Self-reported medication treatment adherence among veterans with bipolar disorder.
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.
Sajatovic
Martha
M
Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106-5000, USA. martha.sajatovic@uhhs.com
Bauer
Mark S
MS
Kilbourne
Amy M
AM
Vertrees
Julia E
JE
Williford
William
W
D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D005260:Female; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D011369:Professional-Patient Relations; D012008:Recurrence; D012650:Self Disclosure; D011795:Surveys and Questionnaires; D014728:Veterans / Q000523:psychology*
D014150:Antipsychotic Agents