to questions 7–8. The Subjective Well-Being Inventory (SUBI) which was developed in ICMR-WHO project. The SUBI can be scored by attributing the values of 3, 2, and 1 to response categories of the positive items and 1, 2, and 3 to the negative items. The minimum and the maximum scores that can thus be obtained are 40 and 120, respectively. Sociodemographic assessment was done first, and then the patient was given MARS and SUBI. Analysis and interpretation of findings were done by using Statistical Package for the Social Sciences (SPSS 20 version manufactured at Armonk, NY: IBM Corp).
| Results|| |
Sociodemographic variables of patients with schizophrenia
About 38.8% of respondents belonged to the age group 31–40 years, majority of the respondents were male, i.e., 77.6%. In religion, majority of the respondents, 72.9%, belonged to the Hindu religion. 57.6% had completed their education up to middle school, i.e., standard VIII, 28.2% of respondents were unemployed. 47.1% of respondents were married. 35.3% of the respondents' family income was between Rs. 3001 and Rs. 6000. 44.7% belonged to low socioeconomic status; this finding is similar to the epidemiological studies of mental disorders which have repeatedly shown higher rates of schizophrenia at the lower end of the socioeconomic continuum, 65.9% respondents belonged to nuclear family. Majority of the respondents (77.6%) were from rural community.
Clinical variables of patients with schizophrenia
74.1% of respondents were diagnosed as paranoid schizophrenia. 72.9% had a gradual onset of illness and 27.1% had a sudden onset of illness. 27.1% of the respondents were suffering from the illness since 4 to 6 years, 18.8% were suffering since <2 years, 16.5% were suffering since 6–8 years, 15.3% since 2–4 years, 14.1% were suffering since more than 10 years, and 8.2% since 8–10 years. 35.3% of the respondents had a family history of mental illness. Majority of the respondents, 67.1%, had history of substance abuse. Majority of the respondents (42.4%) were prescribed with antipsychotics and other medications, 29.4% were prescribed with typical antipsychotics, and 28.2% was prescribed with atypical antipsychotics. 84.7% of the respondents were getting their medication orally, while remaining 15.3% were getting their medication both orally as well as in the injectable form. 56.5% of the respondents came for regular follow-up, while rest 43.5% had irregular follow-up.
Association between the sociodemographic variables and medication adherence of persons with schizophrenia
There is a significant association between the domicile and the Medication Adherence of the patients with Schizophrenia. The Chi-square value was significant with the domicile of the patient (χ2 = 6.06, P < 0.05). No significant association was found between medication adherence and the other domains of sociodemographic variables that is age, gender, religion, education, occupation, marital status, family income, socioeconomic status, family size, and family type.
Association between the clinical variables and medication adherence of persons with schizophrenia
There is significant association between the regularity of follow-up and the medication adherence of the patients with schizophrenia. The Chi-square value was significant with the regularity of follow-up of the patient (χ2 = 4.08, P < 0.05). No significant association was found between medication adherence and the other domains of clinical variables that are diagnosis, mode of onset, duration of illness, family history of mental illness, substance abuse, and medication route of medication.
| Discussion|| |
In the present study it was found that 65.9% are adherent to their medication. 34.1% non adherence as shown in [Table 1] and [Table 2] within the range found in previous study conducted by Hazarika et al. where the researchers had found 37% nonadherence in their study. This finding is also in accordance to the study conducted by Sanele et al. where the researchers had found 37% of participant had low adherence to psychiatric treatment.
|Table 1: The mean score, maximum score, range of total Medication Adherence Rating Scale score, the mean value of the total Medication Adherence Rating Scale score, and the standard deviation of the total Medication Adherence Rating Scale score (n=85)|
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|Table 2: Frequency and percentage distribution of persons with schizophrenia according to their medication adherence (n=85)|
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Chi-square test was used to find out the association between the medication adherence of the persons with schizophrenia and their socio demographic variables. The Chi-square value was significant with the domicile of the patient (χ2 = 6.06, P < 0.05). In a study conducted by Valenstein et al., it was found that patients who were younger and non-White were more likely to have consistently poor adherence, but in the present study, no significant association was found between medicine adherence and age. Borras et al. had found that religion and spirituality contribute to shaping representations of disease and attitudes toward medical treatment in patients with schizophrenia. In the present study, no significant association was found between the patients religion and medication adherence. Acosta et al. reviewed basic nonadherence concepts of prevalence, consequences, evaluation methods, methodological restrictions of available studies, risk factors, and intervention strategies regarding medication adherence in schizophrenia. Nonadherence was reported to be more frequent in men than in women. Regarding patient's age, younger patients showed higher nonadherence rates than older ones. Marital status was not found to be a risk factor. Some studies included financial difficulties, and low education levels among the risk factors. In the present study, no significant association was found between the patients age, gender, socioeconomic status, education with the patients medicine adherence, Hazarika et al. in their study had found no significant association of adherence to religion, educational level, occupation, family income, type of family, and family history. In a similar study conducted by Sanele et al. in order to assess the levels of medication adherence and explore factors that influence adherence in psychiatric outpatients the researchers had found Significant predictors of adherence to psychiatric treatment were age and race. Significant predictors of adherence to psychiatric treatment were age and race. The impact of sociodemographic variables on adherence, such as the type of condition, employment status, and educational level, were insignificant. In the present study, no significant association was found between the patient's medicine adherence to religion, education level, occupation, family income, and type of family.
Significant association was found between the medication adherence of the persons with schizophrenia and their clinical variables. The Chi-square value was significant with the regularity of follow-up of the patient.(χ2 = 4.08, P < 0.05) In a study conducted by Heyscue et al., it was found longer duration of illness correlated with improved compliance, but the present study found no association between duration of illness and medicine adherence. Diaz et al. had conducted a prospective study to measure adherence to conventional and atypical antipsychotics after hospital discharge in patients with a diagnosis of schizophrenia and schizoaffective disorder. The researchers found no significant difference in adherence between the combined groups of atypical and conventional antipsychotics, Dassa et al. had conducted a study to quantify the factors associated with nonadherence to medication among stable patients suffering from schizophrenia in the context of universal access to care, the researchers found that individuals prescribed with atypical antipsychotic drugs were more likely to be adherent than those prescribed typical antipsychotics; in the present study, no association was found between the patients medicine adherence to medicines. Patel et al. had done a cross-sectional study and investigated patients perspectives on factors influencing adherence to antipsychotics; they found that participants taking depot (vs. oral) medication had higher ROMI noncompliance mean scores. In contrast, the present study did not find any association between patient's medicine adherence and the route of administration. Valenstein et al. in their study had found that patients who were on treatment with first-generation antipsychotics, history of substance use were more likely to have consistently poor adherence. Heyscue et al. also in their study had found that history of substance abuse was associated with compliance. Patients with a history of substance abuse had poorer compliance. Kamali et al. in their prospective evaluation of adherence to medication in first-episode schizophrenia had found that one-third of patients with schizophrenia were nonadherent with medication within 6 months of their first episode of illness, alcohol misuse at baseline, and previous drug misuse predicted nonadherence. The findings of the present study do not correspond to these findings as no significant association was found between medicine adherence and substance abuse.
Minimum score of Subjective Well Being was 51 and maximum was 82 with a mean score of 81.29 and standard deviation of 12.84 as shown in [Table 3]. Significant association was found between the Medication Adherence and Subjective Well Being
|Table 3: The mean score, maximum score, range of total Subjective Well-Being Inventory score, the mean value of the total Subjective Well-Being Inventory score and the standard deviation of the total Subjective Well-Being Inventory score (n=85)|
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(χ2 2 = 6.58, P< 0.05) as shown in [Table 4], [Table 5], [Table 6]. The findings are similar to the one found by Karow et al. who in their study had found that compliance with antipsychotic medication was strongly associated with subjective well being. The findings are also supported by the research study of Acosta et al. who had found that the cause of nonadherence is multi factorial.
|Table 4: The association of medication adherence with the subjective well-being among the persons with schizophrenia|
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|Table 5: Association of medication adherence with the eleven factors of subjective well-being in patients with schizophrenia|
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|Table 6: Correlation between Medication Adherence Rating Scale and subjective well-being|
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The implications drawn in this study are of vital concern to the psychiatric nurses. Nurses are key persons of health team. They can take an important role in all level of prevention, such as primary, secondary, and tertiary level. Information and communication with the patient, account of side effect, are simple and effective actions for improvement of adherence. Compared to a conventional care, psychoeducational programs of medication adherence have shown their superiority. Nurses can therefore conduct health education program on importance of medication adherence, in the hospital and the community. Telehealth may be a useful strategy for improving medication adherence. Nursing intervention packages can be build up which can be utilized for the improvement of patients medication adherence.
The limitations of the study were:
- The study sample size was small
- The study was limited only to persons with schizophrenia who were attending OPD of LGB Regional Institute of Mental Health, Tezpur
- The study was limited only to persons with schizophrenia who could read and write Assamese.
- A similar type of study can be carried for larger samples
- An experimental study can be carried out to assess the effectiveness of nursing intervention packages on medication adherence
- A similar type of study can be conducted for the patients with other psychiatric disorders
- A comparative study can be conducted between different types of mental disorders.
- Permission was taken from concerned authorities to carry out the study in the OPD of LGB Regional Institute of Mental Health
- Nature of the study and procedure was explained to the selected participants, and written informed consent was obtained
- Confidentiality was ensure
- Participants had the liberty to leave the study at any point of time they desired
- The study utilized noninvasive procedures, and it was ensured that there would be no physical and psychological harm to the patients.
| Conclusion|| |
The overall findings of the study showed that there is a significant level of association between the Medication Adherence and Subjective Well-Being in Patients with Schizophrenia. Medication nonadherence has been associated with persistence of psychotic symptoms, relapse, and hospitalization in patients with schizophrenia. Nursing intervention packages can be buildup which can be utilized for the improvement of patients medication adherence.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Stuart GW. Principles and Practice of Psychiatric Nursing. 7th
ed. Missouri: Elsevier; 2001.
Mueser KT, Jeste DV. Clinical Handbook of Schizophrenia. 1st
ed. New York: The Guilford press; 2008.
Thompson K, Kulkarni J, Sergejew AA. Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. Schizophr Res 2000;42:241-7.
Sell H, Nagpal R. Assessment of Subjective well being. Available from: whqlibdoc.who.int/searo/rhp/SEARO_RHP_24.pdf. [Last accessed on 2013 June 01].
Hazarika S, Roy D, Talukdar SK. A study of Medication Nonadherence in Schizophrenia; 2012. Available from: http://www.ncbi.nlm.nih.gov/pubmed
. [Last accessed on 2013 Jun 12].
Valenstein M, Ganoczy D, McCarthy JF, Myra Kim H, Lee TA, Blow FC. Antipsychotic adherence over time among patients receiving treatment for schizophrenia: A retrospective review. J Clin Psychiatry 2006;67:1542-50.
Borras L, Mohr S, Brandt PY, Gilliéron C, Eytan A, Huguelet P. Religious beliefs in schizophrenia: Their relevance for adherence to treatment. Schizophr Bull 2007;33:1238-46.
Acosta FJ, Hernández JL, Pereira J, Herrera J, Rodríguez CJ. Medication adherence in schizophrenia. World J Psychiatry 2012;2:74-82.
Heyscue BE, Levin GM, Merrick JP. Compliance with depot antipsychotic medication by patients attending outpatient clinics. Psychiatr Serv 1998;49:1232-4.
Diaz E, Neuse E, Sullivan MC, Pearsall HR, Woods SW. Adherence to conventional and atypical antipsychotics after hospital discharge. J Clin Psychiatry 2004;65:354-60.
Dassa D, Boyer L, Benoit M, Bourcet S, Raymondet P, Bottai T. Factors associated with medication non-adherence in patients suffering from schizophrenia: A cross-sectional study in a universal coverage health-care system. Aust N
Z J Psychiatry 2010;44:921-8.
Patel MX, de Zoysa N, Bernadt M, David AS. A cross-sectional study of patients' perspectives on adherence to antipsychotic medication: Depot versus oral. J Clin Psychiatry 2008;69:1548-56.
Kamali M, Kelly BD, Clarke M, Browne S, Gervin M, Kinsella A, et al
. A prospective evaluation of adherence to medication in first episode schizophrenia. Eur Psychiatry 2006;21:29-33.
Karow A, Czekalla J, Dittmann RW, Schacht A, Wagner T, Lambert M, et al
. Association of subjective well-being, symptoms, and side effects with compliance after 12 months of treatment in schizophrenia. J Clin Psychiatry 2007;68:75-80.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]