Study on covert administration of medications practices among persons with severe mental illness: A cross-sectional study.

BACKGROUND

Covert administration of medication (CoAdM) by caregivers to persons with severe mental illness (SMI) is a commonly observed medication delivery practice in India.

AIMS

This study aims to examine different medication delivery practices adopted by caregivers to provide care to SMI at times of medication refusal.

METHOD

This study was conducted at the outpatient department between April 2019 and November 2019. A semi-structured questionnaire was used to interview the caregivers of persons with SMI to assess medication delivery practices.

RESULTS

A total of 300 caregivers were interviewed. CoAdM was practiced in 96 (32.0%) persons with SMI at least once during their lifetime, and other strategies used were pleading ( = 105, 35.0%), lying ( = 10, 3.3%), and threatening ( = 154, 51.4%). Logistic regression showed that male gender (OR 4.75; CI 1.37-16.46), absent insight (OR 10.0; CI 2.01-47.56), and poor adherence to medication (OR 4.75; CI 1.31-16.92) were significantly associated with CoAdM in the last 1 year. Caregivers perceived significant improvement in self-care ( = -4.37,  < .01), interpersonal ( = -7.61,  < .01), work ( = -5.9,  < .01), family functioning ( = -7.82,  < .01) difficult behavior ( = -8.27,  < .01), and dependency ( = -6.34,  < .01) in persons with SMI with use of CoAdM.

CONCLUSIONS

CoAdM was given to one in three persons with SMI at some point in their lives. Male gender, absent insight and poor adherence were predictive of CoAdM in the last 1 year. Caregiver perceived improvements in self-care, work, interpersonal, family functioning, problem behaviors, and dependency after CoAdM. Policies need to be evolved to serve all stakeholders while keeping these practices in mind.