De Las Cuevas Carlos, de Leon Jose, Peñate Wenceslao, Betancort Moisés
Departamento de Medicina Interna, Dermatología y Psiquiatría, Universidad de La Laguna, Canary Islands, Spain.
Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA; Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain; Biomedical Research Center in Mental Health Net (CIBERSAM), Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain.
Patient Prefer Adherence. 2017 Mar 28;11:681-690. doi: 10.2147/PPA.S133513. eCollection 2017.
To evaluate pathways through which sociodemographic, clinical, attitudinal, and perceived health control variables impact psychiatric patients' adherence to psychopharmacological medications.
A sample of 966 consecutive psychiatric outpatients was studied. The variables were sociodemographic (age, gender, and education), clinical (diagnoses, drug treatment, and treatment duration), attitudinal (attitudes toward psychopharmacological medication and preferences regarding participation in decision-making), perception of control over health (health locus of control, self-efficacy, and psychological reactance), and level of adherence to psychopharmacological medications. Structural equation modeling was applied to examine the nonstraightforward relationships and the interactive effects among the analyzed variables.
Structural equation modeling demonstrated that psychiatric patients' treatment adherence was associated: 1) negatively with cognitive psychological reactance (adherence decreased as cognitive psychological reactance increased), 2) positively with patients' trust in their psychiatrists (doctors' subscale), 3) negatively with patients' belief that they are in control of their mental health and that their mental health depends on their own actions (internal subscale), and 4) positively (although weakly) with age. Self-efficacy indirectly influenced treatment adherence through internal health locus of control.
This study provides support for the hypothesis that perceived health control variables play a relevant role in psychiatric patients' adherence to psychopharmacological medications. The findings highlight the importance of considering prospective studies of patients' psychological reactance and health locus of control as they may be clinically relevant factors contributing to adherence to psychopharmacological medications.
评估社会人口统计学、临床、态度及感知健康控制变量影响精神科患者坚持服用精神药物的途径。
对966名连续就诊的精神科门诊患者进行了研究。变量包括社会人口统计学（年龄、性别和教育程度）、临床（诊断、药物治疗和治疗持续时间）、态度（对精神药物的态度以及参与决策的偏好）、对健康的控制感（健康控制点、自我效能感和心理抵触）以及精神药物的坚持服用水平。应用结构方程模型来检验分析变量之间的非直接关系和交互作用。
结构方程模型表明，精神科患者的治疗依从性与以下因素相关：1）与认知心理抵触呈负相关（随着认知心理抵触增加，依从性降低）；2）与患者对精神科医生的信任（医生分量表）呈正相关；3）与患者认为自己能控制自己的心理健康且心理健康取决于自身行为的信念（内控分量表）呈负相关；4）与年龄呈正相关（尽管较弱）。自我效能感通过内控健康控制点间接影响治疗依从性。
本研究为以下假设提供了支持，即感知健康控制变量在精神科患者坚持服用精神药物方面发挥着相关作用。研究结果强调了考虑对患者心理抵触和健康控制点进行前瞻性研究的重要性，因为它们可能是影响精神药物依从性的临床相关因素。
