Socio-Demographic Determinants of Medication Compliance in Bipolar Disorder Patients in Lahore, Pakistan

Mubeen  Fatima; Ahmad  Umar; Abdul Sammad Ali Khan  Shirwany; Abdul Majeed  Akhtar; Awais  Gohar; Syed Hanzila  Azhar

doi:10.54112/bcsrj.v6i3.1640

Authors

Mubeen Fatima Department of Public Health, University of Lahore, Pakistan
Ahmad Umar Department of Public Health, University of Lahore, Pakistan
Abdul Sammad Ali Khan Shirwany Department of Public Health, University of Lahore, Pakistan
Abdul Majeed Akhtar Department of Public Health, University of Lahore, Pakistan
Awais Gohar Department of Public Health, University of Lahore, Pakistan
Syed Hanzila Azhar Department of of Health Sciences, University of Debrecen, Debrecen, Hungary

DOI:

https://doi.org/10.54112/bcsrj.v6i3.1640

Keywords:

Medication compliance, Bipolar disorder, SEAMS, and Medication adherence

Abstract

Medication non-compliance is a major challenge in the long-term management of bipolar disorder, contributing to relapse, hospitalization, and poor quality of life. Socio-demographic factors can significantly influence adherence behavior, yet data specific to the Pakistani population remain limited. Objectives: The study's primary objective was to evaluate medication compliance in bipolar patients and identify the associated socio-demographic variables affecting medication compliance. Methodology: An analytical cross-sectional study was conducted at the teaching hospital in Lahore, Punjab, which specializes in mental health. A questionnaire based on the Self-Efficacy for Appropriate Medication Use Scale (SEAMS) was utilized, with a sample size of 296 patients aged 18 and above. Statistical analysis was performed using R Studio software. Results: The analysis revealed a median SEAMS score of 19 (IQR = 18, 22). Males demonstrated slightly higher adherence than females (median SEAMS score of 20 vs. 19, respectively). Unmarried individuals exhibited better adherence (median = 21) than married participants (median = 19). Students reported the highest compliance (median = 22), while unemployed individuals had the lowest (median = 18). Significant differences in SEAMS scores were observed across employment and education levels. The robust gamma regression analysis confirmed that uneducated participants (exp(β) = 0.836, p < 0.001) and unemployed individuals (exp(β) = 0.980, p = 0.219) exhibited lower adherence. Additionally, those aged 30-44 and 45-59 showed significantly higher adherence (exp(β) = 1.048, p = 0.014 and exp(β) = 1.050, p = 0.026, respectively). Conclusion: The study highlights the significant influence of sociodemographic factors, particularly employment status and education level, on medication compliance. While gender and age also contribute, the findings suggest that targeted interventions aimed at addressing disparities in employment and education could improve medication adherence in patients with bipolar disorder.

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References

Gast A, Mathes T. Medication adherence influencing factors—an (updated) overview of systematic reviews. Syst Rev [Internet]. 2019;8(1):112. Available from: https://doi.org/10.1186/s13643-019-1014-8

WHO. Bipolar disorder [Internet]. 2024 [cited 2024 Sep 10]. Available from: https://www.who.int/news-room/fact-sheets/detail/bipolar-disorder

Jimmy B, Jose J. Patient medication adherence: measures in daily practice. Oman Med J. 2011 May;26(3):155–9.

Bener A, Dafeeah EE, Salem MO. A study of the reasons for non-compliance with psychiatric treatment and patients’ attitudes towards illness and treatment in Qatar. Issues Ment Health Nurs. 2013 Apr;34(4):273–80.

Guo J, Lv X, Liu Y, Kong L, Qu H, Yue W. Influencing factors of medication adherence in schizophrenic patients: a meta-analysis. Schizophr (Heidelberg, Ger. 2023 May;9(1):31.

Hong J, Reed C, Novick D, Haro JM, Aguado J. Clinical and economic consequences of medication non-adherence in the treatment of patients with a manic/mixed episode of bipolar disorder: results from the European Mania in Bipolar Longitudinal Evaluation of Medication (EMBLEM) study. Psychiatry Res. 2011 Nov;190(1):110–4.

Chakrabarti S. Treatment-adherence in bipolar disorder: A patient-centred approach. World J Psychiatry. 2016 Dec;6(4):399–409.

Deng M, Zhai S, Ouyang X, Liu Z, Ross B. Factors influencing medication adherence among patients with severe mental disorders from the perspective of mental health professionals. BMC Psychiatry [Internet]. 2022;22(1):22. Available from: https://doi.org/10.1186/s12888-021-03681-6

Fuentes I, Rizo-Méndez A, Jarne-Esparcia A. Low compliance to pharmacological treatment is linked to cognitive impairment in the euthymic phase of bipolar disorder. J Affect Disord. 2016 May;195:215–20.

Okasha TA, Radwan DN, Elkholy H, Hendawy HMFM, Shourab EMME, Teama RRA, et al. Psycho-demographic and clinical predictors of medication adherence in patients with bipolar I disorder in a university hospital in Egypt. South African J Psychiatry SAJP J Soc Psychiatr South Africa. 2020;26:1437.

Selvakumar N, Menon V, Kattimani S. A Cross-sectional Analysis of Patterns and Predictors of Medication Adherence in Bipolar Disorder: Single Center Experience from South India. Clin Psychopharmacol Neurosci Off Sci J Korean Coll Neuropsychopharmacol. 2018 May;16(2):168–75.

Siddiqui F. Barriers and challenges to mental health care in Pakistan. Pakistan J Neurol Sci. 2021;16(3):1–2.

Ahmad I, Khalily MT, Hallahan B. Reasons associated with treatment non-adherence in schizophrenia in a Pakistan cohort. Asian J Psychiatr. 2017 Dec;30:39–43.

Javed A, Khan MNS, Nasar A, Rasheed A. Mental Healthcare in Pakistan. Taiwan J Psychiatry [Internet]. 2020;34(1). Available from: https://journals.lww.com/tpsy/fulltext/2020/34010/mental_healthcare_in_pakistan.3.aspx

Daniel W. Determination of sample size for estimating proportions. In biostatistics: A foundation for analysis in health. Stat Med [Internet]. 2001 [cited 2024 Sep 18];20:322–8. Available from: https://books.google.com/books/about/Biostatistics.html?id=OrBpAAAAMAAJ

Ali MH, Maqsood H, Jalil MH, Shoukat HF, Shakeel HA. The prevalence of bipolar spectrum disorder in medical students of Pakistan. Int J Res Med Sci [Internet]. 2019 Apr 26 [cited 2024 Sep 18];7(5):1618–21. Available from: https://www.msjonline.org/index.php/ijrms/article/view/6153

Risser J, Jacobson TA, Kripalani S. Development and psychometric evaluation of the Self-efficacy for Appropriate Medication Use Scale (SEAMS) in low-literacy patients with chronic disease. J Nurs Meas. 2007;15(3):203–19.

Laranjeira C, Carvalho D, Valentim O, Moutinho L, Morgado T, Tomás C, et al. Therapeutic Adherence of People with Mental Disorders: An Evolutionary Concept Analysis. Int J Environ Res Public Health. 2023 Feb;20(5).

Jawad I, Watson S, Haddad PM, Talbot PS, McAllister-Williams RH. Medication nonadherence in bipolar disorder: a narrative review. Ther Adv Psychopharmacol. 2018 Dec;8(12):349–63.

Ni Y, Tong C, Xu L, Qian W, Huang L, Zhang A, et al. Prevalence and associated factors of medication adherence among infertile women undergoing frozen-thawed embryo transfer cycle: A cross-sectional study. Front Pharmacol. 2023;14(March):1–9.

Manhas RS. Prevalence of Non-Adherence to Treatment among Patients of Bipolar Affective Disorder. J Med Sci Clin Res. 2019;7(6).

Gutiérrez-Rojas L, Martínez-Ortega JM, Pérez-Costillas L, Jiménez-Fernández S, Carretero MD, Gurpegui M. Illness Insight and Medication Adherence Among Patients With Bipolar Disorder. J Nerv Ment Dis [Internet]. 2020;208(6). Available from: https://journals.lww.com/jonmd/fulltext/2020/06000/illness_insight_and_medication_adherence_among.8.aspx

Shigemura J, Ogawa T, Yoshino A, Sato Y, Nomura S. Predictors of antidepressant adherence: Results of a Japanese Internet-based survey. Psychiatry Clin Neurosci [Internet]. 2010 Apr 1;64(2):179–86. Available from: https://doi.org/10.1111/j.1440-1819.2009.02058.x

García S, Martínez-Cengotitabengoa M, López-Zurbano S, Zorrilla I, López P, Vieta E, et al. Adherence to Antipsychotic Medication in Bipolar Disorder and Schizophrenic Patients: A Systematic Review. J Clin Psychopharmacol [Internet]. 2016;36(4). Available from: https://journals.lww.com/psychopharmacology/fulltext/2016/08000/adherence_to_antipsychotic_medication_in_bipolar.11.aspx.