title: The relationship of gender and gender identity to treatment adherence among individuals with bipolar disorder.
abstract: BACKGROUND
  It has been demonstrated that 46% to 48% of individuals with bipolar disorder (BD) are at least partially nonadherent with prescribed medication. Reports of whether male gender is a predictor of treatment nonadherence in BD have been inconsistent. The construct of gender may also be a matter of cultural orientation, and psychological gender, as a component of self-perception, may affect the experience of mental illness. Gender identity is the subjective experience of one's individuality as male or female.
  
  
  OBJECTIVE
  This cross-sectional study evaluated gender and gender identity among men and women with BD as they relate to self-reported medication treatment adherence.
  
  
  METHODS
  This secondary analysis of a larger study on treatment adherence evaluated men and women with BD being treated with mood-stabilizing medications in a community mental health clinic. Gender identity and treatment adherence were evaluated using the Bem Sex Role Inventory (BSRI) and the Tablets Routine Questionnaire, respectively. Other measures included assessing BD symptoms using the Hamilton Depression Rating Scale and mania symptoms using the Young Mania Rating Scale, as well as psychosocial support with the Interpersonal Support Evaluation List and locus of control with the Multidimensional Health Locus of Control Scale.
  
  
  RESULTS
  Mean age of the 70 men and 70 women with type I BD was 43.1 years for adherent patients and 40.8 years for nonadherent patients. Women with BD had mean scores on the BSRI consistent with general population norms, whereas men with BD had scores suggesting lower levels of self-perceived masculinity than population norms. There were no differences between men and women on adherence; however, men with high BSRI masculinity scores had less adherence than other men in the sample (P = 0.04). Lower scores on the "powerful others" dimension of locus of control were associated with lower adherence. For women, there was no relationship between BSRI masculinity scores and adherence.
  
  
  CONCLUSIONS
  Gender identity in men with BD differed from general population norms and appeared to be related to adherence. Treatment approaches that are intended to optimize adherence need to consider the construct of gender identity or gender role. ClinicalTrials.gov ID: NCT00183495.
authors.affiliation: Department of Psychiatry and Department of Neurology, Neurological Outcomes Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. martha.sajatovic@uhhospitals.org
authors.forename: Martha
authors.initials: M
authors.lastname: Sajatovic
authors.forename: Weronika
authors.initials: W
authors.lastname: Micula-Gondek
authors.forename: Curtis
authors.initials: C
authors.lastname: Tatsuoka
authors.forename: Christopher
authors.initials: C
authors.lastname: Bialko
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001294:Attitude to Health; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D011369:Professional-Patient Relations; D012646:Self Administration / Q000706:statistics & numerical data; D012649:Self Concept; D012720:Severity of Illness Index; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D014150:Antipsychotic Agents