title: Understanding medication non-adherence in bipolar disorders using a Necessity-Concerns Framework.
abstract: BACKGROUND
  Medication non-adherence is a major problem in patients with severe mental disorders and is associated with poor clinical outcomes and high resource utilization. This study examined the utility of the Necessity-Concerns Framework for understanding patient attitudes towards and levels of adherence with medications prescribed for bipolar disorders.
  
  
  METHODS
  A convenience sample of 223 individuals currently prescribed medication for bipolar disorders, recruited by advertisement in a Manic Depression Fellowship newsletter, completed the Beliefs about Medication Questionnaire and the Medication Adherence Report Scale.
  
  
  RESULTS
  Low adherence was reported by 30% (n=64) and was predicted by greater doubts about personal need for treatment (OR=.50; 95% CI: .31-.82) and stronger concerns about potential negative effects (OR=2.00; 95% CI: 1.20-3.34). These predictors were independent of current mood state, illness and demographic characteristics.
  
  
  CONCLUSIONS
  Participants were a potentially biased sample of volunteers who had been recruited through a patient organisation newsletter. However, clinical characteristics and adherence rates in this study were similar to those reported in other studies conducted in Europe and the USA.
  
  
  CONCLUSIONS
  The Necessity-Concerns Framework is a useful theoretical model for understanding key attitudes towards medication in bipolar disorders. Interventions to facilitate adherence should elicit and address patients' beliefs about medication.
authors.affiliation: Centre for Behavioural Medicine, School of Pharmacy, University of London, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Clatworthy
authors.forename: Richard
authors.initials: R
authors.lastname: Bowskill
authors.forename: Rhian
authors.initials: R
authors.lastname: Parham
authors.forename: Tim
authors.initials: T
authors.lastname: Rank
authors.forename: Jan
authors.initials: J
authors.lastname: Scott
authors.forename: Rob
authors.initials: R
authors.lastname: Horne
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D016312:Treatment Refusal / Q000523:psychology* / Q000706:statistics & numerical data; D006113:United Kingdom; D016903:Drug Monitoring