Factors influencing adherence to psychopharmacological medications in psychiatric patients: a structural equation modeling approach

Abstract

Purpose

To evaluate pathways through which sociodemographic, clinical, attitudinal, and perceived health control variables impact psychiatric patients’ adherence to psychopharmacological medications.

Method

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.

Results

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.

Conclusion

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.

Keywords:

• attitude to health
• medication adherence
• health behavior
• internal-external control
• model
• statistical
• psychiatry

Acknowledgments

The authors acknowledge Lorraine Maw, MA, at the Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA, who helped in editing this article.

Disclosure

No commercial organizations had any role in the completion or publication of this study. The authors report no conflicts of interest in this work.

Notes

a Vicariousness refers to qualities or scenarios wherein one’s experiences occur through another person. For further reading on this topic please see de Leon and De Las Cuevas.⁶⁴

Abbreviation: ADR, adverse drug reaction.