Sajatovic Martha, Micula-Gondek Weronika, Tatsuoka Curtis, Bialko Christopher
Department of Psychiatry and Department of Neurology, Neurological Outcomes Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Gend Med. 2011 Aug;8(4):261-8. doi: 10.1016/j.genm.2011.06.002. Epub 2011 Jul 16.
It has been demonstrated that 46% to 48% of individuals with bipolar disorder (BD) are at least partially nonadherent with prescribed medication. Reports of whether male gender is a predictor of treatment nonadherence in BD have been inconsistent. The construct of gender may also be a matter of cultural orientation, and psychological gender, as a component of self-perception, may affect the experience of mental illness. Gender identity is the subjective experience of one's individuality as male or female.
This cross-sectional study evaluated gender and gender identity among men and women with BD as they relate to self-reported medication treatment adherence.
This secondary analysis of a larger study on treatment adherence evaluated men and women with BD being treated with mood-stabilizing medications in a community mental health clinic. Gender identity and treatment adherence were evaluated using the Bem Sex Role Inventory (BSRI) and the Tablets Routine Questionnaire, respectively. Other measures included assessing BD symptoms using the Hamilton Depression Rating Scale and mania symptoms using the Young Mania Rating Scale, as well as psychosocial support with the Interpersonal Support Evaluation List and locus of control with the Multidimensional Health Locus of Control Scale.
Mean age of the 70 men and 70 women with type I BD was 43.1 years for adherent patients and 40.8 years for nonadherent patients. Women with BD had mean scores on the BSRI consistent with general population norms, whereas men with BD had scores suggesting lower levels of self-perceived masculinity than population norms. There were no differences between men and women on adherence; however, men with high BSRI masculinity scores had less adherence than other men in the sample (P = 0.04). Lower scores on the "powerful others" dimension of locus of control were associated with lower adherence. For women, there was no relationship between BSRI masculinity scores and adherence.
Gender identity in men with BD differed from general population norms and appeared to be related to adherence. Treatment approaches that are intended to optimize adherence need to consider the construct of gender identity or gender role. ClinicalTrials.gov ID: NCT00183495.
已有研究表明，46%至48%的双相情感障碍（BD）患者至少部分未遵医嘱服药。关于男性是否是BD治疗不依从的预测因素的报道并不一致。性别的概念也可能是文化取向的问题，而心理性别作为自我认知的一个组成部分，可能会影响精神疾病的体验。性别认同是个体对自身为男性或女性的主观体验。
这项横断面研究评估了BD男性和女性的性别及性别认同与自我报告的药物治疗依从性之间的关系。
这项对一项关于治疗依从性的大型研究的二次分析，评估了在社区心理健康诊所接受心境稳定剂治疗的BD男性和女性。分别使用贝姆性别角色量表（BSRI）和片剂常规问卷评估性别认同和治疗依从性。其他测量包括使用汉密尔顿抑郁量表评估BD症状，使用杨氏躁狂量表评估躁狂症状，以及使用人际支持评估列表评估社会心理支持，使用多维健康控制点量表评估控制点。
70名I型BD男性和70名女性中，依从患者的平均年龄为43.1岁，不依从患者为40.8岁。BD女性在BSRI上的平均得分与一般人群规范一致，而BD男性的得分表明其自我感知的男性气质水平低于人群规范。男性和女性在依从性上没有差异；然而，在样本中，BSRI男性气质得分高的男性比其他男性的依从性更低（P = 0.04）。控制点“有势力的他人”维度得分较低与依从性较低相关。对于女性，BSRI男性气质得分与依从性之间没有关系。
BD男性的性别认同与一般人群规范不同，且似乎与依从性有关。旨在优化依从性的治疗方法需要考虑性别认同或性别角色的概念。ClinicalTrials.gov标识符：NCT00183495。
