Sajatovic Martha, Biswas Kousick, Kilbourne Amy K, Fenn Howard, Williford William, Bauer Mark S
Department of Psychiatry, Case Western Reserve University, Cleveland, OH 44106-5000, USA.
Psychiatr Serv. 2008 Jul;59(7):753-9. doi: 10.1176/ps.2008.59.7.753.
Clinical characteristics, adverse effects of medication, and treatment attitudes have been associated with adherence in bipolar populations in cross-sectional studies. The aim of this secondary analysis from a larger study was to identify the association between baseline variables and average treatment adherence over a subsequent three-year period.
Veterans with bipolar disorder were evaluated on self-reported adherence status at baseline and every six months over a three-year period. The sample was dichotomized into two clinically relevant categories: those who were primarily adherent and those who were primarily nonadherent. Demographic and clinical variables were examined for the two groups of patients in relation to their average adherence over the three-year period.
The study recruited a sample of 306 persons with severe bipolar disorder. The sample was predominantly male (278 men, or 91%), with a mean+/-SD age of 46.6+/-10.1 years. A total of 240 individuals (78%) were largely adherent to treatment, and 37 individuals (12%) were largely nonadherent to treatment. Nonadherent individuals were less likely to be on intensive somatotherapy regimens (p=.001); experienced more barriers to care, including lack of telephone access (p<.05) and life obligations and commitments (p<.05); and had more prior suicide attempts (p=.003).
Nonadherent individuals with bipolar disorder received less intensive pharmacologic treatments, had more suicide attempts, and experienced more barriers to care than adherent individuals. Nonadherence may have system as well as patient components. Consideration of nonadherence as a function of both patient factors and system factors will enhance our ability to understand nonadherence and intervene more effectively.
在横断面研究中，临床特征、药物不良反应以及治疗态度与双相情感障碍人群的治疗依从性相关。这项来自一项更大规模研究的二次分析的目的是确定基线变量与随后三年期间的平均治疗依从性之间的关联。
对患有双相情感障碍的退伍军人在基线时以及三年期间每六个月进行一次自我报告的依从性状态评估。样本被分为两个具有临床相关性的类别：主要依从者和主要不依从者。检查了两组患者的人口统计学和临床变量与其三年期间的平均依从性之间的关系。
该研究招募了306名患有重度双相情感障碍的样本。样本以男性为主（278名男性，占91%），平均年龄为46.6±10.1岁。共有240人（78%）在很大程度上坚持治疗，37人（12%）在很大程度上不坚持治疗。不依从的个体接受强化躯体治疗方案的可能性较小（p = 0.001）；经历了更多的就医障碍，包括无法使用电话（p < 0.05）以及生活责任和承诺（p < 0.05）；并且有更多的既往自杀未遂经历（p = 0.003）。
与依从的个体相比，双相情感障碍不依从的个体接受的强化药物治疗较少，有更多的自杀未遂经历，并且经历了更多的就医障碍。不依从可能既有系统因素也有患者因素。将不依从视为患者因素和系统因素共同作用的结果，将提高我们理解不依从并更有效干预的能力。
