Beliefs regarding medication and side effects influence treatment adherence in adolescents with attention deficit hyperactivity disorder

A Review of Sex and Gender Factors in Stimulant Treatment for ADHD: Knowledge Gaps and Future Directions

OBJECTIVE

Stimulant medications are the primary pharmacological intervention for ADHD, yet our understanding of how sex and gender impact stimulant treatment outcomes remains limited. Clinical guidelines do not differ for female and male individuals despite possible sex and gender-related differences in effectiveness, adverse events, and pharmacokinetics. This theoretical framework identifies five key knowledge gaps relating to sex and gender effects in stimulant treatment.

METHOD

We investigate the stimulant treatment trajectories of girls and women with ADHD from diagnosis and prescription to daily use and outcomes. We examine the impact of reproductive life transitions and hormonal fluctuations and their interactions with gender socialization and gendered expectations on treatment effectiveness, stigma, and adherence.

RESULTS

By synthesizing existing literature, proposing testable predictions, and suggesting future research directions, we highlight the urgent need for studies that systematically investigate these factors.

CONCLUSION

Addressing these gaps could significantly improve treatment outcomes for girls and women with ADHD, particularly during biological and gender role transitions.

Quality of Life and Adherence to Tyrosine Kinase Inhibitors Among Pediatric, Adolescent, and Young Adult Chronic Myeloid Leukemia Patients: A Systematic Review

The chronic nature of chronic myeloid leukemia (CML) has a negative impact on patients' health-related quality of life (HRQOL) and the need for prolonged oral tyrosine kinase inhibitors (TKIs) poses a risk to low or nonadherence over time. This systematic review seeks to analyze HRQOL outcomes and adherence to TKIs among pediatric, adolescent, and young adult (AYA) patients with CML. Full-text screening ultimately led to the inclusion of 12 articles focused on HRQOL, patient-reported outcomes (PRO) and medication adherence. There was heterogeneity in the findings among the included studies, especially in HRQOL and PROs. TKIs adherence ranged from 45%-78% using self-report and 58%-100% using medical and pharmacy records. Increased TKI adherence was significantly associated with better clinical outcomes, including overall survival. Our findings could inform efforts to develop behavioral interventions to optimize TKI adherence and improve HRQOL outcomes among AYA patients with CML.

Assessment of Potential Factors Influencing Attention-Deficit/Hyperactivity Disorder Drug Adherence: A Database Study

First-line treatment for Attention-Deficit/Hyperactivity Disorder (ADHD) is pharmacological but is associated with poor success rates in adults. The potential to discontinuously use stimulants may confound adherence assessment. Approximately 30-50% of adults with ADHD will experience depressive episodes, and associated treatment with antidepressants is generally recommended. It can therefore be expected that patients with a formal F90 diagnosis would show higher medication adherence than patients without a diagnosis and that the simultaneous use of antidepressants would increase adherence to ADHD medication. The primary aim was to explore the influence of factors of ADHD diagnosis and comorbid antidepressant use on stimulant adherence. A retrospective, longitudinal pharmacoepidemiological study was conducted on South African community pharmacy dispensing records for 2012-2016 for all patients aged between 18 and 40 years with any record of receiving a drug classified as "Central nervous system other" by the MIMS in 2015. Patients endorsed with an ADHD-linked diagnostic code (F90) were identified and contrasted with those receiving ADHD-indicated medication in the absence of a confirmatory diagnostic code. Two methods were applied to assess adherence to ADHD and/or depression treatment drugs: monthly medicine plotting and Proportion of Days Covered (PDC). Patients were classified as being more or less adherent based on monthly medicine plotting criteria. A study population of 89 patients was identified: 50 had F90 diagnostic codes and 39 were classified as "Non F90". Adherence as measured based on PDC was generally higher for antidepressant use than for methylphenidate for patients classified as being more adherent. A trend towards higher consumption of antidepressants was shown for the treatment-adherent group. Diagnostic code distinction revealed significantly higher adherence rates to methylphenidate for F90 code patients. Adherence rates to antidepressants appeared to be generally higher for non-F90 patients. Many factors may influence adherence to ADHD-indicated drugs; however, the impact of a confirmed diagnosis may be a strong determinant of motivation to be adherent to ADHD pharmacotherapy.

Medication adherence and attitudes in adolescent psychiatry: Key influences

Adolescents with mental illnesses often struggle with adhering to prescribed medication regimens. This study investigates how patient perceptions influence medication adherence among adolescents with psychiatric disorders. It also examines the role of patient characteristics and medication-related factors on adherence and attitudes. The Pediatric Medication Adherence Scale (PMAS)- 9 questions and the Pediatric Attitude toward Medication Scale (PAMS)- 18 questions, two reliable self-report scales designed for the adolescent population, were used to assess negative adherence behaviors and patients' perceptions of medication. Statistical analysis examined correlations between adherence, attitudes, and patient characteristics. The scales were administered to 288 adolescents with psychiatric disorders, and a significant correlation was found between concern scores and attitudes toward medication (r = 0.886, p < .05). Patients receiving monotherapy demonstrated lower concern scores and more positive attitudes (p < .05). Experiencing side effects was significantly linked to reduced medication adherence and more negative attitudes toward treatment. Patients with eating disorders demonstrated more negative attitudes, while those using antidepressant-antipsychotic combinations demonstrated more negative attitudes than those using stimulants. This study emphasizes the necessity of addressing critical factors that influence medication adherence and attitudes toward psychiatric medication among adolescents with psychiatric disorders. In particular, it highlights the importance of considering concern perception, managing side effects, and evaluating polypharmacy to optimize pharmacotherapy in this population.

Medication adherence and persistence in children and adolescents with attention deficit hyperactivity disorder (ADHD): a systematic review and qualitative update

Low medication-adherence and persistence may reduce the effectiveness of ADHD-medication. This preregistered systematic review (PROSPERO CRD42020218654) on medication-adherence and persistence in children and adolescents with ADHD focuses on clinically relevant questions and extends previous reviews by including additional studies. We included a total of n = 66 studies. There was a lack of consistency in the measurement of adherence/persistence between studies. Pooling the medication possession ratios (MPR) and using the most common adherence definition (MPR ≥ 80%) indicated that only 22.9% of participants had good adherence at 12-month follow-up. Treatment persistence on medication measured by treatment duration during a 12-month follow-up averaged 170 days (5.6 months). Our findings indicate that medication-adherence and persistence among youth with ADHD are generally poor and have not changed in recent years. Clinicians need to be aware that various factors may contribute to poor adherence/persistence and that long-acting stimulants and psychoeducational programs may help to improve adherence/persistence. However, the evidence to whether better adherence/persistence contributes to better long-term outcomes is limited and requires further research.

Diverging paths: Modeling the relation between adverse effects, attitudes, perceived adherence, and treatment effect in an internet-based cognitive-behavioral intervention for obsessive-compulsive disorder

BACKGROUND AND AIM

The efficacy of internet-based interventions (IBI) for various psychiatric disorders is widely established, but little is known about the mechanisms or possible influencing factors. One of the most prominent problems in IBI is low adherence, but the relationship between adherence and level of improvement is still unclear. Patients' attitudes and beliefs about IBI as well as the experience of adverse effects-another widely neglected topic-may also influence the effectiveness of these interventions. This secondary analysis is aimed at investigating the relationship between adverse effects, attitudes, perceived adherence (i.e., patient's impression of their compliance), and treatment effect in an IBI for obsessive-compulsive disorder (OCD).

METHODS

Participants were 151 individuals with symptoms of OCD, of which 59.96% (n = 90) took part in the post-assessment. Attitudes toward IBI were assessed before they used an IBI for OCD; subjective adherence perception and experience of negative effects were assessed afterward. OCD symptom severity was evaluated at two time points, the difference score defining the treatment effect. A path analysis was conducted to test the hypothesized model. Objective and subjective adherence measures were correlated exploratively.

RESULTS

The path analysis revealed that attitude toward IBI and adverse effects were negatively associated with adherence perception but adherence perception was not associated with the treatment effect. Objective and subjective adherence measures did not correlate.

CONCLUSION

The results did not support the hypothesized model. Since both attitudes toward IBI and adverse effects were negatively associated with adherence perception, managing users' expectations clearly before using IBI might improve adherence. The role of adherence perception on the treatment effect is yet to be clarified.

Challenges and strategies for improving medication adherence among adolescent psychiatric patients: A qualitative study

Despite significant advancements in the development of psychotropic medications, increasing adherence rates remain a challenge in the treatment and management of psychiatric disorders. The purpose of this study is to qualitatively explore the challenges underlying medication adherence and strategies to improve it among adolescents with psychiatric disorders in Malaysia. This qualitative research design presents results from 17 semi-structured interviews with adolescent psychiatric patients, aged 11 to 19 years old, from public hospitals across Peninsular Malaysia. The data collected from interviews were transcribed and processed through thematic analysis using the NVivo 11 software. A total of three main themes concerning medication adherence were identified: (1) challenges; (2) coping strategies and (3) protective factors. In this study, thirteen subthemes emerge as challenges underlying medication adherence experienced by adolescent psychiatric patients. The coping strategies identified in this study fall under three broad subthemes which are problem-focused strategies, emotion-focused strategies and maladaptive strategies. This study also highlights social support and positive medicinal effects as protective factors for non-adherence issues in adolescent psychiatric patients. In conclusion, this study supports the notion that adherence is a multi-factorial phenomenon. This study can inform future development of interventions and targeted health promotion programmes in enhancing adherence.

Subclinical attention-deficit hyperactivity disorder symptoms and unhealthy lifestyle behaviours

BACKGROUND

Literature emphasises the importance of identifying and intervening in the adoption of unhealthy lifestyle behaviours (ULBs) during adolescence at an early stage, to mitigate their long-term detrimental effects. Among the possible associated factors contributing to ULBs, attention-deficit hyperactivity disorder (ADHD) has been shown to play an important role. However, little is known about ADHD subclinical manifestations.

AIMS

The present study aimed to bridge the gap in the literature and shed light on the relationship between subclinical ADHD and early adoption of ULBs during adolescence. Through a clinimetric approach, prevalence of ULBs, severity of ADHD symptoms and psychosocial factors (i.e. allostatic overload, abnormal illness behaviour, quality of life, psychological well-being) were investigated among adolescents. The associations between different degrees of ADHD, ULBs and psychosocial factors were also explored.

METHOD

This multicentre cross-sectional study involved 440 adolescents (54.5% females; mean age 14.21 years) from six upper secondary schools. Participants completed self-report questionnaires on sociodemographic characteristics, ULBs, ADHD symptoms and psychosocial factors.

RESULTS

The most common ULBs were energy drinks/alcohol consumption and problematic smartphone use. Of the sample, 22% showed subclinical ADHD and 20.2% showed clinical ADHD. The subclinical ADHD group showed several ULBs (i.e. altered mindful eating, impaired quality of sleep, problematic technology use) and psychosocial factors, akin to those of ADHD group and different from peers without ADHD symptoms.

CONCLUSIONS

Since subclinical ADHD manifestation is associated with ULBs, similarly to clinical ADHD, identifying subthreshold symptoms during adolescence is crucial, as it could improve health-related outcomes in adulthood across different domains.

Development of the medical adherence scale in adolescents using psychotropic medication and evaluation of validity and reliability in Turkish population

PURPOSE

Although treatment non-adherence is relatively high among adolescents, there is a need for standardized measurement tools that measure adherence to treatment in adolescents. This study aimed to develop a new measurement tool to assess the adherence to treatment of adolescents with mental disorders who use psychotropic medication.

METHODS

The data of this methodologically designed study were collected between 01.04.2022 and 01.07.2023 in the Department of Child and Adolescent Psychiatry of a university hospital in the Aegean Region of Turkey. The Medication Adherence Reporting Scale and Adolescent Medical Adherence Scale draft form were used for data collection. The scale items were formed from the themes, sub-themes, and statements in the qualitative study that the researchers had conducted with adolescents with mental disorders and their parents, clinicians' experiences, and systematic reviews and meta-synthesis in the literature. The study sample consisted of 95 adolescents with mental disorders. Exploratory factor analysis was performed with Varimax rotation to determine the factorial construct validity of the scale. Internal consistency analyses were performed in reliability analyses, and Cronbach's alpha coefficient was used.

RESULTS

The mean age of the adolescents was 14.18 years (1.81); 50.5% were male, and 96.8% were attending school. When the mental disorder diagnoses were analyzed, 65.3% of the adolescents were being followed up with Attention Deficit and Hyperactivity Disorder diagnoses, and 58.8% were using stimulants. The 12-item form of the Adolescent Medical Adherence Scale was found to have a three-factor structure with item-total correlation values ranging between 0.26 and 0.66, and these factors were named functionality, responsibility in treatment, and medication adherence. Factor loadings ranged between 0.44 and 0.86, and the items explained 62.98% of the total variance. The internal consistency coefficients of the scale were between 0.69 and 0.83 for the subscales and 0.82 for the total scale.

CONCLUSION

Based on the analysis and results used in this study, the Adolescent Medical Adherence Scale is a valid and reliable new measurement tool.

PRACTICE IMPLICATIONS

This tool can be used in clinical settings to evaluate adolescents' treatment adherence and prognosis. Clinical studies conducted with adolescents can also determine adherence to treatment and affecting factors.

The concept of treatment beliefs in children and adolescents with chronic health conditions: a scoping review

Children and adolescents with chronic health conditions are faced with ongoing challenges, making self-regulation crucial. As children grow up, they gradually develop differentiated beliefs about illness and treatment. While research indicates treatment beliefs as relevant factor on outcomes like adherence, the specific contents and dimensions of children's and adolescents' treatment beliefs remained unclear. This scoping review therefore aimed at the identification of treatment beliefs dimensions in children and adolescents with chronic health conditions, the underlying theoretical frameworks, and methodological operationalisation. Published literature was examined by applying systematic searches in electronic databases (Medline, PsycINFO, CINAHL) and comprehensive selection criteria, resulting in 49 included studies. The predominant treatment beliefs dimensions were necessity, concerns, perceived benefits and costs/barriers, and expectations. The latter can be differentiated into outcome, social, process, and structural expectations, and expectations of one's own role in the treatment process. In addition, dimensions that cover emotions and reasons for treatment were identified. The results are related to the methods and theoretical models applied, which were often adapted from adult research. However, additional and possibly more child-specific dimensions such as social expectations and emotions were found. This scoping review indicates several research gaps and discusses practical implications.

Continuation of Treatment in Children With ADHD: A Multicenter Turkish Sample Study

OBJECTIVES

The aim of this study was to investigate the variables that may affect treatment continuation in children aged 6 to 12 years who were newly diagnosed with ADHD.

METHODS

A total of 132 children diagnosed with ADHD and their parents participated in the study. Sociodemographic and clinical risk factors affecting continuation of treatment were examined using logistic regression analysis.

RESULTS

Multiple model examination revealed that greater age increased the risk of treatment discontinuation 1.824 times (p = .003) while a lower total length of paternal education increased the risk of discontinuation (1/0.835) 1.198 times (p = .022). Other variables emerging as significant in the univariate model lost that significance in the multiple model.

CONCLUSIONS

Understanding the variables associated with medication discontinuation in ADHD in different populations and taking these variables into account in the development of health policies, will be useful in improving the long-term devastating effects of the disorder.

Non-pharmacological treatment of Attention Deficit Disorder with or without Hyperactivity (ADHD). Overview and report of the first international symposium on the non-pharmacological management of ADHD

Attention Deficit Disorder with or without Hyperactivity (ADHD is a neurodevelopmental disorder which affects the day-to-day functioning of children and adults with this condition. Pharmacological treatment can reduce the symptoms associated with ADHD, but it has some limitations. The objective of this symposium is to determine the effects of non-pharmacological approaches on ADHD symptoms. Results indicate that the following intervention are promising approaches: cognitive behavioral therapy (CBT), mindfulness-based interventions (MBI), yoga, cognitive and metacognitive intervention, neurofeedback and parental training programs. Current research advocates multimodal approaches in conjunction with school or work accommodations integrating innovative technologies.

Impact of a national audit on child and adolescent psychiatrists' prescribing practices

BACKGROUND

A look back review of South Kerry Child and Adolescent Mental Health Services (CAMHS) in Ireland, known as the 'Maskey report' (MR), highlighted substandard prescribing practices. The aim of this 'Maskey Impact Study' (MIS) was to explore changes to child and adolescent psychiatrists' prescribing practices following the MR.

METHOD

The study was cross-sectional and mixed method. A study specific questionnaire was distributed electronically to psychiatrists working in CAMHS (n = 160).

RESULTS

102 psychiatrists participated in the study (response rate 63.8%). Perceived improvement in prescribing practices included improved medical record keeping (63.7%), consent documentation (53.9%), medication information provision (41.2%) and physical health monitoring (60.8%). However, 43.1% of psychiatrists reported a reluctance to prescribe medication even when clinically indicated and 50% were more likely to avoid off-label use. Most respondents reported increased stress levels (80.4%) with higher stress being significantly associated with reticence in prescribing (χ2 = 11.746, p < .001) and avoiding off-label use (χ2 = 15.392, p < 0.001). Thematic analysis highlighted increased medication hesitancy, enforced 'meaningless' bureaucracy and medication mistrust among families.

DISCUSSION

Although improvements reported are welcomed, the increased hesitancy of medication use, avoidance of prescribing more than one medication, and avoidance of off-label use, is of concern with potential unintended adverse consequences. Reluctance in prescribing may deprive youth of access to evidence-based treatments and limit exposure of NCHDs to the safe practice of consultant-initiated psychopharmacology. Further research will be important to determine if this impacts clinical care. Continued education in psychopharmacology is essential along with increased public awareness of the evidence for medication, to help restore public confidence and trust in psychopharmacology.

Short- and Long-Term Outcomes of Suboptimal Medication Adherence in Adolescents with Attention-Deficit/Hyperactivity Disorder: A Systematic Literature Review

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition with severe and life-long consequences. Adolescents and young adults represent a particularly vulnerable subgroup because of the unique demands of their developmental stage. Despite the well-known efficacy of medication treatment for ADHD, there remains a notable concern regarding poor medication adherence in this population. Objectives: This systematic literature review aimed to synthesize the existing empirical evidence on the outcomes and consequences of medication nonadherence among adolescents and young adults with ADHD. Methods: An extensive database search was conducted on September 26, 2022, with no time limits applied. The databases included Scopus, PubMed, CINAHL, Cochrane, and PsycINFO. Results: Six studies met the inclusion criteria. Each study revealed that medication nonadherence was associated with a range of adverse outcomes, including decreased academic performance, heightened familial, and psychological stress, and an increased likelihood of substance use, pregnancy, obesity, and injury. Conversely, adherence led to improvements in at least one ADHD-related outcome. Conclusions: Research exploring the consequences of suboptimal medication adherence in adolescents and young adults with ADHD is currently limited, and effective strategies to address this issue remain scarce. A thorough understanding of such consequences is critical for developing interventions aimed at improving medication adherence and mitigating the risk of adverse outcomes, especially considering the susceptibility of this population.

Treatment Adherence and Related Factors Among Children with Attention-Deficit/Hyperactivity Disorder in Saudi Arabia

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is a common childhood psychiatric disorder. It frequently persists into adulthood and is a risk factor for other mental disorders and adverse outcomes, mainly if not managed optimally. This study aimed to assess ADHD treatment adherence and explore the underlying causes of non-adherence in ADHD children in Saudi Arabia.

Methods

A cross-sectional study of a convenience sample of 221 participants. The survey included demographic characteristics of the child and parents, the child's medical history, quality of services evaluation, as well as medication adherence assessment by Medication Adherence Report Scale (MARS), the general beliefs about medicines questionnaire (General-BMQ), in addition to assessing the parents' beliefs about ADHD and provided/recommended treatment.

Results

The sample was primarily 6 to 8-year-old children (32.81%) and males (78.52%). Most subjects were prescribed extended-release agents (45.7%), and overall, high-quality services were provided to the patients. The adherence rate of ADHD patients to their medication was 89.77%. The mother's education correlated significantly with patient adherence (p=0.029), and the mother's age correlated significantly with their beliefs (p=0.021), in addition to the family income (0.033). Children on Methylphenidate Immediate Release had good compliance with the medication (p=0.008). Moreover, Methylphenidate Extended Release has shown continuity results, increasing the adherence rates (p=0.035).

Conclusion

ADHD medication adherence was high and associated with older age, educational status, and type of medication used. Physicians should consider these factors to improve adherence in their patients.

Attention-Deficit Hyperactivity Disorder Symptoms, Underperception of Respiratory Compromise, and Illness Representations in Black and Latino Children With Asthma

OBJECTIVE

This study examined the associations between attention-deficit/hyperactivity disorder (ADHD) symptoms, underperception of respiratory compromise, and illness representations in Black and Latino children with asthma. We hypothesized that increased child-reported ADHD symptoms, as well as parent reports for their child, would be associated with underperception of respiratory compromise, and maladaptive asthma beliefs.

METHODS

Two hundred ninety-six parent-child dyads were recruited from pediatric asthma and primary care clinics in the Bronx. Participants completed demographic questionnaires, the Conners-3 ADHD Index to measure ADHD symptoms, and the Asthma Illness Representation Scale to assess asthma beliefs. Perception of respiratory compromise was assessed by programmable electronic peak flow monitors that measured the child's subjective estimates of peak expiratory flow (PEF) and actual PEF, with underperception as the primary measure.

RESULTS

Child-reported ADHD symptoms were associated with greater underperception (β = .117, p = .049) of respiratory compromise. Parent-reported ADHD symptoms were associated with greater underperception (β = .129, p = .028) of respiratory compromise. Child-reported ADHD symptoms (β = -.188, p < .001) were associated with more maladaptive asthma beliefs, F(1, 341) = 13.135. Parent-reported ADHD symptoms (β = -.203, p ≤ .001) were associated with more maladaptive asthma beliefs, F(1, 341) = 15.644.

CONCLUSIONS

ADHD symptoms were associated with a greater underperception of respiratory compromise and more maladaptive asthma beliefs. Deficits of attentional processes and/or hyperactivity levels might be contributing factors. We emphasize the need for psychoeducation and interventions that improve perception and health beliefs in children with comorbid ADHD and asthma.

Estimating the Risk of Attention Deficit Hyperactivity Disorder (ADHD) in Parents of Children with ADHD and the Association with Their Children's Disease Severity and Adherence to Medication

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is characterised by inattentiveness, hyperactivity, and impulsivity. Up to half of the affected children have a parent with ADHD. In this study, the risk of ADHD among parents of ADHD children was estimated. The associations between parental ADHD and child ADHD severity and medication adherence were determined.

METHODOLOGY

Parents of children and adolescents diagnosed with ADHD attending the University Kebangsaan Malaysia Medical Centre (UKMMC) were recruited between June to August 2022 and the administered Conners' Adult ADHD Rating Scale (CAARS) self-report short form, Vanderbilt ADHD Parent Rating Scale (performance section), and Medication Adherence Report Scale (MARS).

RESULTS

Forty-five children with ADHD were recruited and 15 out of 45 (33%) parents were detected to have ADHD. ADHD severity was worse in children with ADHD parents for total severity (mean of 34.67 vs. 29.13, p = 0.047) and difficult behaviours at home (mean of 7.87 vs. 6.27, p = 0.036). The children's academic performance and behavioural challenges at home and school were positively correlated with the parental ADHD scores for 'inattention' and 'problems with self-care' subscales.

CONCLUSIONS

A total of 33% of ADHD children had parents with ADHD. ADHD children with ADHD parents were more likely to have behavioural problems at home and more severe ADHD. However, no statistical significance was noted with medication adherence.

Relationship Between Medication Literacy and Beliefs Among Persons with Type 2 Diabetes Mellitus in Guangdong, China

Purpose

To establish the relationship between medication literacy and medication beliefs among persons with type 2 diabetes mellitus (T2DM).

Patients and methods

A cross-sectional survey of 246 patients with T2DM was conducted between April and November 2022 at a tertiary hospital in Dongguan City, Guangdong Province, China. Subsequently, these patients were administered the General Information Questionnaire, the Chinese version of Medication Literacy Assessment Scale, and the Chinese version of Beliefs about Medicines Questionnaire-Specific via survey.

Results

The medication literacy score of patients with T2DM was 7.82±3.007, and the medication beliefs score was 2.26±4.011. The Pearson correlation analysis revealed a statistically significant but weakly positive correlation (r = 0.271, P < 0.001) between medication literacy and beliefs among patients diagnosed with T2DM. However, there was no significant correlation found between medication literacy and necessity (r = -0.021, P > 0.05), while a lowly negative correlation was observed between medication literacy and concerns (r = -0.307, P < 0.001). Moreover, the multiple linear regression analysis indicated that medication literacy, age, education level, and duration of medication usage were all significant factors influencing patients' medication beliefs (all P < 0.05). Together, these variables accounted for 15.3% of the total variance observed in the regression equation.

Conclusion

The study found a positive correlation between medication literacy and beliefs, and a negative correlation between medication literacy and concerns. These results indicate that enhancing medication literacy can improve medication adherence among individuals with T2DM by reducing concerns and strengthening medication beliefs.

Mentalizing in Adolescents and Young Adults with Attention Deficit Hyperactivity Disorder: Associations with Age and Attention Problems

INTRODUCTION

Growing, albeit heterogenous evidence questions whether attention deficit/hyperactivity disorder (ADHD) is associated with socio-cognitive impairments, especially beyond childhood. This study focuses on mentalizing - the socio-cognitive ability to attribute and reason in terms of mental states. We aimed to characterize mentalizing performance in terms of correct scores and types of errors in adolescents and young adults with ADHD.

METHODS

Forty-nine adolescents and adults with ADHD and 49 healthy controls matched for age and gender completed a computerized naturalistic mentalizing task, the Movie for Assessment of Social Cognition (MASC). Repeated measures analyses of variance examined the effects of age group and ADHD diagnosis on MASC performance. Additionally, associations between mentalizing scores, the severity of attention problems, and the presence of comorbidity were explored in the ADHD group.

RESULTS

Results showed an increased prevalence of hypomentalizing errors in adolescents with ADHD. Lower mentalizing scores in adolescents with ADHD were correlated with indices of inattentiveness, impulsivity, and vigilance problems. Hypomentalizing errors in adolescents showed to be particularly associated with inattentiveness, after controlling for age and comorbidity. In contrast, adults with ADHD performed similarly to controls and their scores on the mentalizing task were not correlated to attention problems.

CONCLUSION

These findings highlight potential developmental differences in mentalizing abilities in ADHD youths and their association with attentional impairments.

Treatment Beliefs of Children and Adolescents With Chronic Diseases: Development of the Rehabilitation Treatment Beliefs Questionnaire for Children and Adolescents

OBJECTIVE

Rehabilitation is an important component in the health care of children and adolescents with chronic diseases and aims at supporting patients' self-regulation for dealing with the disease. Patients' beliefs about illness and treatment are core elements in the self-regulation process. While questionnaires measuring illness beliefs for children and adolescents exist, questionnaires about their rehabilitation-related treatment beliefs are lacking. We therefore developed a questionnaire to assess the rehabilitation-related treatment beliefs of children and adolescents with chronic diseases (Rehabilitation Treatment Beliefs Questionnaire, RTBQ) and tested its psychometric properties.

METHODS

Ahead of their rehabilitation, children and adolescents, aged 12-17 years, answered 129 items, which were developed based on previous qualitative findings exploring children and adolescents' rehabilitation-related treatment beliefs. Psychometric testing included item analyses, exploratory factor analysis, internal consistency and bivariate correlations of the extracted scales, and the discriminatory power and difficulty of the final items.

RESULTS

The sample consisted of 170 participants with a mean age of 14.3 years (SD = 1.6); 53.5% were female. After item analyses, 47 items remained for the exploratory factor analysis which revealed 22 items allocated to 4 scales: "expectations of communication and interaction," "expectations of the treatment process," "expectations of treatment success and sustainability," and "expectations of one's own role in the rehabilitation process." The psychometric properties were acceptable to good.

CONCLUSIONS

The RTBQ assesses various dimensions of rehabilitation-related treatment beliefs of children and adolescents with chronic diseases. While first psychometric results are promising, further psychometric testing is needed.

Barriers and facilitators of antiretroviral therapy (ART) adherence habit formation in Sub-Saharan Africa: Evidence from a qualitative study in Kampala, Uganda

RATIONALE

In 2020, nearly 40 million people lived with HIV/AIDS (PLWHA) worldwide, of whom 70% were receiving antiretroviral therapy (ART). Two-thirds of PLWHA reside in Sub-Saharan Africa (SSA), where rates of viral load suppression are often suboptimal and frequently attributed to low ART adherence. Strong pill-taking habits are often reported as a key strategy among those who successfully maintain medication adherence, yet not enough is known about the barriers and facilitators in SSA to pill-taking in response to the same contextual cue, which is a necessary step in the habit formation process.

OBJECTIVE

To address this knowledge gap and to inform a subsequent intervention to promote context-dependent repetition, called anchoring, we used a formative qualitative approach to collect in-depth narratives about barriers and facilitators of the anchoring intervention for establishing ART pill-taking habits at the Mildmay Hospital in Kampala, Uganda.

METHODS

We conducted interviews with 25 randomly selected patients starting ART, 5 expert patients, and 10 providers at Mildmay, and performed a rapid analysis to inform the intervention in a timely manner.

RESULTS

We found that pill taking in response to the same contextual cue, or anchor, was threatened by stigma and food insecurity and that the COVID-19 pandemic exacerbated these barriers. We also determined that important linguistic changes were needed to the instructional materials and reminder messages in the subsequent intervention to avoid words and phrases with negative connotations for this target population.

CONCLUSIONS

Several important barriers and facilitators to context-dependent pill taking in Uganda were identified through our formative research that helped to inform important revisions to our subsequent intervention. These findings underscore the importance of understanding local barriers and facilitators when designing and planning interventions, particularly when implementing theory-based intervention approaches that have yet to be tested in a new setting.

Reported Side or Adverse Effects Associated with Medication Nonadherence Among Adolescents and Young Adults with Attention-Deficit/Hyperactivity Disorder

Background and Objective: The purpose of this study was to determine what side effects were most associated with medication nonadherence as reported by adolescents and young adults with attention-deficit/hyperactivity disorder (ADHD). Methods: A combination of multiple linear regression and chi-square automatic interaction detection techniques were utilized in analyzing the survey data responses of 157 adolescents and young adults with ADHD. Results: The mean number of side effects reported was M = 10.33 side effects with 77% of the sample reporting at least one side effect. In aggregate, the number or severity of side effects were not significantly associated with medication nonadherence. Rather, it was the severity of particular side effects, upset stomach and vomiting, which were significantly associated with medication nonadherence. Conclusions: Health care providers should utilize this information as an indicator that medication nonadherence will be an issue when these side effects are present.

Perceptions and Experiences of Adolescents with Mental Disorders and Their Parents about Psychotropic Medications in Turkey: A Qualitative Study

This descriptive phenomenological study aimed to evaluate the perception and experiences of adolescents with mental disorders and their parents about the use of and adherence to psychotropic medications. A total of 12 semi-structured interviews with adolescents between the ages of 12 to 18 who were attending an outpatient psychiatric clinic for children and adolescents and 12 interviews with parents were conducted between October 2021 and January 2022 in Manisa, Turkey. Colaizzi’s phenomenological interpretation method was used for the analysis of the participants’ statements. Our study highlights the main positive effects of psychotropic medication and barriers to medication intake and adherence. Positive effects included symptom management and health improvement. Barriers varied from those directly linked to medication effects (e.g., negative side effects or lack of perceived effect) to personal barriers (e.g., forgetting to take medication or feelings of not being oneself due to medication intake) and societal barriers. In general, the barriers were reflected in concerns related to long-term consequences, such as medication dependence, and in concerns about diminished life prospects. Possible recommendations to improve the use of and adherence to psychotropic medication among adolescents include educating adolescents and parents not only about treatment options but also about mental disorders.

A systematic review of interventions to enhance adherence and persistence with ADHD pharmacotherapy

Although high rates of poor adherence/persistence have been documented in ADHD, there is limited research targeting the problem. This systematic review evaluated interventions to address poor adherence/persistence to ADHD pharmacotherapy, with the aim of guiding the development of future interventions. An extensive search was conducted from January 1980 until January 2021. Thirteen studies were identified involving interventions based on psychoeducation, behavioural therapy, combined psychoeducation/behavioural therapy, technology-based interventions, written informed consent and a nursing support line. All 13 studies (including five RCTs) reported improvement in adherence/persistence and five studies (including four RCTs) also reported improvement in ADHD symptomatology. Almost all studies involved interventions utilising some form of education. Three RCTs of psychoeducation alone were included, with two of the three studies reporting adherence benefits at three and 12 months respectively. The third RCT was terminated early due to poor recruitment. A behavioural intervention RCT reported improved adherence six months post intervention (but not at 12 months), although a substantial drop-out rate was observed. A final included RCT used a Smartphone Application and reported a short term increase in adherence. The authors of the studies in this review make salient attempts at improving adherence and provide insight for future intervention development. We believe future interventions should involve combinations of strategies, have a theoretical framework and target the most common reasons for non-adherence. Interventions should also be integratable into routine care and include patient input to maximise sustainability.

Application of the protection motivation theory to understand determinants of compliance with the measure of banning gathering size >4 in all public areas for controlling COVID-19 in a Hong Kong Chinese adult general population

BACKGROUND

Restriction of gathering size in all public areas is a newly and commonly exercised governmental social distancing policy during the COVID-19 pandemic. Its effectiveness depends on the general public's compliance. This study applied the Protection Motivation Theory (PMT) to investigate determinants (i.e., perceived severity, perceived susceptibility, perceived response efficacy, and perceived self-efficacy) of compliance with the social distancing policy of banning gathering of >4 people in all public areas (BG4PA) in the Hong Kong general adult population.

METHODS

300 participants were interviewed through a population-based telephone survey during April 21-28, 2020.

RESULTS

The compliance rate of BG4PA was high (78%). Adjusted for the background factors, multiple linear regression analysis found that perceived response efficacy and perceived self-efficacy were significantly and positively associated with compliance with BG4PA (p<0.05), while the associations between perceived severity/perceived susceptibility and compliance were of marginal significance (0.05

CONCLUSIONS

PMT can be applied to understand compliance with BG4PA. Perceived response efficacy and perceived self-efficacy were more influential than perceived severity and perceived susceptibility. Health promotion may focus on improving coping appraisal.

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MESH Headings

• Adult
• COVID-19/epidemiology
• COVID-19/prevention & control
• Cross-Sectional Studies
• Hong Kong/epidemiology
• Humans
• Motivation
• Pandemics/prevention & control
• Surveys and Questionnaires

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Grants

• Internal funding of Center for Health Behaviours Research, the Chinese University of Hong Kong

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Affiliation(s)

Yanqiu Yu Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
Mason M. C. Lau Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
Joseph T. F. Lau Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China School of Psychiatry, Wenzhou Medical University, Wenzhou, China

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Collaborators Collapse

Eliciting preferences for continuing medication among adult patients and parents of children with attention-deficit hyperactivity disorder

BACKGROUND

Adherence to medication for attention-deficit hyperactivity disorder (ADHD) is less than optimal. Previous studies have primarily focused on qualitative assessment of factors that influence medication adherence.

OBJECTIVE

This study aimed to quantify the factors that influence patient and parent preferences for continuing ADHD medication.

METHOD

A discrete-choice experiment was conducted to investigate preferences. Adults, and parents of children, with ADHD were presented with eight hypothetical choice tasks of three options (Medication A, Medication B, No Medication) described by six attributes related to medication outcomes. Preferences were estimated using a mixed multinomial logit model.

RESULTS

Overall, respondents' preferences (n = 216) for continuing medication were negative (mean [β] = -1.426, p < .001); however, a significant heterogeneity in preferences was observed amongst respondents (standard deviation = 0.805, p < .001). Improvements in education, aggressive behaviour, social behaviour and family functioning, and side effects and stigma, influenced respondents' decision to continue taking medication. The respondents were willing to continue medication if they experienced positive effects, but side effects (even moderate) were the strongest concern for not continuing medication. While side effects were the most important factor for both adult patients and parents of children with ADHD, improvement in education was relatively more important for adults and improvement in aggressive behaviour, social behaviour and family functioning was relatively more important for parents of children with ADHD. Parents were more likely to not continue a medication with severe side effects even at the highest level of improvement in education.

CONCLUSIONS

Side effects are the most important factor that influenced preferences for continuing medication for both adults with ADHD, as well as parents of children with ADHD. While overall the respondents preferred not to take/give medication, discrete-choice experiment showed that the relative importance of factors that influenced continuation of medications was different for the two groups.

PATIENT AND PUBLIC INVOLVEMENT

Adults, and parents of children, with ADHD participated in this study by completing the online questionnaire. The questionnaire was based on findings of research in the literature, as well as earlier focus groups conducted with adults, and parents of children, with ADHD. The face validity of the questionnaire was determined by asking parents of children, and adults, with ADHD (n = 3) to complete the survey and participate in a short discussion on their understanding of the questions and their recommendations on improving the clarity of the survey.

Beliefs about medication and their association with adherence in Chinese patients with non-dialysis chronic kidney disease stages 3-5

There is a scarcity of research into the impact of medication beliefs on adherence in patients with non-dialysis chronic kidney disease (CKD). This study is to determine the psychometric properties of the Chinese version of the Beliefs about Medicines Questionnaire (BMQ)-Specific among patients with non-dialysis CKD stages 3-5, and to assess the beliefs of CKD patients and their association with medication adherence.A cross-sectional study was conducted in CKD patients who recruited at the nephrology clinics of Xi'an Central Hospital, Xi'an, Shaanxi, China. The original BMQ-Specific was translated into Chinese. The internal consistency and test-retest reliability of the Chinese version of the BMQ-Specific scale were assessed, while exploratory and confirmatory factor analyses were also applied to determine its reliability and validity. The Kruskal-Wallis test and multiple ordered logistic regression were performed to identify the relationship between beliefs about and adherence to medication among CKD patients.This study recruited 248 patients. Cronbach's α values of the BMQ-Specific necessity and concern subscales were 0.826 and 0.820, respectively, with intraclass correlation coefficients of 0.784 and 0.732. Factor analysis showed that BMQ-Specific provided a good fit to the two-factor model. The adherence of patients was positively correlated with perceived necessity (r = 0.264, P < .001) and negatively correlated with concern (r = -0.294, P < .001). Medication adherence was significantly higher for the accepting group (high necessity and low concern scores) than for the ambivalent group (high necessity and concern scores; β = -0.880, 95% confidence interval [CI] = -1.475 to -0.285), skeptical group (low necessity and high concern scores; β = -2.620, 95% CI = -4.209 to -1.031) and indifferent group (low necessity and concern scores; β = -0.918, 95% CI = -1.724 to -0.112).The Chinese version of BMQ-Specific exhibited satisfactory reliability and validity for use in patients with non-dialysis CKD stages 3-5 and has been demonstrated to be a reliable screening tool for clinicians to use to predict and identify the non-adherence behaviors of patients.

Review of barriers and interventions to promote treatment engagement for pediatric attention deficit hyperactivity disorder care

Attention deficit hyperactivity disorder (ADHD) is a common and impairing behavioral health disorder, impacting over 5% of children worldwide. There are multiple evidence-based pharmacological and psychosocial treatments for ADHD, and greater service utilization is associated with improved acute and long-term outcomes. However, long-term outcomes are suboptimal as multimodal treatments are often not accessed and most care ends prematurely. This narrative review discusses barriers to engagement for children and adolescents with ADHD and their families as well as interventions to overcome these barriers. Families face a variety of structural and attitudinal barriers, ranging from cost and access to stigma and low self-efficacy to successfully implement change. There are multiple interventions that may enhance engagement with ADHD care including psychoeducation, integration of behavioral services in general medical settings, telehealth as well as specific adaptations to existing ADHD treatments, such as the use of motivational interviewing or shared decision making. Integration of behavioral health into general medical settings and telehealth have been found in controlled studies to increase access by reducing both structural and attitudinal barriers. Adding motivational interviewing, shared decision making and other engagement interventions to evidence-based ADHD treatments has been found to reduce attitudinal barriers that translates into improved participation and satisfaction while enhancing outcomes. However, little is known about how to promote extended engagement with ADHD services even though a chronic care model for ADHD is recommended.

eHealth Literacy and Beliefs About Medicines Among Taiwanese College Students: Cross-sectional Study

Background

Good eHealth literacy and correct beliefs about medicines are beneficial for making good health care decisions and may further influence an individual's quality of life. However, few studies have discussed these two factors simultaneously. Moreover, gender differences are associated with health literacy and beliefs about medicines. Therefore, it is important to examine the multiple relationships between college students’ eHealth literacy and beliefs about medicines, as well as gender differences.

Objective

This study aims to (1) examine the multiple relationships between eHealth literacy and beliefs about medicines and (2) analyze gender differences in eHealth literacy and beliefs about medicines with Taiwanese college students.

Methods

We used a paper-and-pencil questionnaire that included age, gender, 3-level eHealth literacy, and beliefs about medicines to collect data. In total, 475 data points were obtained and analyzed through independent t tests and canonical correlation analyses.

Results

The t test (t₄₇₃=3.73; P<.001; t₄₇₃=–2.10; P=.04) showed that women had lower functional eHealth literacy and more specific concerns about medicines than men. Canonical correlation analyses indicated that the first and second canonical correlation coefficients between eHealth literacy and beliefs about medicines reached a significant level, implying that a multivariate relationship indeed existed.

Conclusions

These findings reveal that women in Taiwan have lower functional eHealth literacy and stronger concerns about medicines than men. In addition, students with higher eHealth literacy have more positive perceptions of and beliefs about medicines.

Assessment of illness representations in mental disorders: A mini review

Health beliefs, and especially illness representations, have been widely used to understand clinical outcomes and psychosocial adjustment in people with physical diseases. However, this area of research has been under-explored in the field of mental health, and the few studies that have been conducted have used very different methods. Therefore, the aim of our study was to identify the tools and methods that have been used to evaluate illness representations in psychiatry. To this end, a mini review has been conducted and 58 articles were retained. This mini review highlights that the quantitative method is the most used, and that the scales mobilised are often adapted for the study, but not validated. Indeed, multiple modifications and adaptations have been made by the authors (e.g. deletion of subscales, addition of items), which lead to questions about the reliability of what is measured. In the future, it is essential to have a validated generic tool for mental disorders, which could be based on the Illness perceptions questionnaire for schizophrenia.

Interventions to Improve Adherence to Cardiovascular Medication: What About Gender Differences? A Systematic Literature Review

BACKGROUND

Compared to men, women have lower treatment rates for cardiovascular disease (CVD), are at higher risk for medication non-adherence and have different reasons for being non-adherent. The aim of this study was to synthesize and evaluate gender-specific adherence-promoting interventions for cardiovascular medication and gender-specific effects of gender-neutral interventions.

METHODS

A systematic literature search was performed in PubMed, Embase, PsycINFO, CINAHL and Cochrane Library from January 2007 to October 2019. Intervention studies (with control group) aimed at improving cardiovascular medication adherence with minimally 14 weeks follow-up were included. Two reviewers independently screened titles and abstracts. Full text was obtained for selected abstracts and screened for final inclusion. Data extraction included gender-specific targeting or analysis.

RESULTS

The search identified 6502 citations. After screening title and abstract, full text was obtained from 127 potentially eligible articles. Ultimately, 11 articles were included that analyzed gender differences in gender-neutral interventions. Two reported a gender-specific intervention effect. Using an electronic reminder device, one study increased statin adherence in women. The other found a larger increase in adherence to CVD medication following telephone counseling for men than women. Nine studies did not identify a gender-specific effect.

CONCLUSION

Despite differences in levels of and reasons for non-adherence, most studies addressing adherence did not analyze potential differences in effect by gender. Moreover, none of the identified studies used gender-specific adherence promoting interventions. Increasing awareness about gender differences in adherence might lead to better tailoring of interventions to gender-specific needs and better results in improving adherence.

Psychological factors involved in psychopharmacological medication adherence in mental health patients: A systematic review

BACKGROUND

Psychopharmacological medication adherence is essential for psychiatric patients' treatment and well-being.

OBJECTIVE

This review aimed to identify psychological factors related to health control that have been linked to psychopharmacological medication adherence in psychiatric patients.

METHODS

A literature search was performed through the databases Medline, PubMed, PsycINFO, and Google Scholar to identify relevant studies published before October 15th, 2019. Articles published in peer-reviewed journals that analyzed the psychological factors of health belief and health control involved in psychopharmacological medication adherence in a psychiatric population were included.

RESULTS

The search identified 124 potentially relevant papers, 29 of which met the eligibility criteria. The final sample was 222 adolescents, most with a diagnosis of attention deficit/hyperactivity disorder (ADHD), and 6139 adults diagnosed especially with schizophrenia spectrum disorder, bipolar disorder, or depressive disorder. Results suggested that medication adherence is associated with health beliefs and psychological variables, such as self-efficacy and locus of control. Family support was also positively related to medication adherence.

CONCLUSION

Psychopharmacological medication adherence requires a consideration of multicausality, which depends on sociodemographic, clinical, and psychological factors.

PRACTICE IMPLICATIONS

These findings should be considered in the development and implementation of psychological interventions focused on self-control and family support.

Treatment of ADHD in adults - prevalence of discontinuation and associated factors - results from a cross-sectional analysis of Danish register data

BACKGROUND

A growing number of adults are receiving pharmacological treatment for ADHD but a sizable proportion also discontinues or have gaps in treatment. The primary aims of this study were to identify how many patients treated for ADHD in adulthood, have at least one event of discontinuation in treatment and to identify possible associated variables.

METHODS

Within the Danish population aged 18-60 years on the 1st of January 2013, we identified the number of individuals who had been prescribed ADHD-medication at least once during the 1st of January 2002-31st of December 2013 using Danish register data. Among those who filed more than one prescription, treatment discontinuation was defined as having more than 211 days between two prescriptions. In crude and adjusted logistic regression analysis, we explored potential associations to discontinuation for variables such as gender and age at treatment initiation.

RESULTS

In a population, if N = 3,165,844 individuals, n = 42,892 had received at least one prescription for ADHD medication. Among those with more than one prescription (N = 38,289), 29.4% had discontinued their treatment at least once, according to our definition of treatment discontinuation. ADHD treatment discontinuation was associated with being male, unemployment, lower educational attainment, receiving incapacity benefits and younger age at treatment initiation (p < 0.001).

CONCLUSIONS

A large proportion of individuals treated for ADHD had at least one discontinuation of treatment according to our definition. Although the present study does not allow for investigating the direction of these effects, nor whether some patients later resumed treatment, having at least one discontinuation was associated with a range of variables relating to e.g. age and gender, and provides an emerging profile for clinicians of patients more likely to discontinue.

Necessity and concerns about lipid-lowering medical treatments and risk factors for non-adherence: A cross-sectional study in Palestine

AIMS

Strong evidence indicates that drugs reduce blood lipids and improve cardiovascular end-points, leading to their wide usage. However, the success of these drugs can be affected by poor patient's adherence to prescribed medication. This study aimed to evaluate medication adherence in patients with dyslipidaemia in association with patient beliefs about medicines.

METHODS

The study was conducted from January 2019 to July 2019 at the middle governmental primary healthcare clinics in Ramallah and Bethlehem cities, and used a cross-sectional design. Adherence was determined using the 4-item Morisky medication adherence scale, while beliefs were determined using the Beliefs about Medicines Questionnaire.

RESULTS

Of 220 patients, 185 agreed to participate in the study, resulting in a response rate of 84.1%. Of the participants, 106 (57.3%) were men, and almost half (88, 46.5%) were ≥56 years. Medication non-adherence was high (47.6%), but a majority (65.5%) reported believing their treatment to be necessary for their continued good health. Accordingly, the mean necessity score (17.3, SD 3.7) significantly outweighed (P < .001) the mean concerns score (14.0, SD 3.5). Multivariate regression demonstrated four variables to be significantly correlated with non-adherence: illiterate (OR = 2.52; CI: 0.9-4.3; P = .03), polypharmacy (OR = 3.18; CI: 1.9-5.7; P = .007), having comorbidity (OR = 3.10; CI: 2.2-4.6; P = .005) and having concerns about side effects (OR = 2.89; CI: 1.1-4.6, P = .04).

CONCLUSION

Non-adherence among patients taking lipid-lowering agents was high despite most holding positive beliefs regarding medication necessity. This may be due to concern also being high. Physicians should identify and target high-risk patients and individualise their treatment plans in order to achieve adequate control of dyslipidaemia.

Relationship Between Illness Representations, Psychosocial Adjustment, and Treatment Outcomes in Mental Disorders: A Mini Review

Understanding and improving the psychosocial adjustments (e.g., quality of life, depression) and treatment outcomes (e.g., adherence, beliefs about treatments) of people with mental disorders are major health issues. The self-regulation model (SRM) postulates that illness representations play a central role on adjustment and treatment of people with physical illnesses. Recently, the SRM has been used with people with mental disorders. However, the manifestations of somatic and psychiatric disorders can be very different. Therefore, the use of SRM in the field of mental health is very complex. This difficulty, as well as the growing interest for illness representations in the field of mental health, justifies the utility to conduct a review on this topic. The current review shows that illness representations are related to psychosocial adjustment and/or treatment outcomes for people with various mental disorders [e.g., psychotic disorders, mood disorder, posttraumatic stress disorder (PTSD), attention deficit hyperactivity disorder (ADHD)]. However, some limitations to the applicability of SRM to mental disorders have been highlighted. These limitations should be considered in future studies.

Impact of personality on adherence to and beliefs about ADHD medication, and perceptions of ADHD in adolescents

BACKGROUND

Adherence to attention deficit hyperactivity disorder (ADHD) medication can prevent serious consequences, possibly with lifelong effects. Numerous factors have been observed that influence adherent behaviour, but the impact of personality traits has been inadequately explored. The purpose of this study was to explore the associations between personality traits and adherence to ADHD medication, beliefs about the medication, and perceptions of ADHD.

METHOD

Adolescents (n = 99) on ADHD medication were administered: Health-Relevant Personality Traits Five-Factor Inventory, Medication Adherence Report Scale, Beliefs about Medicines Specific and Brief Illness Perceptions Questionnaires.

RESULTS

The personality trait Antagonism correlated with adherence behaviour (r = - 0.198, p = 0.005) and perceived personal control of ADHD (r = - 0.269, p = 0.007). Negative Affectivity correlated with beliefs regarding necessity (r = 0.319, p = 0.001), concerns (r = 0.344, p = 0.001), and experienced side effects of medication (r = 0.495, p = 0.001), alongside perceptions regarding duration (r = 0.272, p = 0.007), identity (r = 0.388, p < 0.001), being emotionally affected (r = 0.374, p < 0.01), personal control (r = - 0.287, p = 0.004) and concerns about ADHD (r = 0.465, p < 0.001). Impulsivity correlated with perceived consequences (r = - 0.226, p = 0.0255) and personal control of ADHD (r = - 0.379, p < 0.001). Hedonic Capacity correlated with concerns about medication (r = - 0.218, p = 0.0316) and perceived identification with ADHD (r = - 0.203, p = 0.045).

CONCLUSION

Personality traits are related to adherence, beliefs about ADHD medicines and perceptions of ADHD. Antagonism is associated with adherence, especially intentional non-adherence, while Negative Affectivity correlates with numerous perceptions of ADHD and beliefs about medications. Personality assessments could be useful in the care and treatment of adolescents with ADHD.

Exploring Factors Influencing Medication Adherence From Initiation to Discontinuation in Parents and Adolescents With Attention Deficit Hyperactivity Disorder

This study explored factors influencing parents' and adolescents' decisions to initiate, continue, and discontinue medication for attention deficit hyperactivity disorder (ADHD). Three focus groups were conducted with parents (n = 23) of children with ADHD, and 2 with adolescents diagnosed with ADHD (n = 11). Parents and adolescents independently discussed the complexities surrounding their decisions to adhere to ADHD medication. Parents' negative beliefs about medication (fear of side effects) discouraged them from initiating therapy. Once initiated, parents struggled in balancing the need to medicate (improvements in learning and behavior) and concerns (weight loss, perceived delayed development) about the medication. Parents who had more concerns about the medication were more in favor of discontinuation. For adolescents, the desire for self-expression without being medicated was the primary factor determining nonadherence and/or discontinuation of the medication. Adolescents' medication-related concerns were relatively different from the parents. Phase- and group-specific interventions are required to improve medication adherence in people with ADHD.

Reliability and validation of Swedish translation of Beliefs about Medication Specific (BMQ-Specific) and Brief Illness Perception Questionnaire (B-IPQ) for use in adolescents with attention-deficit hyperactivity disorder

Objectives: The purpose of this study was to assess the reliability and validity of Swedish translations of the Beliefs about Medicines Questionnaire-Specific (BMQ-Specific) and Brief Illness Perception Questionnaire (B-IPQ) for use in adolescents with ADHD.Methods: Forward and backward translations of the BMQ-Specific and B-IPQ scales to Swedish were conducted and reviewed by adolescents with ADHD and professionals. The validity and reliability of both questionnaires were investigated in a cross-sectional study of 101 adolescents (13-17 years) on a long-term prescription of ADHD medication recruited from two child and adolescent psychiatric outpatient clinics in Sweden.Results: Regarding the BMQ-Specific, principal component analysis (PCA) loadings confirmed the previously defined components of Specific-Necessity and Specific-Concern. The PCA for B-IPQ revealed two components, the first one, B-IPQ Consequences, captured questions regarding perceptions of the implication of having ADHD (items 1, 2, 5, 6 and 8) and the second one, B-IPQ-Control, the perceptions of the capability to manage the ADHD disorder (items 3, 4 and 7). The Cronbach alpha coefficients for BMQ-Specific-Necessity scale was α = 0.80, for BMQ-Specific-Concern scale α = 0.75, B-IPQ Consequences α = 0.74 and for B-IPQ-Control α = 0.44.Conclusions: The present results prove the Swedish translation of BMQ-Specific and B-IPQ to be valid and reliable for utilization in adolescents with ADHD. The PCA confirmed the original components for BMQ-Specific and the recent findings of two main B-IPQ components describing emotional and cognitive implications versus the capability for self-care maintenance of ADHD.

Utilizing the Common-Sense model of illness representations to explore children's perceptions of, and coping with ADHD

BACKGROUND

Attention Deficit Hyperactivity Disorder (ADHD) among children is associated with difficulties in everyday functioning. According to the Common-Sense Model of Illness Representations (CSM), individuals' beliefs about their illness condition guide their attempts to cope with it. The model suggests five dimensions of illness representations: beliefs regarding the identity of the symptoms, its duration, causes, consequences, and one's ability to achieve control over it.

AIMS

The study aimed to explore the validity of the CSM-dimensions of illness representations for children with ADHD, while also exploring the possible relationships between types of beliefs and coping strategies.

METHOD

A deductive qualitative content analysis was used for analyzing data constructed from semi-structured individual interviews with 14 children diagnosed with ADHD.

RESULTS

The results have shown that there is a variation in children's beliefs regarding their ADHD. Those beliefs are, for the most part, captured by the five CSM-dimensions. An additional dimension of 'Uniqueness' is suggested, which reflects children's beliefs on the way ADHD distinguishes them from other children. Patterns regarding types of beliefs and types of coping strategies were identified.

CONCLUSIONS

The CSM is a useful theoretical model to understand children's beliefs of, and coping with their ADHD.

Unmet care needs of children with ADHD

Background

Non-compliance to, or drop-out from treatment for childhood ADHD, result in suboptimal outcome. Non-compliance and drop-out may be due to mismatches between patients' care needs and treatments provided. This study investigated unmet care needs in ADHD patients. Unmet needs were assessed in two different treatment settings (general outpatient setting versus youth-ACT). Youth-ACT treatment is an intensive outreach-oriented treatment for patients with severe psychiatric and psychosocial problems. Comparison of a general outpatient sample with a youth-ACT sample enabled us to assess the influence of severity of psychiatric and psychosocial problems on perceived care needs.

Methods

Self-reported unmet care needs were assessed among 105 ADHD patients between 6 and 17 years of age in a general outpatient (n = 52) and a youth-ACT setting (n = 53).

Results

ADHD patients most frequently reported unmet needs regarding mental health problems, information on diagnosis/treatment, and future prospects. Outpatients differed from youth-ACT patients with respect to 30% of the unmet care needs that were investigated. Outpatients perceived more unmet needs regarding information on diagnosis/treatment (p = 0.014). Youth-ACT patients perceived more unmet needs concerning medication side effects (p = 0.038), quality and/or quantity of food (p = 0.016), self-care abilities (p = 0.016), regular/suitable school or other daytime activities (p = 0.013), making and/or keeping friends (p = 0.049), and future prospects (p = 0.045).

Conclusions

Focusing treatment of ADHD patients on unmet needs may reduce non-compliance and drop-out. In clinical practice, systematic assessment of unmet care needs in all ADHD patients may be warranted, e.g. using the CANSAS questionnaire during the screening/intake phase.

The Association Among Medication Beliefs, Perception of Illness and Medication Adherence in Ischemic Stroke Patients: A Cross-Sectional Study in China

PURPOSE

To examine the association and the mediating effect among medication beliefs, perception of illness, and medication adherence in ischemic stroke patients.

PATIENTS AND METHODS

This is a cross-sectional study, 306 ischemic stroke patients recruited from The Second Affiliated Hospital of Harbin Medical University, China between June 2018 and October 2018. The Beliefs about Medications Questionnaire (BMQ) was used to assess a patient's beliefs about medication. The Brief Illness Perceptions Questionnaire (BIPQ) was used to rapidly determine the cognitive and emotional representation of ischemic stroke. Self-reported adherence was assessed using the Medication Adherence Report Scale (MARS). Logistic regression analysis, Pearson correlations, and mediation analysis were used to evaluate the association and mediating effects among medication beliefs, perception of illness, and medication adherence.

RESULTS

Overall, 220 (65.48%) participants were non-adherent to their ischemic stroke medications. Non-adherent patients had greater stroke severity (p = 0.031) compared to adherent patients. After adjusting for demographic characteristics, specific concern (odds ratio [OR]: 0.652, 95% confidence interval [CI]: 0.431 to 0.987, p-value [P] = 0.043), and the perception of illness (overall score) (OR: 0.964, 95% CI: 0.944 to 0.985, P = 0.001) were significantly associated with medication adherence in ischemic stroke patients. The mediation analysis showed the significant indirect effects of specific concern, general overuse, and general harm. It suggested that some impacts of medication beliefs have been mediated on medication adherence.

CONCLUSION

Perceived concern about adverse effects of medicines and perception of illness have an influential impact on self-reported medication adherence in ischemic stroke patients. To enhance adherence, patients' beliefs about medication and perceptions of their disease should be reconsidered. Future work should investigate interventions to influence patient adherence by addressing concerns about their ischemic stroke medications and the perception of the disease.

Illness representations among adolescents with attention deficit hyperactivity disorder: associations with quality of life, coping, and treatment adherence

Research into the causes and outcomes of attention deficit hyperactivity disorder (ADHD) has been extensive, yet little is known about the perception of ADHD as a disorder and its related outcomes among diagnosed youth. The present study applied the Common-Sense Model of Illness Representations (CSM) to examine the perception of ADHD and its association with quality of life (QoL), coping strategies, and treatment adherence among 63 diagnosed adolescents (10-18 years). Adolescents recruited from clinics, parent support groups, and an educational service completed self-report measures of the key constructs. Results indicated that adolescents generally perceive their ADHD as mildly threatening; four illness beliefs (perceived impact, personal control, timeline, and coherence) are significant predictors of coping and four (perceived impact, causes, personal control, and treatment control) are that of QoL. Adolescents who perceived minimal impact, expected longer duration, had strong sense of coherence, and believed in personal control of ADHD coped with the disorder more actively. Those who made weaker attribution to psychological and environmental causes, believed in personal control and the effectiveness of behavioral treatment enjoyed better QoL. In addition, female adolescents seem to experience more difficulties in the management of ADHD than male counterparts. These findings have potentially important clinical implications, suggesting that perceptions of ADHD related to the disorder's impact, duration, coherence, and personal control, may be important for clinicians to address when caring for adolescents with the disorder.

A Review of Factors Influencing the Three Phases of Medication Adherence in People with Attention-Deficit/Hyperactivity Disorder

Objectives: Factors affecting adherence to medications in people with attention-deficit/hyperactivity disorder (ADHD) are not well understood in the context of their influence on the different phases of adherence, that is, initiation, implementation, and discontinuation. This review aimed to identify the factors affecting the three phases of medication adherence in people with ADHD. Methods: Six electronic databases, including Medline, PubMed, IPA, CINAHL, Embase, and PsycINFO, were systematically searched from inception through October 2018 with the limitations of English language and human studies. The search strategy was based on three concepts (adherence, ADHD, and factors) and their relevant terminologies. Results: Considerable variability was observed with regards to the criteria used to define adherence in identified studies (n = 48). Most studies focused on the implementation phase of adherence (n = 27), while only a handful focused on the initiation (n = 6) and discontinuation (n = 5) phase of adherence. The remaining studies (n = 10) examined multiple phases of adherence. Conflicting information received about medication, medication frequency, and fears of medication's effect on growth were the unique factors impacting initiation, implementation, and discontinuation, respectively. Moreover, factors within each phase of adherence also differed with different populations such as parents, children, adolescents, and adults. Fear of addiction, medication effectiveness, psychiatric comorbidity, and medication side effects were the most common factors identified in all three phases of adherence. Conclusions: This review found some unique factors in each phase of adherence while some overlap was also noted. Future interventions to improve adherence should be phase- and group specific rather than consider adherence as a single variable.

Factors Associated with Treatment Adherence in Children with Attention Deficit Hyperactivity Disorder

BACKGROUND

Attention deficit/hyperactivity disorder (ADHD) is a common psychiatric disorder in children. The aim of this study was to investigate factors related to treatment adherence in children with ADHD.

METHODS

This cross-sectional study was done in 118 children (aged 6-12 years) with ADHD who have been on medications for at least 6 months. The patients were selected based on the convenience sampling method from those who were referred to child psychiatry clinic. Medication Adherence Report Scale, Belief about Medicines Questionnaire specific version, and Children Symptom Inventory-4 were completed by parents and teachers.

FINDINGS

Medication adherence had significant negative correlation with inattention scores on teacher-report forms (r = -0.27, P= 0.003) and poor economic status (P = 0.03). There was a positive correlation between medication adherence and history of psychopharmacological treatment in the family (P = 0.01), and father's education level (P = 0.001). Treatment adherence had no significant correlation with age, gender, comorbid disorders, mother's education, family history of ADHD, medication side effects, or parental concerns and beliefs about the necessity of drug use.

CONCLUSION

The factors found to have a correlation with adherence should be taken in to account by clinicians so that adherence can be improved in their patients.

Perceptions of ADHD Among Diagnosed Children and Their Parents: A Systematic Review Using the Common-Sense Model of Illness Representations

Research on children and parents' experiences of ADHD has grown in recent years, attracting attention to their subjective perception of ADHD as a disorder. Theoretical accounts of illness perception suggest that it is multi-dimensional, consisting of at least five core constructs (see the common-sense model of illness representations or CSM: Leventhal et al., in: Rachman (ed) Medical psychology, Pergamon, New York, vol 2, pp 7-30, 1980, in: Baum, Taylor, Singer (eds) Handbook of psychology and health: social psychological aspects of health, Earlbaum, Hillsdale, vol 4, pp 219-252, 1984). We suggest that the application of CSM in children/adolescents with ADHD and their parents may play an important role in understanding their coping behavior, treatment adherence, and emotional well-being. A systematic search identified 101 eligible studies that investigated the perception of ADHD among diagnosed children/adolescents and their parents. In general, these studies support the existence of the multiple facets of illness representations proposed by the CSM in both diagnosed youngsters and parents indicating substantial variability among both parents and youngsters on each of these facets. The comprehensive assessment of the representations of ADHD indicates imbalance attention to the different representations of ADHD in the literature; disproportional research attention has been paid to the perceived effectiveness of treatment (i.e., treatment control dimension) compared to other illness representations (e.g., timeline, consequence, and coherence), despite research showing their relevance to treatment adherence among other implications. The review identifies the limitation of existing relevant research, needed foci for future studies, specific testable hypotheses, and potential clinical implications of the multifaceted representations of ADHD among youngsters and carers alike.

"When I Stop My Medication, Everything Goes Wrong": Content Analysis of Interviews with Adolescent Patients Treated with Psychotropic Medication

OBJECTIVES

Medication nonadherence constitutes a major problem in adolescent psychiatry. Previous studies have identified various factors associated with nonadherent behavior. The aim of this study is to explore adolescents' health beliefs and subjective perceptions relating to psychotropic medication, and to statistically link these to reported medication adherence.

METHODS

The findings presented in this study are part of the multicenter SEMA study (Subjective Experience and Medication Adherence in Adolescents with Psychiatric Disorders). Patients 12-18 years of age were included, who had been treated with a psychotropic medication for at least 2 weeks. The validated MARS (Medication Adherence Rating Scale) and the QATT (Questionnaire on Attitudes Toward Treatment) were used to measure adherence, and a qualitative semi-structured interview was conducted to examine patients' subjective experiences and perceptions. A conventional content analysis was conducted, and Fisher's exact tests were performed to analyze group differences between completely adherent and not completely adherent patients.

RESULTS

A total of 64 patients were included in the study. 40.6% (n = 26) were classified as not completely adherent. Distribution patterns of answers to 7 out of 64 questions showed statistically significant group differences between completely and not completely adherent patients. Patients with lower adherence reported the following: feeling worse after taking medication; a lower sense of self-efficacy concerning the improvement of their symptoms; a less trustful physician-patient relationship; a worsened attitude toward medication after experiencing adverse events/"side effects"; less support from their relatives; and fewer individuals in their family who were fully informed about their condition.

CONCLUSIONS

To our knowledge, this is the first interview-based study to investigate subjective experiences and health beliefs of adolescents with psychiatric disorders and to correlate these findings with rates of medication adherence. The study results will be useful for the development of tools and approaches to increase medication adherence, for example, psychoeducation programs and personalized treatment concepts.

Treatment adherence in systemic sclerosis: A cross-sectional study

BACKGROUND

Treatment adherence is an important medical and pharmaco-economical phenomenon, influenced by multiple variables. Treatment adherence in systemic sclerosis (SSc) has been poorly studied.

OBJECTIVE

The aim of the present study was to assess treatment adherence in SSc patients and to identify factors associated with good and poor adherence.

METHODS

We conducted a monocentric, cross-sectional, observational study. Treatment adherence was evaluated by the Compliance Questionnaire of Rheumatology (CQR). The necessity of treatment and concerns about treatment were investigated using the Beliefs about Medicines Questionnaire-Specific (BMQ-S). The Illness Perception Questionnaire-Revised (IPQ-R) assessed illness perceptions. Disease-related characteristics were collected retrospectively.

RESULTS

A total of 66 patients were enrolled in this study. Of these, 47 (71.2%) had a weighted CQR score of ≤80% ("poor adherence") and 19 (28.8%) had a weighted CQR score of >80% ("good adherence"). No significant relationship between demographic, clinical or psychological factors and overall adherence could be found, except with the IPQ subscale "timeline acute/chronic" (p = 0.042). Our patient population estimated the necessity of their medication high (mean necessity score 20.5), with moderate concern beliefs (mean concern score 15.1). Subjective adherence, as self-reported by patients, was high.

CONCLUSIONS

This study demonstrated low treatment adherence rates in SSc patients. We could not identify demographic, clinical or psychological factors associated with treatment adherence, except with the IPQ subscale "timeline acute/chronic". This suggests a correlation between poor adherence and the belief that the disease will be chronic without improvement over time. Symptom relief was an important motivating factor for taking medication. The treatment necessity was scored higher than treatment concerns, but the necessity beliefs were not associated with adherence.

Attention-Deficit/Hyperactivity Disorder Medication Use in Adolescents: The Patient's Perspective

PURPOSE

The purpose of the study was to gain more insight into the attitudes of adolescents using medication for attention-deficit/hyperactivity disorder (ADHD).

METHODS

A cross-sectional study among adolescents (aged 12-18 years) who filled at least two prescriptions for ADHD medication in the preceding year was conducted. Adolescents were invited to fill in an online questionnaire containing questions on sociodemographics, health status, illness perceptions, medication adherence, and medication beliefs.

RESULTS

We invited 1,200 adolescents of whom 181 adolescents (122 males, mean age 14.2 ± 1.7 years) completed the online questionnaire. They mostly used methylphenidate (n = 167; 92%) as a pharmacological treatment for ADHD. Half of the study population (n = 93; 51%) experienced side effects, such as decreased appetite and sleep problems. Most participants (n = 150; 83%) had an indifferent attitude (perceived low necessity and low concerns) toward their ADHD medication. More than half of the study population (n = 111; 61%) reported to be nonadherent based on the Medication Adherence Report Scale. The highest score of the Brief Illness Perception Questionnaire was on "treatment control," suggesting that adolescents do think their medication is effective, despite their indifferent drug attitude.

CONCLUSIONS

Most adolescents using ADHD medication had an indifferent attitude toward their medication and reported low adherence rates. These findings should be taken into account when treating adolescents with ADHD; regular counseling and monitoring of the pharmacological treatment might be useful to optimize treatment.