Rutgers University School of Social Work/Center for Education and Research on Mental Health Therapeutics, New Brunswick, NJ, USA.
J Child Psychol Psychiatry. 2009 Dec;50(12):1523-31. doi: 10.1111/j.1469-7610.2009.02113.x. Epub 2009 Jul 21.
Despite the effectiveness of psychotropic treatment for alleviating symptoms of psychiatric disorders, youth adherence to psychotropic medication regimens is low. Adolescent adherence rates range from 10-80% (Swanson, 2003; Cromer & Tarnowski, 1989; Lloyd et al., 1998; Brown, Borden, and Clingerman, 1985; Sleator, 1985) depending on the population and medication studied. Youth with serious mental illness face increased potential for substance abuse, legal problems, suicide attempts, and completed suicide (Birmaher & Axelson, 2006). Nonadherence may increase the potential for negative outcomes. The Drug Attitude Inventory (DAI) was created to measure attitudes toward neuroleptics and to predict adherence in adults (Hogan, Awad, & Eastwood, 1983). No studies have been identified that have used this instrument in adolescent psychiatric populations. The present study was undertaken to evaluate the utility of the DAI for measuring medication attitudes and predicting adherence in adolescents diagnosed with mental health disorders.
Structural equation modeling was used to compare the factor structure of the DAI in adults with its factor structure in adolescents. The relationship between adolescent DAI scores and adherence was examined also.
The adult factor structure demonstrated only "fair" fit to the adolescent data (RMSEA = .061). Results indicated a low, but significant positive correlation (r = .205, p < .05) between DAI scores and adherence.
Lack of optimal model fit suggests that DAI items may require alteration to reflect adolescent experiences with psychiatric medication more accurately. Differences between adolescents and adults in developmental stage, symptom chronicity, diagnosis, and medication class may explain why the adult model demonstrated only "fair fit" to the adolescent data and why the correlation between DAI scores and adherence was low. The DAI may be improved for use with adolescents by creating items reflecting autonomy concerns, diagnostic characteristics, treatment length, and side effect profiles relevant to adolescent experiences.
尽管精神药物治疗在缓解精神障碍症状方面非常有效，但青少年对精神药物治疗方案的依从性却很低。根据所研究的人群和药物，青少年的依从率在 10-80%之间不等（Swanson，2003；Cromer & Tarnowski，1989；Lloyd 等人，1998；Brown、Borden 和 Clingerman，1985；Sleator，1985）。患有严重精神疾病的青少年面临着更高的潜在药物滥用、法律问题、自杀企图和自杀成功的风险（Birmaher & Axelson，2006）。不依从可能会增加不良后果的风险。药物态度量表（DAI）是为了测量对神经阻滞剂的态度，并预测成人的依从性而创建的（Hogan、Awad 和 Eastwood，1983）。目前尚未发现有研究将该工具用于青少年精神科人群。本研究旨在评估 DAI 用于测量青少年精神障碍患者药物态度和预测依从性的效用。
使用结构方程模型比较了 DAI 在成人和青少年中的因子结构。还研究了青少年 DAI 评分与依从性之间的关系。
成人因子结构对青少年数据的拟合仅为“一般”（RMSEA =.061）。结果表明，DAI 评分与依从性之间存在低但显著的正相关（r =.205，p <.05）。
模型拟合不佳表明，DAI 项目可能需要改变，以更准确地反映青少年的精神药物治疗体验。青少年和成人在发育阶段、症状持续性、诊断和药物类别方面的差异可能解释了为什么成人模型对青少年数据的拟合仅为“一般”，以及为什么 DAI 评分与依从性之间的相关性较低。通过创建反映自主性问题、诊断特征、治疗时间和与青少年经验相关的副作用特征的项目，DAI 可以得到改进，以便在青少年中使用。
