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A patient perspective of the impact of medication side effects on adherence: results of a cross-sectional nationwide survey of patients with schizophrenia
Open accessAbstract
BACKGROUND: Antipsychotic medications often have a variety of side effects, however, it is not well understood how the presence of specific side effects correlate with adherence in a real-world setting. The aim of the current study was to examine the relationship between these variables among community-dwelling patients with schizophrenia. METHODS: Data were analyzed from a 2007-2008 nationwide survey of adults who self-reported a diagnosis of schizophrenia and were currently using an antipsychotic medication (N = 876). The presence of side effects was defined as those in which the patient reported they were at least "somewhat bothered". Adherence was defined as a score of zero on the Morisky Medication Adherence Scale. To assess the relationship between side effects and adherence, individual logistic regression models were fitted for each side effect controlling for patient characteristics. A single logistic regression model assessed the relationship between side effect clusters and adherence. The relationships between adherence and health resource use were also examined. RESULTS: A majority of patients reported experiencing at least one side effect due to their medication (86.19%). Only 42.5% reported complete adherence. Most side effects were associated with a significantly reduced likelihood of adherence. When grouped as side effect clusters in a single model, extra pyramidal symptoms (EPS)/agitation (odds ratio (OR) = 0.57, p = 0.0007), sedation/cognition (OR = 0.70, p = 0.033), prolactin/endocrine (OR = 0.69, p = 0.0342), and metabolic side effects (OR = 0.64, p = 0.0079) were all significantly related with lower rates of adherence. Those who reported complete adherence to their medication were significantly less likely to report a hospitalization for a mental health reason (OR = 0.51, p = 0.0006), a hospitalization for a non-mental health reason (OR = 0.43, p = 0.0002), and an emergency room (ER) visit for a mental health reason (OR = 0.60, p = 0.008). CONCLUSIONS: Among patients with schizophrenia, medication side effects are highly prevalent and significantly associated with medication nonadherence. Nonadherence is significantly associated with increased healthcare resource use. Prevention, identification, and effective management of medication-induced side effects are important to maximize adherence and reduce health resource use in schizophrenia.
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“In seven studies, patients feeling dizziness, fatigue, tiredness, sedation, lethargy, and sleepiness were the most frequently reported side-effects that contributed to medication non-adherence [11, 33, 36, 37, 50, 52, 65].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [33]
In the citing paper
“Likewise, in five studies, weight gain was another medication-related side-effect that associated with medication non-adherence and patients’ perception toward their medication [25, 33, 36, 44, 55].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [33]
In the citing paper
“In two studies, side-effects such as decreased sexual interest and having a symptom of sexual dysfunction were associated with patients’ medication adherence [33, 36].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [33]
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“Sexual dysfunction can negatively impact a patient’s quality of life and potentially lead to treatment nonadherence (Bebbington et al., 2009; Dibonaventura et al., 2012; Kelly et al., 2018; Mir et al., 2008).”
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“Medication side-effects are common (1) and distressing for patients, leading to decreased quality of life (2) and reduced adherence (3, 4).”
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“Archives of Psychiatry and Psychotherapy, 2015; 4: 39–47 to predict antipsychotic medication adherence are illness insight [4, 7], the severity of psychopathology [7], cognitive impairments [8], attitudes toward medication [4, 9], substance abuse [2], antipsychotic side-effects [10] and the quality of the therapeutic…”
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“Research shows that yoga therapy is an effective treatment for GAD.”
BackgroundInfluentialLi, X., Langleben, D. D., Lynch, K. G., Wang, G., Elman, I., Wiers, C. E., & Shi, Z. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1247961 · Cited by 7
“These effects may contribute to the high rates (22, 23) of treatment non-adherence with the OUD medication-assisted treatment (MAT) involving opioid agonists such as buprenorphine and methadone (24, 25), which, despite their positive clinical outcomes in terms of reducing overdose mortality, infectious diseases, crime…”
BackgroundMorris, A., Reed, T., McBride, G., & Chen, J. (2024) · Schizophrenia Research · doi:10.1016/j.schres.2024.06.056 · Cited by 7
“This is of concern because consumers with schizophrenia and MetS have a higher likelihood of poorer compliance with antipsychotic medication and experience greater severity of psychotic symptoms and illness recurrence rates (Godin et al., 2018; Dibonaventura et al., 2012; Arango et al., 2008).”
Citrome, L., Correll, C. U., Cutler, A. J., Dunbar, M., Hoberg, A. R., Hopkinson, C., Mattingly, G. W., McGrory, J. A., Rege, B., Weiden, P. J., et al. (2025) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s499367 · Cited by 8
Peters-Strickland, T. S., Zhao, C. Y., Perry, P. P., Eramo, A., Salzman, P. M., McQuade, R. D., Johnson, B. R., & Sanchez, R. (2016) · CNS Spectrums · doi:10.1017/s1092852916000365 · Cited by 7
“A recent nationwide survey revealed that more than one-half of patients with schizophrenia were nonadherent to their antipsychotic therapy.(5) Nonadherence in schizophrenia is associated with many negative clinical and patient-rated outcomes, including an increased risk of psychiatric * Address for correspondence: Tim…”
BackgroundKretchy, I. A., Appiah, B., Agyabeng, K., Kwarteng, E. B., Ganyaglo, E., & Aboagye, G. O. (2021) · International Journal of Clinical Pharmacy · doi:10.1007/s11096-021-01264-9 · Cited by 7
“Yet there is a paucity of studies that have examined the perspectives of both patients and caregivers about psychotropic medicines, although non-adherence in patients have been predicted by negative beliefs [30–32] and experience of side effects [29, 33].”
BackgroundResultAloudah, N. M. (2023) · Patient Preference and Adherence · doi:10.2147/ppa.s404092 · Cited by 7
Fluorescence of neutrophil granulocytes as a biomarker for clozapine use
Man, W. H., ten Berg, M. J., Wilting, I., Huisman, A., Cahn, W., Douma, J. W., den Breeijen, H., Heerdink, E. R., Egberts, T. C. G., & van Solinge, W. W. (2013) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2013.08.005 · Cited by 7
“8% within 4–5 years, with a peak incidence in the first 6–18 weeks of treatment) (Atkin et al., 1996; Dibonaventura et al., 2012; Reid et al., 1998), necessitating weekly blood monitoring in the first 18 weeks of treatment followed by blood monitoring once every 4 weeks according to European guidelines and regulatory…”
MethodEmerging IT for Medication Adherence
Gimpel, G., Varshney, U., & Ahluwalia, P. (2016) · IT Professional · doi:10.1109/mitp.2016.49 · Cited by 7
Izadi, S. R., Pachur, T., Wheeler, C. S., McGuire, J., & Waters, E. A. (2017) · Patient Education and Counseling · doi:10.1016/j.pec.2017.05.029 · Cited by 7
“This has occurred in diverse clinical contexts, including undergoing biologic therapy for rheumatoid arthritis [12], adhering to antipsychotic [13] and antidepressant [14] medications, and initiating adjuvant chemotherapy for breast cancer [15].”
Gaudiano, B. A., Ellenberg, S., Price, L. H., & Moitra, E. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.09.048 · Cited by 7
“, 2012); 2) positive (happiness) and negative (irritability, sadness, nervousness) affect (0 = “very slightly or not at all” to 4 = “extremely”), using items from the Positive and Negative Affect Schedule (Watson and Clark, 1994); 3) medication side effects (0 = “not at all” to 1 = “extremely bothered”) (Dibonaventura…”
MethodCorrell, C. U. (2025) · CNS Drugs · doi:10.1007/s40263-025-01206-3 · Cited by 7
“Individualized experience while a patient is undergoing antipsychotic treatment is heavily impacted by adverse side effects, such as motor abnormalities, sedation, sexual dysfunction, metabolic dysfunction, and weight gain; these are commonly associated with non-adherence [21, 24].”
Gubert, C., Kong, G., Shadani, S., Connell, S., Masson, B. A., van de Garde, N., Narayana, V. K., Renoir, T., & Hannan, A. J. (2025) · Schizophrenia Bulletin · doi:10.1093/schbul/sbaf056 · Cited by 7
Ashoorian, D. M., Davidson, R. M., Rock, D. J., Seubert, L., & Clifford, R. M. (2015) · Therapeutic Advances in Psychopharmacology · doi:10.1177/2045125315598466 · Cited by 6
Çoker, F. (2021) · Journal of Psychiatric Nursing · doi:10.14744/phd.2021.18199 · Cited by 6
Rodolico, A., Concerto, C., Ciancio, A., Siafis, S., Fusar‐Poli, L., Romano, C., Scavo, E. V., Petralia, A., Salomone, S., Signorelli, M. S., et al. (2022) · Brain Sciences · doi:10.3390/brainsci12070891 · Cited by 6
“It is likely that the disproportion between the symptoms identified by the patient and the clinician is the result of the greater tendency of patients to report symptoms that determine distress [37] as present but are otherwise recognized as mild or absent by the clinician [38].”
BackgroundWard, K. M., & Citrome, L. (2024) · Expert Opinion on Drug Safety · doi:10.1080/14740338.2024.2328812 · Cited by 6
“Furthermore, improved tolerability is associated with greater adherence [116], which in turn is associated with improved quality of life [117] and reduced relapse rates and cost of care [118].”
BackgroundNugent, K. L., Spahr, E., Toroney, J., Mojtabai, R., Nettles, C., Turner, L. W., Fenton, A., Spivak, A., Cullen, B., Everett, A. S., et al. (2015) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0000000000000311 · Cited by 6
“Adverse effects of psychiatric medications are a major risk factor for nonadherence and reduced quality of life.(5,6) Therefore, it is crucial to assess patients for the presence of medication adverse effects in both clinical and research settings.”
BackgroundAshoorian, D. M., Davidson, R. M., Rock, D. J., Dragović, M., & Clifford, R. M. (2015) · International Clinical Psychopharmacology · doi:10.1097/yic.0000000000000072 · Cited by 6
“In a recent survey of mental health patients, nearly 80% reported at least one side effect that was bothersome and there was a significant association between their medication side effects and nonadherence (Dibonaventura et al., 2012).”
BackgroundEffect of Medication Education on Drug Adherence with Mental Disorders: A Clinical Trial Study
Sadeghian, E., dost, M. N., tapak, L., & Shamsaei, F. (2019) · نشریه روان پرستاری · doi:10.21859/ijpn-06066 · Cited by 6
Erşan, E. E. (2019) · Community Mental Health Journal · doi:10.1007/s10597-019-00506-5 · Cited by 6
The Benefits and Risks of Adherence to Medical Therapy
Scialli, A., Saavedra, K., & Fugh-Berman, A. (2021) · The Journal of Scientific Practice and Integrity · doi:10.35122/001c.21386 · Cited by 4
Addressing Patients’ Unmet Needs to Improve Outcomes in Schizophrenia
Harvey, P. D., & Kane, J. M. (2021) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.ic20018ah3c · Cited by 6
Ebrahem, S. M. (2016) · American Journal of Nursing Science · doi:10.11648/j.ajns.20160506.11 · Cited by 7
Treatment of surgical infections with tobramcin.
Stone, H. H., KOLB, L. D., GEHEBER, C. E., & CURRIE, C. A. (1975) · PubMed · Cited by 6
Sun, Y., Yu, H. H., Wang, Z., Zhang, J., Zhou, Y., Cui, W., & Jiang, W. (2024) · BMC Nursing · doi:10.1186/s12912-024-01882-4 · Cited by 5
“Some individuals with schizophrenia experience noticeable medication-related adverse reactions like weight gain, sleep disturbances, and impaired attention that significantly impact their medication experience [13].”
BackgroundSharma, D., Higgins, O., Sawicki, A., Ramamurthy, P., Field, B., Hussein, P., Singh, K. A., & Ranjitkar, S. (2025) · Journal of Oral Pathology and Medicine · doi:10.1111/jop.13639 · Cited by 6
Addisu, Z. D., Demsie, D. G., Tafere, C., Siraj, E. A., Yazie, T. S., Yimer, E. G., Alemu, N. G., Milikit, Y. Z., Wabela, B. N., Yismaw, M. B., et al. (2025) · Scientific Reports · doi:10.1038/s41598-025-21647-6 · Cited by 11
Vadukapuram, R., Zahid, S., Lee, H. K., & Patel, R. S. (2020) · Cureus · doi:10.7759/cureus.7936 · Cited by 5
“A nationwide survey of self-reported adult schizophrenia patients (N = 876) found that medication adverse effects such as extrapyramidal symptoms, tardive dyskinesia, agitation, and sedation were significantly associated medication non-compliance [23,24].”
BackgroundCastillo, A. F., Davis, A. L., Fischhoff, B., & Krishnamurti, T. (2021) · Health Informatics Journal · doi:10.1177/14604582211059463 · Cited by 6
Vrubļevska, J. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1134692 · Cited by 5
“These side effects caused by antipsychotics therefore have a negative impact on adherence (21).”
BackgroundImpact of prescription length supply policy on patient medication adherence in Thailand
Jarujumrus, I., & Taychakhoonavudh, S. (2023) · BMC Health Services Research · doi:10.1186/s12913-023-09530-4 · Cited by 6
“Second, the database was primarily operated for reimbursements, and did not include several predictors that have previously been associated with adherence, including education level, [53] race and ethnicity, [54] socioeconomic status, [55] adverse events with medications, [56] the relationship between healthcare provi…”
MethodAdherence to Psychotropic Medication Before and During COVID-19
Froese, B., Aquino, G., Valencia, E., Tan, Q., Yogendran, M. S., Katz, C., Bolton, J. M., Falk, J., Kowalec, K., Chateau, D., et al. (2023) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0000000000001713 · Cited by 5
“Copyright © 2023 Wolters Kluwer H disease severity, medication-induced adverse effects, and patient relationship with the healthcare system.(8,21,22) This study has important limitations to recognize.”
BackgroundChua, Y. C., Roystonn, K., Pushpa, K., Verma, S. K., & Tang, C. Y. Z. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-06190-4 · Cited by 5
Cahaya, N., Kristina, S. A., Widayanti, A. W., & Green, J. (2024) · Exploratory Research in Clinical and Social Pharmacy · doi:10.1016/j.rcsop.2024.100544 · Cited by 7
Slow Carbamazepine Clearance in a Nonadherent Malay Woman With Epilepsy and Thyrotoxicosis
Yeap, L., Lim, K. S., Ng, C. C., Khor, A. H., & Lo, Y. L. (2013) · Therapeutic Drug Monitoring · doi:10.1097/ftd.0000000000000024 · Cited by 5
“Avoidance of medication adverse effects is one of the main contributing factors to poor adherence.(50) CBZ-related adverse effects are positively related to elevated serum drug concentrations, the swiftness of serum concentration surge, or the fluctuations of serum levels between dosing intervals.”
BackgroundMasuda, S., Sakamaki, S., Yasuhara, Y., Zhao, Y., Takase, K., Yoshihiro, K. A. I., Tanioka, T., & Locsin, R. C. (2016) · Open Journal of Psychiatry · doi:10.4236/ojpsych.2016.61015 · Cited by 5
“As a result, it will cause negative effects on patient recuperation because of the adverse effect caused by alteration in the therapeutic regimen [7].”
BackgroundBerry, A., Drake, R., & Yung, A. R. (2020) · BMC Health Services Research · doi:10.1186/s12913-020-05654-z · Cited by 7
Metadata
- Authors
- DiBonaventura, M., Gabriel, S., Dupclay, L., Gupta, S., & Kim, E.
- Affiliations
- Kantar Health (United States) (US)
- Novartis (United States) (US)
- Corresponding author
- DiBonaventura, Marco
- Venue
- BMC Psychiatry
- Published
- 2012-03-20
- Volume
- 12
- Issue
- 1
- Pages
- 20-20
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC3342101
- OpenAlex
- W2157910519
- Cited by
- 333
- References
- 31
- Citations by year
- 2026: 16 · 2025: 30 · 2024: 32 · 2023: 27 · 2022: 22 · 2021: 34 · 2020: 22 · 2019: 27 · 2018: 22 · 2017: 20 · 2016: 24 · 2015: 22 · 2014: 13 · 2013: 19 · 2012: 2
- FWCI
- 15.48
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- schizophrenia, antipsychotic adverse effects, medication adherence, medication non-adherence, sedation, prolactin, metabolic side effects, health care utilization, hospitalization, emergency department visits, patient perspectives, community-dwelling patients, Morisky Medication Adherence Scale, health care costs, quality of life
- MeSH terms
- Adult, Attitude to Health, Cross-Sectional Studies, Female, Health Surveys, Humans, Male, Middle Aged, Schizophrenia, Schizophrenic Psychology, Antipsychotic Agents, Medication Adherence
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