美国拉丁裔人群中精神药物治疗的不依从性：一项综合文献综述。
Psychotropic medication nonadherence among United States Latinos: a comprehensive literature review.
作者信息
Lanouette Nicole M, Folsom David P, Sciolla Andres, Jeste Dilip V
机构信息
Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr., 9116A-13, La Jolla, CA 92093, USA.
出版信息
Psychiatr Serv. 2009 Feb;60(2):157-74. doi: 10.1176/appi.ps.60.2.157.
OBJECTIVE
Psychotropic medication nonadherence is a major public health problem, but few studies have focused on Latinos. The authors systematically reviewed the literature on rates of and factors influencing antipsychotic, antidepressant, and mood stabilizer nonadherence among U.S. Latinos.
METHODS
MEDLINE and PsycINFO were searched by using the keywords adherence, compliance, Latino, Hispanic, psychotropic, and related terms; bibliographies from relevant reviews and studies were also searched. Twenty-one studies met inclusion criteria: published since 1980 in English or Spanish and measured psychotropic medication nonadherence rates among U.S. Latino adults. Information was extracted about study design and objective, location, population, medication type, participant demographic characteristics, adherence measures, adherence rates, and factors related to adherence.
RESULTS
In the 17 studies that included Latinos and other minority groups, mean nonadherence rates were 41%, 31%, and 43%, respectively, among Latinos, Euro-Americans, and African Americans, with an overall effect size of .64 between Latinos and Euro-Americans. In the four studies that included only Latinos, the mean nonadherence rate was 44%. Ten of 16 studies found that Latinos had significantly lower adherence rates than Euro-Americans. Risk factors for nonadherence included being a monolingual Spanish speaker, lacking health insurance, experiencing access barriers to high-quality care, and having lower socioeconomic status. Protective factors included family support and psychotherapy.
CONCLUSIONS
Rates of nonadherence to psychotropic medications were found to be higher for Latinos than for Euro-Americans. Further investigation is needed to understand the potentially modifiable individual and society-level mechanisms of this discrepancy. Clinical and research interventions to improve adherence should be culturally appropriate and incorporate identified factors.
目的
精神药物治疗的不依从是一个重大的公共卫生问题，但很少有研究关注拉丁裔群体。作者系统回顾了关于美国拉丁裔群体中抗精神病药、抗抑郁药和心境稳定剂不依从率及影响因素的文献。
方法
使用关键词依从性、顺应性、拉丁裔、西班牙裔、精神药物及相关术语检索MEDLINE和PsycINFO数据库；还检索了相关综述和研究的参考文献。21项研究符合纳入标准：1980年以来以英文或西班牙文发表，且测量了美国拉丁裔成年人群体中精神药物治疗的不依从率。提取了有关研究设计与目的、地点、人群、药物类型、参与者人口统计学特征、依从性测量方法、依从率以及与依从性相关因素的信息。
结果
在17项纳入拉丁裔和其他少数群体的研究中，拉丁裔、欧裔美国人和非裔美国人的平均不依从率分别为41%、31%和43%，拉丁裔和欧裔美国人之间的总体效应量为0.64。在4项仅纳入拉丁裔的研究中，平均不依从率为44%。16项研究中有10项发现拉丁裔的依从率显著低于欧裔美国人。不依从的风险因素包括只会说西班牙语、没有医疗保险、获得高质量医疗服务存在障碍以及社会经济地位较低。保护因素包括家庭支持和心理治疗。
结论
研究发现拉丁裔精神药物治疗的不依从率高于欧裔美国人。需要进一步调查以了解这种差异潜在的可改变的个体和社会层面机制。改善依从性的临床和研究干预措施应符合文化背景并纳入已确定的因素。
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