title: Illness experience and reasons for nonadherence among individuals with bipolar disorder who are poorly adherent with medication.
abstract: OBJECTIVE
  Nonadherent individuals are the most likely to avoid participating in research studies, thus limiting potential opportunities to develop evidence-based approaches for adherence enhancement. This mixed-method analysis evaluated factors related to adherence among 20 poorly adherent community mental health clinic patients with bipolar disorder (BD).
  
  
  METHODS
  Illness experience was evaluated with qualitative interview. Quantitative assessments measured symptoms (Hamilton Depression Rating Scale, Young Mania Rating Scale, Brief Psychiatric Rating Scale), adherence behavior, and treatment attitudes. Poor adherence was defined as missing 30% or more of medication.
  
  
  RESULTS
  Minorities (80%), unmarried individuals (95%), and those with substance abuse (65%) predominated in this nonadherent group of patients with BD. Individuals were substantially depressed (mean Hamilton Depression Rating Scale, 19.2), had at least some manic symptoms (mean Young Mania Rating Scale, 13.6), and had moderate psychopathology (mean Brief Psychiatric Rating Scale, 41.2). Rates of missed medications were 41% to 43%. Forgetting to take medications was the top reason for nonadherence (55%), followed by side effects (20%). Disorganized home environments (30%), concern regarding having to take long-term medications (25%) or fear of side effects (25%), and insufficient information regarding BD (35%) were relatively common. Almost one third of patients had individuals in their core social network who specifically advised against medication. Access problems included difficulty paying for medications among more than half of patients. Interestingly, patients reported good relationships with their providers.
  
  
  CONCLUSIONS
  Forgetting to take medication and problems with side effects are primary drivers of nonadherence. Lack of medication routines, unsupportive social networks, insufficient illness knowledge, and treatment access problems may likewise affect overall adherence. Complementary quantitative and qualitative data collection can identify reasons for nonadherence and may inform specific clinical approaches to enhance adherence.
authors.affiliation: Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA. martha.sajatovic@uhhospitals.org
authors.forename: Martha
authors.initials: M
authors.lastname: Sajatovic
authors.forename: Jennifer
authors.initials: J
authors.lastname: Levin
authors.forename: Edna
authors.initials: E
authors.lastname: Fuentes-Casiano
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Cassidy
authors.forename: Curtis
authors.initials: C
authors.lastname: Tatsuoka
authors.forename: Janis H
authors.initials: JH
authors.lastname: Jenkins
mesh_terms: D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D016903:Drug Monitoring