Targeting the problem of treatment non-adherence among mentally ill patients: The impact of loss, grief and stigma

Psychotropic medication non-adherence and its determinants among people living with mental illnesses in Ethiopia: systematic review and meta-analysis study

BACKGROUND

Over half of patients take medications incorrectly, with non-adherence being a significant challenge in managing mental illnesses and to healthcare systems globally. In mental health, non-adherence to psychotropic medications exacerbates symptoms, increases relapse rates, and contributes to treatment resistance, higher hospitalization rates, and mortality. It also places a financial burden on healthcare systems through preventable hospitalizations and prolonged treatments. Understanding the prevalence and determinants of non-adherence is particularly critical in low-resource settings like Ethiopia, where mental health services are underfunded and sociocultural factors influence treatment behaviors. Therefore, this study aimed to estimate the pooled prevalence and determinants of psychotropic medication non-adherence in Ethiopia.

METHODS

Primary articles were sourced from PubMed (Medline), EMBASE, CINAHL, Web of Science, PsycINFO, Google, and Google Scholar. The review included studies reporting the prevalence and determinants of psychotropic medication non-adherence among individuals with mental illness. Data were extracted using Microsoft Excel and analyzed in STATA 14. A random effects model was applied to estimate the pooled prevalence, and subgroup analyses were performed to explore heterogeneity. Publication bias was assessed using Egger's test and a funnel plot.

RESULTS

Seventeen studies with 7,097 participants were included. The pooled prevalence of psychotropic medication non-adherence was 43.98% (38.15, 49.81). Subgroup analysis revealed regional variations with prevalence rates of 52.85% in Harari, 52.4% in Amhara, 46.39% in Oromia, 39.8% in Addis Ababa, and 27.42% in Tigray. Significant determinants included negative attitudes toward treatment (OR: 3.69; 95% CI: 2.73-4.99), lack of insight (OR: 3.20; 95% CI: 1.71-5.99), medication side effects (OR: 2.84; 95% CI: 2.05-3.93), perceived stigma (OR: 2.41; 95% CI: 1.87-3.10), substance use (OR: 2.36; 95% CI: 2.02-2.74), and poor social support (OR: 2.30; 95% CI: 1.61-3.29).

CONCLUSIONS AND RECOMMENDATIONS

This study found that over four in ten people with mental illness were non-adherent to medications. It is recommended to design intervention strategies that address the factors associated with non-adherence to psychotropic medication.

PROSPERO REGISTRATION

CRD42024563343.

Adherence to psychopharmacological treatment in patients with severe and persistent mental disorders: A systematic review

INTRODUCTION

It is known that non-adherence to psychiatric medications has harmful consequences for both patients and society.

OBJECTIVE

To collect information on the incidence of non-adherence, and the factors and causes affecting adherence to psychopharmacological treatment in patients with severe and persistent mental disorders.

METHODS

A systematic review of scientific articles on adult patients (>17 years) published in the last five years (2015-2020) on specialised databases such as PubMed, Scopus, Scielo and BioMed. Original articles from indexed journals with an impact factor >0.5, in English or Spanish, with an analytical, prospective, retrospective, cross-sectional and randomised design were included. Once the articles were identified, they were analysed, extracting the information necessary to answer the research questions.

RESULTS

Fifteen articles were included. Of these, 40% (n = 6) were published in 2020, 20% (n = 3) were produced in China and 53.3% (n = 8) had an observational design. A total of 5,837 patients were included, of which 50.6% were men (n = 2,955), with moderate adherence (n = 10; 66.7%) reported in 10 investigations. Non-adherence varies from 7.7% to 60.6%. The factors that affect adherence are specific to the patient (age and sex), their family support network, and related to the disease or the treatment. The main cause of non-adherence is lack of insight.

CONCLUSIONS

Adherence to treatment with psychotropic drugs is multifactorial. Access to mental health services should be improved, with an emphasis placed on patient education and providing greater knowledge of mental illness. Interventions to promote education and interaction with the psychiatrist could be beneficial.

Computational psychiatry approach to stigma subtyping in patients with mental disorders: explicit and implicit internalized stigma

BACKGROUND

Psychiatric stigma has potentially controversial effects on patients health-related behaviors. It appears that both stigmatization and motivation in psychiatric patients are heterogeneous and multi-dimensional, and that the relationship between stigma and treatment motivation may be more complex than previously believed.

AIM

To determine psychiatric stigma subtypes as they relate to treatment motivation among inpatients with various mental disorders.

METHODS

Sixy-three psychiatric inpatients were examined by the Treatment Motivation Assessment Questionnaire (TMAQ) and the Russian version of Internalized Stigma of Mental Illness scale (ISMI). K-Means cluster and dispersion analysis were conducted.

RESULTS

Cluster 3 (25 subjects) was the least stigmatized. Cluster 1 (18 subjects) showed an explicit stigma. Cluster 2 (20 subjects) showed an implicit stigma that took the form of the lowest treatment motivation compared to other clusters. Implicitly stigmatized patients, in contrast to explicitly stigmatized individuals, showed a decline in 3 out of 4 TMAQ factors (Mean dif.=1.051.67).

CONCLUSION

Cooperation with doctors, together with reliance on ones own knowledge and skills to cope with the disorder, might be the way to overcome an internalized stigma for patients with mental disorders.

A correlational and cross-sectional study on the relationship between internalized stigma and religious coping in patients with schizophrenia

Self stigmatization, which occurs as a result of internalization of public stigma in severe mental illnesses, is a factor that impairs the mental well-being of individuals and their compliance with treatment. Data on exactly which factors are associated with internalized stigma are still insufficient. Our aim in this clinical study is to investigate the relationship between internalized stigma and religious coping in patients with schizophrenia. Sociodemographic Data Form, Religious Coping Scale, internalized stigma of mental illness (ISMI) Scale were applied to 147 schizophrenic patients who were followed up by the community mental health center and met the inclusion criteria. The results were analyzed with IBM SPSS 22 package program. Descriptive statistics, Mann-Whitney U test, Pearson Chi-Square, Fisher Exact test, Spearman correlation analysis and multiple linear regression analysis were applied. There was a negative correlation between positive and negative religious coping in patients with schizophrenia (r: -0.467, P < .001); a positive correlation between negative religious coping and social withdrawal (r: 0.711, P < .001) and perceived discrimination (r: 0.706, P < .001); negative correlation between positive religious coping and social withdrawal (r: -0.343, P < .001) and perceived discrimination (r: -0.302, P < .001). There was no significant relationship between other subdimensions of ISMI and religious coping scale. There was a significant negative correlation between ISMI total score and positive religious coping (r: -0.256, P: .002), a significant positive correlation with negative religious coping (r: 0.683, P < .001). Multiple linear regression analysis was applied to reveal the explanatory effect of age, duration of illness and religious coping on internalized stigma, and according to the model obtained (R = 0.729, R2 = 0.516, F = 32.071, P < .001), 51.6% of the change in the total score of the ISMI can be explained by this model. The significant relationship between positive and negative religious coping and internalized stigma in patients included in the study suggests that it may be beneficial to consider religious coping attitudes in addition to other interventions in the fight against stigma in severe mental illnesses such as schizophrenia.

Therapeutic Adherence of People with Mental Disorders: An Evolutionary Concept Analysis

Patient therapeutic adherence lies at the core of mental health care. Health Care professionals and organizations play a major role in promoting adherence among people with mental disorders. However, defining therapeutic adherence remains complex. We used Rodgers' evolutionary concept analysis to explore the concept of therapeutic adherence in the context of mental health. We conducted a systematic literature search on Medline/PubMed and CINAHL for works published between January 2012 and December 2022. The concept analysis showed that major attributes of therapeutic adherence include patient, microsystem and meso/exosystem-level factors. Antecedents are those related to patients, such as their background, beliefs and attitudes, and acceptance of mental illness-and those related to patient-HCP therapeutic engagement. Lastly, three different consequences of the concept emerged: an improvement in clinical and social outcomes, commitment to treatment, and the quality of healthcare delivery. We discuss an operational definition that emerged from the concept analysis approach. However, considering the concept has undergone evolutionary changes, further research related to patient adherence experiences in an ecological stance is needed.

Parental Factors Associated with Child or Adolescent Medication Adherence: A Systematic Review

Medication adherence, especially among children and adolescents with psychiatric disorders, is often seen as a major treatment challenge. The purpose of this study is to systematically review studies addressing specific aspects of parental factors that are positively or negatively associated with medication adherence among children and adolescents with psychiatric disorders. A systematic literature search of English language publications, from inception through December 2021, was conducted from PubMed, Scopus, and MEDLINE databases. This review has complied with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. A total of 23 studies (77,188 participants) met inclusion criteria. Nonadherence rates ranged between 8% to 69%. Parents' socioeconomic background, family living status and functioning, parents' perception and attitude towards the importance of medication taking in treating psychiatric disorders, and parents' mental health status are significant parental characteristics associated with medication adherence in children and adolescents with psychiatric disorders. In conclusion, by identifying specific parental characteristics related to the medication adherence of children and adolescents with psychiatric disorders, targeted interventions on parents could be developed to guide parents in improving their child's medication adherence.

Integrating Loss and Processing Grief in Psychotherapy of Psychosis

Objective: While recovery from psychosis is possible, recovery is a multidimensional construct driven by various factors. One relevant factor to recovery from psychosis that has often been overlooked in the psychotherapy literature is the importance of facing loss and processing grief in relation to psychosis. Methods: A review of the existing empirical literature on grief associated with psychosis was conducted. Clinicians with significant therapeutic experience working with persons with psychosis reviewed cases to examine the losses the patients had suffered and how they responded to these losses. The clinicians considered essential principles that are relevant when helping patients with psychosis integrate loss and process grief. Results: Persons who have experienced psychosis often experience the loss of role functioning, interpersonal relationships, cognition, and self-concept. However, when these losses are not fully integrated into the person's identity, it can result in either more losses due to denial and metacognitive impairments or increased hopelessness and depression due to internalized stigma. Five elements in psychotherapy of psychosis were identified that can facilitate the integration of loss and processing of grief: understand the personal experience of the psychotic episode, attend to feelings of grief and the primary loss, explore the meaning of psychotic symptoms and identity implications, integrate psychotic vulnerabilities into the sense of self, and foster realistic hope in the face of an uncertain future. Conclusion: Psychotherapy can enable persons with psychosis to make meaning of their losses, process their grief, integrate their psychotic vulnerability into their sense of self, and develop realistic hope.

Nursing students' beliefs about mental health, interest in work, and job tendencies

PURPOSE

To explore nursing students' mental health educational level, mental illness beliefs, and interest in working in mental health.

DESIGN AND METHODS

Descriptive research conducted with 173 nursing students which convenience sampled. The questionnaire was composed of mental illness beliefs, interest in working in mental health, and tendency to work in nursing areas.

FINDINGS

Main finding demonstarted perception of dangerous from mental illness related to low interest in working in mental health regarding all nursing students.

PRACTICE IMPLICATIONS

There is a necessity to discuss mental health beliefs within theoretical and practical learning as it may eventually can contribute to the quality of care and improve the image of mental healthcare.

Accuracy of self-reported adherence and therapeutic drug monitoring in a psychiatric emergency ward

The aims of the study were: (1) the evaluation of the agreement between therapeutic drug monitoring (TDM) and a self-assessment of adherence to psychopharmacological treatments; (2) the identification of predictors of TDM results.Adherence in patients admitted into a psychiatric emergency service (PES) for a relapse of a schizophrenia spectrum disorder (SSD) or a bipolar disorder (BD; DSM-5) was assessed both directly with TDM and indirectly with a self-reported measure (Medication Adherence Report Scale -MARS- 10 items). The agreement between TDM and MARS was evaluated. Fifty-seven patients with SSD and 76 people with BD participated in the study. TDM was in range in about 50% of the global sample. No evidence of an association between MARS total scores and TDM results was found. Sensitivity, specificity, positive and negative predictive values of almost all MARS total scores were near to 50%. Smoking was strongly associated with a reduction of TDM results within the reference range. In the BD group, female sex was a predictor of TDM in range. In this clinical setting, self-assessment of adherence is neither reliable nor predictive. Furthermore, smoking is a strong predictor of poor adherence to psychopharmacological therapy.

Coping mechanisms used by the families of mental health care users in Mahikeng sub-district, North West province

BACKGROUND

Families of the mental health care users (MHCUs) face different challenges in dealing with, supporting and caring for MHCUs on a daily basis. The divergent coping mechanisms that the family members use aim to lower the negative, psychological and emotional impact of the stress. These include: escape, avoidance and denial.

AIM

To explore, describe and contextualise coping mechanisms used by the families of MHCUs and to suggest recommendations for improving their coping mechanisms in Mahikeng sub-district, North West province (NWP), South Africa.

SETTING

The study was conducted in three community health centres in Mahikeng sub-district, NWP, South Africa.

METHODS

A qualitative-exploratory-descriptive and contextual research design was used. Non-probability convenience and purposive sampling techniques were used to select participants. WhatsApp video calls were used to collect data which were analysed following Creswell's six steps of qualitative data analysis.

RESULTS

The study established three themes namely; challenges experienced by the family members, coping mechanism used by the family members, and suggestions for improvement in the coping mechanisms for the family members.

CONCLUSION

The findings of this study show that the family members of MHCUs are faced with different challenges. Some of the coping mechanisms used by the family members are insufficient and require improvement to enable them to cope effectively. When the coping mechanisms of the family members of MHCUs are improved, their well-being and that of the MHCUs might improve significantly.

CONTRIBUTION

The findings of this study provides information that may be used to improve the coping mechanisms of the families of MHCUs in the NWP, South Africa.