Treatment adherence to psychotropic drugs among non-Western migrants: a systematic review

Abstract

Background

Low medication adherence is a significant challenge in all medical fields and particularly in mental health treatment, where a lack of insight into one’s own disease can repress the ability to adhere. In recent years, the increase in migration combined with a high prevalence of mental illnesses among migrants and the possible consequences of nonadherence, point towards the need for a focus on adherence with psychotropic drugs among migrants.

Aim

To review current literature, exploring the potential impact of being a migrant from a non-Western country living in a Western country on the level of adherence to psychotropic medication and subsequently to discuss these findings.

Methods

A systematic review of studies investigating adherence among non-western migrants was conducted. The literature search was conducted using PubMed and Embase databases in October 2020.

Results

Seven observational studies were included, all ranging from moderate to high-quality. Six out of seven studies found an association between being a non-Western migrant in a Western country and low adherence to psychotropic drugs.

Conclusion

Studies indicate an association between being a non-Western migrant in a Western country and low adherence to psychotropic drugs. None of the included studies investigated possible causes of the low adherence in migrants. Communication difficulties are, however, considered possible barriers to healthcare access and a contributing factor to nonadherence. There is a need for studies assessing the possible impact of interventions aiming at increasing adherence such as intercultural mediators and training of healthcare providers in cultural competencies.

Keywords:

• Migrants
• adherence
• mental illness
• access
• psychotropic

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Additional information

Notes on contributors

Maria Sacha

Maria Sacha, MD at the at Competence Centre for Transcultural Psychiatry, Mental Health Services in the Capital Region of Denmark.

Hinuga Sandahl

Hinuga Sandahl, MD, PhD, researcher at the Competence Centre for Transcultural Psychiatry, Mental Health Services in the Capital Region of Denmark. Dr Sandahl’s research areas are mental health, migration, trauma, sleep disturbances and mental health service research and disparities in service delivery.

Line Harck

Line Harck, MD at the at Competence Centre for Transcultural Psychiatry, Mental Health Services in the Capital Region of Denmark.

Jessica Carlsson

Jessica Carlsson, MD, PhD, is the head of research at the Competence Centre for Transcultural Psychiatry and associate professor at the Medical Faculty, University of Copenhagen. Dr Carlsson’s research areas are transcultural psychiatry, migration, mental health and trauma in refugee populations.