Hamrin Vanya, Iennaco Joanne DeSanto
1 Department of Psychiatry, Vanderbilt University , Nashville, Tennessee.
2 School of Nursing, Vanderbilt University , Nashville, Tennessee.
J Child Adolesc Psychopharmacol. 2017 Mar;27(2):148-159. doi: 10.1089/cap.2015.0187. Epub 2016 Aug 3.
Medication adherence rates in adolescents are poor. The World Health Organization identified that those at greatest risk were nonwhite adolescents with depression. Medication nonadherence results in poorer mental health outcomes.
The first aim of the study was to investigate if two motivational interviewing (MI) sessions would improve medication adherence in adolescents taking antidepressants and mood stabilizers. The second aim was to evaluate if attitudes toward medication correlated with adherence. The third aim was to determine if self-reported adherence scores were similar to electronic adherence data collected.
The quasi-experimental study contained an MI intervention, including a baseline and postintervention assessment of adherence over 30 days. A total of 48 adolescents, ranging in age from 12 to 18 years, were recruited from a university mental health center to participate in the study; 41 completed the study. Four nurse practitioners and two child psychiatrists mastered the MI techniques evaluated with standardized measures. The Medication Electronic Monitoring System (MEMS) was the primary measure of medication adherence. The Drug Attitude Inventory (DAI) was used as a secondary measure. Finally, participants completed the client evaluation of MI and a satisfaction survey of MI.
At endpoint, 70.7% of the participants were taking their medications between 80% and 100% of the time, as measured over 30 days, compared with 43.9% of participants at baseline. Mean adherence scores significantly improved by 17% after two MI sessions. Mean baseline adherence scores were 63.7%, whereas mean endpoint adherence scores were 80.6% (p < 0.0001). The effect size was 0.65, demonstrating moderate effect. Participants (n = 29) who demonstrated 80% or greater adherence had DAI mean scores of 16.48, whereas those below 80% had a DAI mean of 15.5 (p = 0.73), demonstrating no significant difference on drug attitudes between the two groups at endpoint. DAI baseline mean scores were 14.2, whereas endpoint mean scores were 16.2. There was a significant difference between self-rated adherence and objective data collected from the MEMS caps as participants over-reported medication adherence by an average of 18.4% at baseline (t = 6.84, df = 40, p < 0.001). Participants reported a high degree of satisfaction with MI.
MI is a promising intervention for adolescents to improve psychotropic medication adherence.
青少年的药物治疗依从率较低。世界卫生组织指出，风险最高的是患有抑郁症的非白人青少年。药物治疗不依从会导致更差的心理健康结果。
该研究的首要目的是调查两次动机性访谈（MI）是否能提高服用抗抑郁药和情绪稳定剂的青少年的药物治疗依从性。第二个目的是评估对药物的态度与依从性是否相关。第三个目的是确定自我报告的依从性评分是否与收集的电子依从性数据相似。
这项准实验研究包含一次MI干预，包括对30天内依从性的基线和干预后评估。从一所大学心理健康中心招募了48名年龄在12至18岁之间的青少年参与该研究；41人完成了研究。四名执业护士和两名儿童精神科医生掌握了用标准化测量方法评估的MI技术。药物电子监测系统（MEMS）是药物治疗依从性的主要测量方法。药物态度量表（DAI）用作次要测量方法。最后，参与者完成了对MI的客户评估和对MI的满意度调查。
在研究终点，在30天的测量期内，70.7%的参与者服药时间达到80%至100%，而基线时这一比例为43.9%。经过两次MI访谈后，平均依从性评分显著提高了17%。基线平均依从性评分为63.7%，而终点平均依从性评分为80.6%（p < 0.0001）。效应大小为0.65，表明有中度效果。依从性达到80%或更高的参与者（n = 29）的DAI平均评分为16.48，而低于80%的参与者的DAI平均评分为15.5（p = 0.73），表明在研究终点两组之间在药物态度上无显著差异。DAI基线平均评分为14.2，而终点平均评分为16.2。自我报告的依从性与从MEMS瓶盖收集的客观数据之间存在显著差异，因为参与者在基线时平均多报了18.4%的药物治疗依从性（t = 6.84，自由度 = 40，p < 0.001）。参与者对MI表示高度满意。
MI是一种有前景的干预措施，可提高青少年对精神药物的依从性。
