title: Factors influencing adherence to psychopharmacological medications in psychiatric patients: a structural equation modeling approach.
abstract: OBJECTIVE
  To evaluate pathways through which sociodemographic, clinical, attitudinal, and perceived health control variables impact psychiatric patients' adherence to psychopharmacological medications.
  
  
  METHODS
  A sample of 966 consecutive psychiatric outpatients was studied. The variables were sociodemographic (age, gender, and education), clinical (diagnoses, drug treatment, and treatment duration), attitudinal (attitudes toward psychopharmacological medication and preferences regarding participation in decision-making), perception of control over health (health locus of control, self-efficacy, and psychological reactance), and level of adherence to psychopharmacological medications. Structural equation modeling was applied to examine the nonstraightforward relationships and the interactive effects among the analyzed variables.
  
  
  RESULTS
  Structural equation modeling demonstrated that psychiatric patients' treatment adherence was associated: 1) negatively with cognitive psychological reactance (adherence decreased as cognitive psychological reactance increased), 2) positively with patients' trust in their psychiatrists (doctors' subscale), 3) negatively with patients' belief that they are in control of their mental health and that their mental health depends on their own actions (internal subscale), and 4) positively (although weakly) with age. Self-efficacy indirectly influenced treatment adherence through internal health locus of control.
  
  
  CONCLUSIONS
  This study provides support for the hypothesis that perceived health control variables play a relevant role in psychiatric patients' adherence to psychopharmacological medications. The findings highlight the importance of considering prospective studies of patients' psychological reactance and health locus of control as they may be clinically relevant factors contributing to adherence to psychopharmacological medications.
authors.affiliation: Departamento de Medicina Interna, Dermatología y Psiquiatría, Universidad de La Laguna, Canary Islands, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: De Las Cuevas
authors.affiliation: Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA; Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain; Biomedical Research Center in Mental Health Net (CIBERSAM), Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: de Leon
authors.affiliation: Departamento de Psicología Clínica, Psicobiología y Metodología, Universidad de La Laguna, Canary Islands, Spain.
authors.forename: Wenceslao
authors.initials: W
authors.lastname: Peñate
authors.affiliation: Departamento de Psicología Clínica, Psicobiología y Metodología, Universidad de La Laguna, Canary Islands, Spain.
authors.forename: Moisés
authors.initials: M
authors.lastname: Betancort
keywords: attitude to health; health behavior; internal-external control; medication adherence; model; psychiatry; statistical