Salazar Luke Joshua, Srinivasan Krishnamachari, Heylen Elsa, Ekstrand Maria L
Dept. of Psychiatry, St. John's Medical College, Sarjapur Road, Bengaluru, Karnataka, India.
Division of Mental Health and Neurosciences, St. John's Research Institute, Bengaluru, Karnataka, India.
Indian J Psychol Med. 2023 Nov;45(6):622-628. doi: 10.1177/02537176231173869. Epub 2023 Jun 30.
Only a few studies have explored the relationship between psychosocial factors and medication adherence in Indian patients with noncommunicable diseases (NCDs). We aimed to examine the association of psychosocial variables with medication adherence in people with NCDs and comorbid common mental disorders (CMDs) from primary care in rural southern India.
We performed a secondary analysis using baseline data from a randomized controlled trial in 49 primary care health centers in rural southern India (HOPE study). Participants were adults (≥30 years) with NCDs that included hypertension, diabetes, and/or ischemic heart disease, and comorbid depression or anxiety disorders. Medication adherence was assessed by asking participants if they had missed any prescribed NCD medication in the past month. Data were collected between May 2015 and November 2018. The association between psychosocial and demographic variables and medication nonadherence were assessed via logistic regression analyses.
Of the 2486 participants enrolled, almost one-fifth (18.06%) reported missing medication. Male sex (OR = 1.74, 95% CI 1.37-2.22) and higher internalized mental illness stigma (OR = 1.46, 95% CI 1.07-2.00) were associated with higher odds of missing medication. Older age (OR = 0.40, 95% CI 0.26-0.60, for participants aged 64-75 years vs 30-44 years), reporting more social support (OR = 0.65, 95% CI 0.49-0.86), and higher satisfaction with health (OR = 0.74, 95% CI 0.61-0.89) were associated with lower odds of missing medication.
Greater internalized mental illness stigma and less social support are significantly associated with lower rates of medication adherence in patients with NCDs and comorbid CMDs in rural India.
仅有少数研究探讨了印度非传染性疾病（NCD）患者心理社会因素与药物依从性之间的关系。我们旨在研究印度南部农村地区基层医疗中，非传染性疾病患者及合并常见精神障碍（CMD）患者的心理社会变量与药物依从性之间的关联。
我们利用印度南部农村49个基层医疗健康中心的一项随机对照试验的基线数据进行了二次分析（HOPE研究）。参与者为患有非传染性疾病（包括高血压、糖尿病和/或缺血性心脏病）且合并抑郁或焦虑症的成年人（≥30岁）。通过询问参与者过去一个月是否漏服过任何非传染性疾病的处方药物来评估药物依从性。数据收集时间为2015年5月至2018年11月。通过逻辑回归分析评估心理社会和人口统计学变量与药物不依从之间的关联。
在纳入的2486名参与者中，近五分之一（18.06%）报告漏服过药物。男性（OR = 1.74，95% CI 1.37 - 2.22）和较高的内化精神疾病耻辱感（OR = 1.46，95% CI 1.07 - 2.00）与漏服药物的较高几率相关。年龄较大（64 - 75岁参与者与30 - 44岁参与者相比，OR = 0.40，95% CI 0.26 - 0.60）、报告有更多社会支持（OR = 0.65，95% CI 0.49 - 0.86）以及对健康的满意度较高（OR = 0.74，95% CI 0.61 - 0.89）与漏服药物的较低几率相关。
在印度农村地区，较高的内化精神疾病耻辱感和较少的社会支持与非传染性疾病合并常见精神障碍患者较低的药物依从率显著相关。
