A Systematic Review and Meta-Analysis of the Effectiveness of Adherence Therapy and Its Treatment Duration in Patients with Schizophrenia Spectrum Disorders

Figures & data

Figure 1 Results of the search and screening process.

Notes: PRISMA figure adapted from Liberati A, Altman D, Tetzlaff J et al. The PRISMA statement for systematic review and meta-analysis of studies that evaluate health care intervention: explanation and elaboration. Journal of Clinical Epidemiology. 2009; 62(10). Creative Commons.²¹

Figure 2 Risk of bias in each of the five studies.^17,24–27

Figure 3 Overall risk assessment of the five studies.

Table 1 Summary of the Five Selected Studies

Author/Year	Participants/Location	Interventions	Number and Duration of AT Sessions	Follow Up	Outcome Measures	Results
Chien et al, 2019^Citation24	Schizophrenia spectrum disorders (N = 134; E = 67, C = 67)/ Hong Kong	E: AT + TAU C: TAU (mental health assessment, administrationof medications and brief education (2 h every 3–4 weeks) by CPNs, psychiatric consultations by psychiatrist, and referrals to community care and welfare services by psychiatrist/medical social worker)	6 sessions, each time 2 h /2 weeks	T0: baseline T1: at 1 week T2: after 6 months T3: after 12 months	Psychiatric symptoms (PANSS) adherence attitudes (ITAQ) adherence behaviors (ARS)	AT resulted in significantly improved insight, psychosocial functioning, symptom severity, medication adherence, and number of rehospitalization relative to usual care
Gray et al, 2006^Citation17	Schizophrenia spectrum disorders (N = 371; E = 175, C = 196)/ Netherlands, Germany, England, and Italy	E: AT + TAU C: Health education + TAU (regular contact with psychiatrists and case managers, pharmacological therapy and the availability of daycare, social support, acute hospital admission as required, health education on diet, and healthy lifestyle)	8 sessions 30–50 min each time, mean duration 36 min	T0: baseline T1: 52 weeks	Psychiatric symptoms (BPRS) adherence attitudes (SAI-C) adherence behaviors (MAQ)	No significant effect on the quality of life, insight, medication adherence, or psychiatric symptoms
Maneesakorn et al, 2007^Citation25	Schizophrenia (N = 28; E = 14, C = 14)/ Thailand	E: AT + TAU C: TAU (standard care, including medication treatment, occupational therapy, group counseling, and recreational therapy)	8 sessions 15–60 min each time, mean duration 43.68 min	T0: baseline T1: 9 weeks	Psychiatric symptoms (PANSS) adherence attitudes (DAI-30)	AT resulted in significant improvements in psychiatric symptoms, attitude toward medication, and satisfaction with medication
Schulz et al, 2013^Citation26	Schizophrenia (N = 123; E = 72, C = 51)/ Germany and Switzerland	E: AT + TAU C: TAU (medication, psychotherapy, and occupational therapy; psycho-educational programs included information and advice about medication and side effects)	8 sessions mean duration 42 min (5 inpatient sessions plus 3 home-based sessions)	T0: baseline T1: 12 weeks	Psychiatric symptoms (PANSS) adherence attitudes (DAI-30) adherence behaviors (CDR, MARS)	No effect on beliefs about treatment or global functioning. Significant improvement in psychiatric symptoms
Von Bormann et al, 2015^Citation27	Schizophrenia (N = 70; E = 38, C = 32)/ Thailand	E: AT + TAU C: TAU (medication, vocational and recreational therapy, and outreach community psychiatric support)	8 sessions mean duration 41 min	T0: baseline T1: 26 weeks	Psychiatric symptoms (PANSS) adherence attitudes (DAI-30)	AT significantly improved psychopathology, but had no significant effect on treatment attitudes, functioning, or side effects

Abbreviations: E, experimental group; C, control group; AT, adherence therapy; TAU, treatment as usual; PANSS, positive and negative syndrome scale; ITAQ, insight and treatment attitude questionnaire; ARS, adherence rating scale; BPRS: brief psychiatric rating scale; SAI-C, schedule for the assessment of insight – compliance; MAQ, medication adherence questionnaire; DAI-30, drug attitude inventory; CDR, concentration to dose ratio; MARS, medication adherence rating scale.

Figure 4 The effects of AT and TAU on psychiatric symptoms.^17,24–27

Figure 5 The effects of AT and TAU on medication adherence attitudes.^17,24–27

Figure 6 The effects of AT and TAU on medication adherence behaviors.^17,24,26

Figure 7 Subgroup analysis by intervention duration.^17,24,26

Liberati A, Altman D, Tetzlaff J, et al. The PRISMA statement for systematic review and meta-analysis of studies that evaluate health care intervention: explanation and elaboration. J Clin Epidemiol. 2009;62:10. doi:10.1016/j.jclinepi.2009.06.006

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Schulz M, Gray R, Spiekermann A, Abderhalden C, Behrens J, Driessen M. Adherence therapy following an acute episode of schizophrenia: a multi-centre randomised controlled trial. Schizophr Res. 2013;146(1–3):59–63. doi:10.1016/j.schres.2013.01.028

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von Bormann S, Robson D, Gray R. Adherence therapy following acute exacerbation of schizophrenia: a randomised controlled trial in Thailand. Int J Soc Psychiatry. 2015;61(1):3–9. doi:10.1177/0020764014529099

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