Sapra Mamta, Vahia Ipsit V, Reyes Pia N, Ramirez Paul, Cohen Carl I
Department of Psychiatry, Salem Veteran Affairs Medical Center, 1970 Roanoke Blvd, Salem, VA 24153, United States.
Schizophr Res. 2008 Dec;106(2-3):348-55. doi: 10.1016/j.schres.2008.09.004. Epub 2008 Oct 11.
There are limited data examining subjective influences on medication adherence among older persons with schizophrenia. The subjective reasons for adherence to antipsychotic medication and associated clinical and psychosocial factors in this population are examined.
The sample consisted of 198 community dwelling persons aged >or=55 who developed schizophrenia before age 45. Using the Rating of Medication Influences Scale (ROMI), a principal component factor analysis with varimax rotation yielded three subscales: Medication Affinity and Prevention, Influence of Others, and Impact of Authority. These subscales were dichotomized into high and low based on a median split. We also created an ordinal High Adherence measure based on the summed scores of each person's three dichotomized ROMI subscales. A modified Health Belief Model was used to examine the association between 18 predictor variables and the ROMI subscales and the adherence scale.
The mean subscale rankings were Medication Affinity and Prevention > Impact of Authority > Influence of Others. In logistic regression, lower education, more side effects, higher depression scores, and more mental health services were associated with higher scores on Influence of Others subscale. More side effects and more entitlements were associated with higher scores on the Medication Affinity and Prevention subscale. The Impact of Authority subscale had no significant associations. More side effects and higher depression scores were associated with higher scores on High Adherence measure.
We identified a three-dimensional model for explaining the subjective reasons for medication adherence in older persons with schizophrenia. Our findings suggest that cognitive approaches and use of authority figures may be useful for promoting adherence in older adults. Independent variables associated with these subscales may provide guidance for improving adherence in this population.
关于主观因素对老年精神分裂症患者药物依从性影响的数据有限。本文对该人群中坚持服用抗精神病药物的主观原因以及相关的临床和社会心理因素进行了研究。
样本包括198名年龄≥55岁、45岁之前患精神分裂症的社区居民。使用药物影响评定量表（ROMI），通过主成分因子分析和方差最大化旋转得出三个子量表：药物亲和力与预防、他人影响、权威影响。根据中位数分割将这些子量表分为高分组和低分组。我们还根据每个人三个二分的ROMI子量表的总分创建了一个有序的高依从性测量指标。采用修正的健康信念模型来检验18个预测变量与ROMI子量表及依从性量表之间的关联。
子量表的平均排名为：药物亲和力与预防＞权威影响＞他人影响。在逻辑回归分析中，受教育程度较低、副作用较多、抑郁得分较高以及接受的心理健康服务较多与他人影响子量表得分较高相关。副作用较多和权益较多与药物亲和力与预防子量表得分较高相关。权威影响子量表无显著关联。副作用较多和抑郁得分较高与高依从性测量指标得分较高相关。
我们确定了一个三维模型来解释老年精神分裂症患者药物依从性的主观原因。我们的研究结果表明，认知方法和权威人物的运用可能有助于提高老年人的依从性。与这些子量表相关的自变量可能为改善该人群的依从性提供指导。
