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Cited by 555Medication Adherence and ComplianceMental Health Treatment and AccessSchizophrenia research and treatment

Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis

Open access
Semahegn, Agumasie, Torpey, Kwasi, Manu, Adom, Assefa, Nega, Tesfaye, Gezahegn, Ankomah, Augustine·2020·Systematic Reviews
DOI 10.1186/s13643-020-1274-3PMC PMC6966860
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Abstract

Background: Major psychiatric disorders are growing public health concern that attributed 14% of the global burden of diseases. The management of major psychiatric disorders is challenging mainly due to medication non-adherence. However, there is a paucity of summarized evidence on the prevalence of psychotropic medication non-adherence and associated factors. Therefore, we aimed to summarize existing primary studies’ finding to determine the pooled prevalence and factors associated with psychotropic medication non-adherence. Methods: A total of 4504 studies written in English until December 31, 2017, were searched from the main databases ( n = 3125) (PubMed (MEDLINE), Embase, CINAHL, PsycINFO, and Web of Science) and other relevant sources (mainly from Google Scholar, n = 1379). Study selection, screening, and data extraction were carried out independently by two authors. Observational studies that had been conducted among adult patients (18 years and older) with major psychiatric disorders were eligible for the selection process. Critical appraisal of the included studies was carried out using the Newcastle Ottawa Scale. Systematic synthesis of the studies was carried out to summarize factors associated with psychotropic medication non-adherence. Meta-analysis was carried using Stata 14. Random effects model was used to compute the pooled prevalence, and sub-group analysis at 95% confidence interval. Results: Forty-six studies were included in the systematic review. Of these, 35 studies (schizophrenia ( n = 9), depressive ( n = 16), and bipolar ( n = 10) disorders) were included in the meta-analysis. Overall, 49% of major psychiatric disorder patients were non-adherent to their psychotropic medication. Of these, psychotropic medication non-adherence for schizophrenia, major depressive disorders, and bipolar disorders were 56%, 50%, and 44%, respectively. Individual patient’s behaviors, lack of social support, clinical or treatment and illness-related, and health system factors influenced psychotropic medication non-adherence. Conclusion: Psychotropic medication non-adherence was high. It was influenced by various factors operating at different levels. Therefore, comprehensive intervention strategies should be designed to address factors associated with psychotropic medication non-adherence. Systematic review registration: PROSPERO CRD42017067436

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review and meta-analysis found that 49% of adults with major psychiatric disorders were non-adherent to psychotropic medication. Non-adherence was associated with individual behaviors, social support, clinical/treatment/illness factors, and health-system factors.

Key findings

  • The pooled prevalence of psychotropic medication non-adherence was 49% (95% CI 44%, 55%) across 35 studies, with 63,957 cases from a sample of 120,134.
  • Subgroup non-adherence was 56% (95% CI 48%, 63%) for schizophrenia (9 studies, 2,643 participants), 50% (95% CI 40%, 59%) for major depressive disorder (16 studies, 42,255 participants), and 44% (95% CI 43%, 45%) for bipolar disorder (10 studies, 73,250 participants).
  • Regional pooled non-adherence was 48% in Africa, 48% in North America, 49% in Europe, and 57% in Asia.
  • Factors mapped across 46 studies included individual patient behaviors, lack of social support, clinical/treatment/illness-related factors, and health system factors.

Methods

  • Systematic review and meta-analysis registered in PROSPERO (CRD42017067436) and reported per PRISMA; searches covered PubMed/MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and other sources including Google Scholar up to December 31, 2017, yielding 4,504 studies.
  • Eligible studies were observational studies among adults aged 18 years and older with major depressive disorder, schizophrenia, or bipolar disorder that reported psychotropic medication adherence/non-adherence and/or associated factors; 46 studies were included, and 35 were meta-analyzed.
  • Two authors independently selected studies and extracted data; quality was appraised with the Newcastle-Ottawa Scale; meta-analysis used Stata 14 with random-effects inverse-variance models, subgroup analysis by disorder, and publication-bias assessment (Egger’s test p = 0.683; Begg’s test p = 0.831).

Limitations

  • The paper does not include a dedicated limitations section; it states that there is “a large amount of heterogeneity in the definition and measurement methods used to assess medication adherence” and calls for individually tailored approaches.
  • Evident from the text: included studies were observational, and many were cross-sectional, so reported associations should not be interpreted as causal.
  • Evident from the text: the search was restricted to English-language studies available before December 31, 2017, and the meta-analysis pooled studies using different adherence scales and populations, which likely contributes to heterogeneity.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s13643-020-1274-3

Cites

Statistics

Nothing to recompute.

Claims the paper makes

0 of 170 cited sources checked · 0 supported · 0 flagged

  • Findingcitation

    Unemployment was associated with medication non-adherence in four studies.

    “In four studies, unemployment was one of the factors associated with medication non-adherence [25, 31, 56, 60].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [25] Hibdye G, Dessalegne Y, Debero N, Bekan L, Sintayehu M. Prevalence of drug non-adherence and associated factors among patients with bipolar disorder at outpatient unit of Amanuel Hospital, Addis Ababa, Ethiopia. J Psychiatry. 2015;1:003. https://doi.org/10.4172/2378-5756.S1-003. source

      Not checked in the free run.

    • cites [31] Odo HO, Agbonile IO, Esan PO, Jeffrey S, BOJ S. Assessment of adherence to psychotropic medications among out-patients at the Pharmacy Department of a Psychiatric Hospital, in Benin City, Nigeria. Asian J Pharm. 2014;8:211–5. source

      Not checked in the free run.

    • cites [56] Mahaye S, Mayime T, Nkosi S, Mahomed FN, Pramlal J, Setlhabana O, et al. Medication adherence of psychiatric patients in an outpatient setting. African J Pharm Pharmacol. 2012;6(9):608–12.

      Not checked in the free run.

    • cites [60] Shigemura J, Ogawa T, Yoshino A, Sato Y, Nomura S. Predictors of antidepressant adherence: results of a Japanese internet-based survey. Psychiatry Clin Neurosci. 2010;64:179–86. source

      Not checked in the free run.

  • Findingown data

    Health system factors influenced psychotropic medication non-adherence.

    “Individual patient’s behaviors, lack of social support, clinical or treatment and illness-related, and health system factors influenced psychotropic medication non-adherence.”
    Quote in the paperSubstantial claim
  • Findingown data

    The pooled prevalence of psychotropic medication non-adherence in North America was 48%.

    “the psychotropic medication non-adherence was 48%, 48%, 49%, and 57% in Africa, North America, Europe, and Asia, respectively (Fig. 2).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Medication non-adherence measured by different scales and definitions can be pooled into a single prevalence estimate.
  • Findingown data

    The pooled prevalence of psychotropic medication non-adherence among major depressive disorder patients was 50% (95% CI 40-59).

    “psychotropic medication non-adherence for schizophrenia, major depressive disorders, and bipolar disorders were 56%, 50%, and 44%, respectively.”
    • Also stated in: § Major depressive disorder medication non-adherence · plain
      “medication non-adherence among patients with major depressive disorders was 50% (95% CI 40%, 59%).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Medication non-adherence measured by different scales and definitions can be pooled into a single prevalence estimate.
  • Findingown data

    The pooled prevalence of psychotropic medication non-adherence in Africa was 48%.

    “the psychotropic medication non-adherence was 48%, 48%, 49%, and 57% in Africa, North America, Europe, and Asia, respectively (Fig. 2).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Medication non-adherence measured by different scales and definitions can be pooled into a single prevalence estimate.
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 17
  • May combine two claims. 24

  • The quote only partly states this claim.

    Findingown data

    The pooled prevalence of psychotropic medication non-adherence among bipolar disorder patients was 44% (95% CI 43-45).

    “psychotropic medication non-adherence for schizophrenia, major depressive disorders, and bipolar disorders were 56%, 50%, and 44%, respectively.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Medication non-adherence measured by different scales and definitions can be pooled into a single prevalence estimate.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The systematic review included 46 studies.

    “Forty-six studies were included in the systematic review.”
    • Also stated in: § Results · plain
      “A total of 46 studies were included in this systematic review and meta-analysis.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Where patients were suspicious about the medication, believed that the medication would harm them, heard voices telling them not to take the medication, and taking medication is unnatural were less likely to adhere in one study.

    “Likewise, where patients were suspicious about the medication, believes that the medication would harm them, heard voices telling them not to take the medication, and taking medication is unnatural were less likely to adhere [36].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] Kikkert MJ, Schene AH, Maarten WJ, Robson D, Born A, Helm H, et al. Medication adherence in schizophrenia: exploring patients’, carers’ and professionals’ views. Schizophr Bull. 2006;32(4):786–94. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Having long-term medication prescriptions, long duration maintenance therapy, and irregular follow-up were associated with psychotropic medication non-adherence.

    “Similarly, having long-term medication prescriptions, long duration maintenance therapy [29, 54], and irregular follow-up [29] were associated with psychotropic medication non-adherence.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [29] Mert DG, Turgut NH, Kelleci M, Murat S. Perspectives on reasons of medication nonadherence in psychiatric patients. Patient Prefer Adherence. 2015;9:87–93. source

      Not checked in the free run.

    • cites [54] Lacasta-tintorer D, García-lecina R, Flamarich-zampalo D, Font-canal T, Martín MIF. Do depressed patients comply with treatments prescribed? A cross-sectional study of adherence to the antidepressant treatment. Actas Esp Psiquiatr. 2011;39(5):288–93.

      Not checked in the free run.

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    Findingcitation

    Patients' or caregivers' perceived medication efficacy such as subjective relief of symptoms, patients' feel drugs have no effect on the illness, not helpful, being ineffective, and feeling of cured were side-effect-related factors associated with medication non-adherence.

    “Likewise, patients’ or caregivers’ perceived medication efficacy such as subjective relief of symptoms, patients’ feel drugs have no effect on the illness, not helpful, being ineffective [36, 46, 50], and feeling of cured [51] were side-effect-related factors associated with medication non-adherence.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [36] Kikkert MJ, Schene AH, Maarten WJ, Robson D, Born A, Helm H, et al. Medication adherence in schizophrenia: exploring patients’, carers’ and professionals’ views. Schizophr Bull. 2006;32(4):786–94. source

      Not checked in the free run.

    • cites [46] Olivares JM, Rodriguez-morales A, Diels J, Povey M. Long-term outcomes in patients with schizophrenia treated with risperidone long-acting injection or oral antipsychotics in Spain: results from the electronic schizophrenia treatment adherence registry (e-STAR ) *. Eur Psychiatry. 2009;24(5):287–96. source

      Not checked in the free run.

    • cites [50] Roy R, Jahan M, Kumari S. Reasons for drug non-compliance of psychiatric patients: a centre-based study. J Indian Acad Appl Psychol. 2005;31(1):24–8.

      Not checked in the free run.

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    Findingcitation

    Taking lower potent concomitant psychotropic medications, recovery from illness, felt better, and failure to improve with medication were factors associated with medication efficacy related with psychotropic medication non-adherence.

    “Taking lower potent concomitant psychotropic medications [47, 65], recovery from illness [34], felt better [24, 52], and failure to improve with medication [37] were the factors associated with medication efficacy related with psychotropic medication non-adherence.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [47] Åkerblad A, Bengtsson F, Holgersson M, Von Knorring L. Identi fi cation of primary care patients at risk of nonadherence to antidepressant treatment. Patient Prefer Adherence. 2008;2:379–86.

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    • cites [65] Nega M, Semahegn A, Demissie M. Psychotropic medication non-adherence and associated factors among patients with severe psychiatric disorders attending psychiatry clinics in selected hospitals, eastern Ethiopia: a cross-sectional study. Unpubl Thesis 2016

      Not checked in the free run.

    • cites [34] Gurmu AE, Abdela E, Allele B, Cheru E, Amogne B. Rate of non-adherence to antipsychotic medications and factors leading to non-adherence among psychiatric patients in Gondar University Hospital, Northwest Ethiopia. Hindawi Publ Corp. Advances in Psychiatry.2014;2014:ID 475812. https://www.hindawi.com/journals/apsy/2014/475812/. source

      Not checked in the free run.

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    Findingcitation

    Misunderstanding about treatment consequences, lack of awareness of their illness and/or mental disorder in general, and sometimes appreciating subjective relief symptoms were factors associated with medication non-adherence among major psychiatric disorder patients.

    “Likewise, misunderstanding about the treatment consequences, lack of awareness of their illness and or mental disorder in general, and sometimes appreciating subjective relief symptoms [30, 36, 37] were the factors associated with medication non-adherence among major psychiatric disorder patients.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [30] Novick D, Montgomery W, Treuer T, Aguado J, Kraemer S, Haro JM. Relationship of insight with medication adherence and the impact on outcomes in patients with schizophrenia and bipolar disorder: results from a 1-year European outpatient observational study. BMC Psychiatry. 2015;15(1):189. [cited 2017 Jun 18]. https://doi.org/10.1186/s12888-015-0560-4. source

      Not checked in the free run.

    • cites [36] Kikkert MJ, Schene AH, Maarten WJ, Robson D, Born A, Helm H, et al. Medication adherence in schizophrenia: exploring patients’, carers’ and professionals’ views. Schizophr Bull. 2006;32(4):786–94. source

      Not checked in the free run.

    • cites [37] Teferra S, Hanlon C, Beyero T, Jacobsson L, Shibre T. Duplicated-perspectives on reasons for non-adherence to medication in persons with schizophrenia in Ethiopia: a qualitative study of patients, caregivers and health workers. BMC Psychiatry. 2013;13:168. source

      Not checked in the free run.

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    Findingcitation

    Sleepiness during day time (medication dose time) and potentially life-threatening or distressing side-effects seriously affected patients' medication non-adherence in two studies.

    “In two studies, sleepiness during day time (medication dose time) and potentially life-threatening or distressing side-effects seriously affected patients’ medication non-adherence [37, 44].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [37] Teferra S, Hanlon C, Beyero T, Jacobsson L, Shibre T. Duplicated-perspectives on reasons for non-adherence to medication in persons with schizophrenia in Ethiopia: a qualitative study of patients, caregivers and health workers. BMC Psychiatry. 2013;13:168. source

      Not checked in the free run.

    • cites [44] Johnson FR, Özdemir S, Manjunath R, Hauber AB, Burch P, Thompson TR, et al. Approach linked references are available on JSTOR for this article: factor treatments a stated-preference approach. Med Care. 2007;45(6):545–52. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Affective morbidity, obsessive-compulsive disorders, recovering from mania-hypomania, personality disorders and sensation of seeking personality traits, and alcohol abuse disorders were negatively associated with medication adherence.

    “Of these, affective morbidity, obsessive-compulsive disorders, recovering from mania-hypomania [64], personality disorders and sensation of seeking personality traits [47], and alcohol abuse disorders [61] were negatively associated with medication adherence.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [64] Baldessarini RJ, Perry R, Pike J. Factors associated with treatment nonadherence among US bipolar disorder patients. Hum Psychopharmacol Clin Exp. 2008;23:95–105. source

      Not checked in the free run.

    • cites [47] Åkerblad A, Bengtsson F, Holgersson M, Von Knorring L. Identi fi cation of primary care patients at risk of nonadherence to antidepressant treatment. Patient Prefer Adherence. 2008;2:379–86.

      Not checked in the free run.

    • cites [61] Bambauer KZ, Adams AS, Zhang F, Minkoff N, Grande A, Weisblatt R, et al. Physician alerts to increase antidepressant adherence. Arch Intern Med. 2006;166:498–504. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Limited or inadequate patient information, weak professional or family support, therapeutic alliance, social involvement, and low education were social support-related factors in two studies.

    “In two studies, limited or inadequate patient information, weak professional or family support, therapeutic alliance, social involvement, and low education were some of the social support-related factors [36, 37].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [36] Kikkert MJ, Schene AH, Maarten WJ, Robson D, Born A, Helm H, et al. Medication adherence in schizophrenia: exploring patients’, carers’ and professionals’ views. Schizophr Bull. 2006;32(4):786–94. source

      Not checked in the free run.

    • cites [37] Teferra S, Hanlon C, Beyero T, Jacobsson L, Shibre T. Duplicated-perspectives on reasons for non-adherence to medication in persons with schizophrenia in Ethiopia: a qualitative study of patients, caregivers and health workers. BMC Psychiatry. 2013;13:168. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Poor service structure and cumbersome purchasing procedure (affect access), availability and timely use or collection of psychotropic medication during follow-up visit, and patients not covered by health insurance scheme were health care system factors associated with medication non-adherence.

    “These factors were poor service structure and cumbersome purchasing procedure (affect access), availability and timely use or collection of psychotropic medication during follow-up visit, and patients not covered by health insurance scheme [58].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [58] Akincigil A, Bowblis JR, Levin C, Walkup JT, Saira Jan P, Crystal S. Adherence to antidepressant treatment among privately insured patients diagnosed with depression. NIH Public Access Med Care. 2007;45(4):363–9.

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Various social support-related factors (cohesiveness, family reminding, transport to hospital, lower family harmony, discrimination, disruption of family functioning, weak community functioning, homelessness, old age caregivers, lack of family compliance, lack of advice, not receiving social assistance, caregivers' attribution) were associated with psychotropic medication non-adherence.

    “Cohesiveness, family reminding, and transport to hospital [37], lower family harmony or lack of resilient family support, discrimination by nearby people, disruption of family functioning or household routine and religious practices [45], weak community functioning [39], homelessness [42, 43], had old age caregivers or lack of caregivers [50], lack of family compliance of follow-up [51], lack of”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [37] Teferra S, Hanlon C, Beyero T, Jacobsson L, Shibre T. Duplicated-perspectives on reasons for non-adherence to medication in persons with schizophrenia in Ethiopia: a qualitative study of patients, caregivers and health workers. BMC Psychiatry. 2013;13:168. source

      Not checked in the free run.

    • cites [45] Iseselo MK, Kajula L, Yahya-malima KI. The psychosocial problems of families caring for relatives with mental illnesses and their coping strategies: a qualitative urban based study in Dar Es Salaam. BMC Psychiatry. 2016;16:1–12. source

      Not checked in the free run.

    • cites [39] Mohamed S, Rosenheck R, Mcevoy J, Swartz M, Stroup S, Lieberman JA. Cross-sectional and longitudinal relationships between insight and attitudes toward medication and clinical outcomes in chronic schizophrenia. Schizophr Bull. 2009;35(2):336–46. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Medication non-adherence was affected by the number of hospitalizations, irregular hospitalization and frequently discharge of patients, length of stay, lack of patients' satisfaction with health care services, and long distance to access the health service/recollect medications.

    “Medication non-adherence was affected by the number of hospitalizations [28], irregular hospitalization and frequently discharge of patients, length of stay [42, 46], lack of patients’ satisfaction with health care services [44], and long distance to access the health service/recollect medications [50].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [28] Moritz S, Favrod J, Andreou C, Morrison AP, Bohn F, Veckenstedt R, et al. Beyond the usual suspects : positive attitudes towards positive symptoms is associated with medication noncompliance in psychosis. Schizophr Bull. 2013;39(4):917–22. source

      Not checked in the free run.

    • cites [42] Sajatovic M, Valenstein M, Blow F, Ganoczy D, Ignacio R. Treatment adherence with lithium and anticonvulsant medication among patients with bipolar disorder. Psychiatr Serv. 2007;58(6):855–63. source

      Not checked in the free run.

    • cites [46] Olivares JM, Rodriguez-morales A, Diels J, Povey M. Long-term outcomes in patients with schizophrenia treated with risperidone long-acting injection or oral antipsychotics in Spain: results from the electronic schizophrenia treatment adherence registry (e-STAR ) *. Eur Psychiatry. 2009;24(5):287–96. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Unfriendly, judgmental behavior, inflexible appointment systems, mistrust, and having negative patient-physician relationships were factors associated with patients' psychotropic medication non-adherence in three studies.

    “Consequently, unfriendly, judgmental behavior, inflexible appointment systems, mistrust, and having negative patient-physician relationships were the factors associated with patients’ psychotropic mediation non-adherence [28, 30, 60].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [28] Moritz S, Favrod J, Andreou C, Morrison AP, Bohn F, Veckenstedt R, et al. Beyond the usual suspects : positive attitudes towards positive symptoms is associated with medication noncompliance in psychosis. Schizophr Bull. 2013;39(4):917–22. source

      Not checked in the free run.

    • cites [30] Novick D, Montgomery W, Treuer T, Aguado J, Kraemer S, Haro JM. Relationship of insight with medication adherence and the impact on outcomes in patients with schizophrenia and bipolar disorder: results from a 1-year European outpatient observational study. BMC Psychiatry. 2015;15(1):189. [cited 2017 Jun 18]. https://doi.org/10.1186/s12888-015-0560-4. source

      Not checked in the free run.

    • cites [60] Shigemura J, Ogawa T, Yoshino A, Sato Y, Nomura S. Predictors of antidepressant adherence: results of a Japanese internet-based survey. Psychiatry Clin Neurosci. 2010;64:179–86. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Lack of money for transportation, to purchase proper food, and to buy medications were factors associated with patients' adherence to their medication.

    “In addition, the lack of money for transportation, to purchase proper food, and to buy medications were the factors associated with patients’ adherence to their medication.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [11] Taj F, Tanwir M, Aly Z, Khowajah AA, Tariq A, Syed FK, et al. Factors associated with non-adherence among psychiatric patients at a Tertiary Care Hospital, Karachi, Pakistan: a questionnaire based cross-sectional study. J Pak Med Assoc. 2008;58(432):432–6.

      Not checked in the free run.

    • cites [24] Tesfay K, Girma E, Negash A, Tesfaye M. Non-adherence among adult psychiatric out patients in Jimma University Specialized Hospital, Southwest Ethiopia. Ethiop J Health Sci. 2013;23(3):227–38.

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    • cites [32] Ibrahim A, Pindar SK, Yerima MM, Rabbebe IB, Shehu S, Garkuwa HA, et al. Medication-related factors of non adherence among patients with schizophrenia and bipolar disorder: outcome of a cross-sectional survey in Maiduguri, North-eastern Nigeria. J Neurosci Behav Heal. 2015;7(5):31–9. source

      Not checked in the free run.

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    Findingcitation

    Health care providers would be unable to explain and optimize prescribing pattern, timing, and dose benefit of medication; lack of friendly deal with medication complexity, tolerability, efficacy, and health belief issues were critical factors influencing medication adherence in three studies.

    “In three studies, health care providers would be unable to explain and optimize prescribing pattern, timing, and dose benefit of medication. In addition, the lack of friendly deal with medication complexity, tolerability, efficacy, and health belief issues were critical factors influence medication adherence [11, 44, 52].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [11] Taj F, Tanwir M, Aly Z, Khowajah AA, Tariq A, Syed FK, et al. Factors associated with non-adherence among psychiatric patients at a Tertiary Care Hospital, Karachi, Pakistan: a questionnaire based cross-sectional study. J Pak Med Assoc. 2008;58(432):432–6.

      Not checked in the free run.

    • cites [44] Johnson FR, Özdemir S, Manjunath R, Hauber AB, Burch P, Thompson TR, et al. Approach linked references are available on JSTOR for this article: factor treatments a stated-preference approach. Med Care. 2007;45(6):545–52. source

      Not checked in the free run.

    • cites [52] Burra TA, Chen E, Mcintyre RS, Grace SL, Blackmore ER, Stewart DE, et al. Predictors of self-reported antidepressant adherence predictors of self-reported antidepressant. Behav Med. 2007;32(4):127–34. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Medication non-adherence is consistently associated with patients' behavioral practices (e.g., substance abuse) and patients' socio-demographic characteristics (such as educational status, age, gender, and employment).

    “Similarly, medication non-adherence is consistently associated with patients behavioral practices (e.g., substance abuse) [14, 74] and also patients’ socio-demographic characteristics (such as educational status, age, gender, and employment) [14, 72].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [14] Dunn LB, Leckband S, Dolder CR, Pharm D, Leckband SG, Ph R, et al. Prevalence of and risk factors for medication nonadherence in patients with schizophrenia. J Clin Psychiatry. 2002;63(10):892–909. source

      Not checked in the free run.

    • cites [74] Kreyenbuhl J, Record EJ, Palmer-bacon J. A review of behavioral tailoring strategies for improving medication adherence in serious mental illness. Clin Res. 2016;18(2):191–201.

      Not checked in the free run.

    • cites [72] Colom F, Vieta E, Tacchic M, Sanchez-Moreno J, Scott J. Identifying and improving non-adherence in bipolar disorder Identifying and improving non-adherence in bipolar disorders. Bipolar Disord. 2005;7(Suppl 5):24–31. source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Medication non-adherence among patients with schizophrenia, major depressive disorder, and bipolar disorder were 56%, 50%, and 44%, respectively.

    “Medication non-adherence among patients with schizophrenia, major depressive disorder, and bipolar disorder were 56%, 50%, and 44%, respectively.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Financial factors seriously affected medication adherence, including unaffordability of medication, increased health care cost, lack of health insurance, patients' poor capacity, and limited resources.

    “Financial factors seriously affected medication adherence. These included unaffordability of medication, increased health care cost [73, 74], lack of health insurance [75], patients’ poor capacity, and limited resources [73].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [73] Chapman SCE, Horne R. Medication nonadherence and psychiatry: review. Curr Opin Psychiatry. 2013;26(5):446–52. source

      Not checked in the free run.

    • cites [74] Kreyenbuhl J, Record EJ, Palmer-bacon J. A review of behavioral tailoring strategies for improving medication adherence in serious mental illness. Clin Res. 2016;18(2):191–201.

      Not checked in the free run.

    • cites [75] Lanouette NM, Folsom DP, Sciolla A, Jeste DV. Psychotropic medication nonadherence among United States Latinos : a comprehensive literature review. Psychiatr Serv. 2009;60(2):157–74. source

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    Findingcitation

    In the present systematic review, medication non-adherence is associated with poor functioning of the health system (including lack of psychotherapy, lack of information, long treatment duration with little health personnel follow-up, inadequate discharge planning, increased hospitalizations, poor support and care environment, access barriers to high-quality care, health care providers unable to提供

    “In the present systematic review, medication non-adherence is associated with poor functioning of the health system such as lack of psychotherapy, lack of information, long treatment duration with little health personnel follow-up, inadequate discharge planning, increased hospitalizations, poor support and care environment, experiencing access barriers to high-quality care and health care”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [14] Dunn LB, Leckband S, Dolder CR, Pharm D, Leckband SG, Ph R, et al. Prevalence of and risk factors for medication nonadherence in patients with schizophrenia. J Clin Psychiatry. 2002;63(10):892–909. source

      Not checked in the free run.

    • cites [72] Colom F, Vieta E, Tacchic M, Sanchez-Moreno J, Scott J. Identifying and improving non-adherence in bipolar disorder Identifying and improving non-adherence in bipolar disorders. Bipolar Disord. 2005;7(Suppl 5):24–31. source

      Not checked in the free run.

    • cites [74] Kreyenbuhl J, Record EJ, Palmer-bacon J. A review of behavioral tailoring strategies for improving medication adherence in serious mental illness. Clin Res. 2016;18(2):191–201.

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Psychotropic medications had an appetite stimulation that increased food demand, incurring additional economic burden and contributing to medication non-adherence.

    “Psychotropic medications had an appetite stimulation that has been increasing food demand which incurs an additional economic burden [11, 24, 32, 37, 42, 45, 50] and contribute for medication non-adherence.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [11] Taj F, Tanwir M, Aly Z, Khowajah AA, Tariq A, Syed FK, et al. Factors associated with non-adherence among psychiatric patients at a Tertiary Care Hospital, Karachi, Pakistan: a questionnaire based cross-sectional study. J Pak Med Assoc. 2008;58(432):432–6.

      Not checked in the free run.

    • cites [24] Tesfay K, Girma E, Negash A, Tesfaye M. Non-adherence among adult psychiatric out patients in Jimma University Specialized Hospital, Southwest Ethiopia. Ethiop J Health Sci. 2013;23(3):227–38.

      Not checked in the free run.

    • cites [32] Ibrahim A, Pindar SK, Yerima MM, Rabbebe IB, Shehu S, Garkuwa HA, et al. Medication-related factors of non adherence among patients with schizophrenia and bipolar disorder: outcome of a cross-sectional survey in Maiduguri, North-eastern Nigeria. J Neurosci Behav Heal. 2015;7(5):31–9. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    This systematic review of factors influencing psychotropic medication non-adherence, consistent with other systematic reviews, has shown that medication adherence is mainly affected by patients' negative attitude toward their medication, lack of insight, negative health belief, and perceived stigma.

    “This systematic review of factors influencing psychotropic medication non-adherence which is consistent with other systematic reviews [14, 72, 73, 77] has shown that medication adherence is mainly affected by patients’ negative attitude toward their medication, lack of insight, negative health belief, and perceived stigma.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [14] Dunn LB, Leckband S, Dolder CR, Pharm D, Leckband SG, Ph R, et al. Prevalence of and risk factors for medication nonadherence in patients with schizophrenia. J Clin Psychiatry. 2002;63(10):892–909. source

      Not checked in the free run.

    • cites [72] Colom F, Vieta E, Tacchic M, Sanchez-Moreno J, Scott J. Identifying and improving non-adherence in bipolar disorder Identifying and improving non-adherence in bipolar disorders. Bipolar Disord. 2005;7(Suppl 5):24–31. source

      Not checked in the free run.

    • cites [73] Chapman SCE, Horne R. Medication nonadherence and psychiatry: review. Curr Opin Psychiatry. 2013;26(5):446–52. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The systematic review and meta-analysis was registered in PROSPERO (CRD42017067436).

    “This systematic review and meta-analysis has been registered in the international Prospective Register of Systematic Reviews (PROSPERO 2017:ID:CRD42017067436) [16]”
    • Also stated in: § Systematic review registration · plain
      “PROSPERO CRD42017067436”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Potential publication bias was assessed by inspecting the funnel plot and using Egger's regression test and Begg's rank correlation.

    “Potential publication bias was assessed by inspecting the funnel plot [71].”
    • Also stated in: § Publication bias · plain
      “statistical tests Egger’s regression test (one-tailed test), p = 0.683, and Begg’s rank correlation (one-tailed), p = 0.831, were computed”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [71] Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The systematic review and meta-analysis was written in accordance with PRISMA statements guidelines.

    “written in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statements guidelines [17]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1–9 Available from: http://www.systematicreviewsjournal.com/content/4/1/1. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Critical appraisal of the included studies was carried out using the Newcastle Ottawa Scale.

    “Critical appraisal of the included studies was carried out using the Newcastle Ottawa Scale.”
    • Also stated in: § Quality assurance of the systematic review · plain
      “The studies’ methodological quality critical appraisal was carried out using the Newcastle-Ottawa Scale [20]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa: Ottawa Health Research Institute; 2010.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The meta-analysis was based on the recommendation for the meta-analysis of observational studies.

    “based on the recommendation for the meta-analysis of observational studies [67].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [67] Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology. A proposal for reporting. JAMA. 2000;283(15):2008–12. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Eligibility criteria, selection method, quality assessment, data extraction template, and regular meeting for discussion schedule were pre-designed by authors to assure the quality.

    “Eligibility criteria, selection method, quality assessment, data extraction template, and regular meeting for discussion schedule were pre-designed by authors to assure the quality.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The search included both published and non-peer reviewed studies comprehensively to minimize publication bias.

    “We searched both published and non-peer reviewed studies comprehensively for the systematic review and meta-analysis to minimize publication bias.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Study selection, screening, and data extraction were carried out independently by two authors.

    “Study selection, screening, and data extraction were carried out independently by two authors.”
    • Also stated in: § Selection of studies into systematic review · plain
      “two authors (AS and GT) independently screened the title and abstract of the studies to proceed to the next step of the studies selection.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Any difference during studies selection process was resolved through consensus.

    “Any difference during studies selection process was resolved through consensus.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Previous systematic reviews have indicated that medication non-adherence is a common challenge in the treatment of psychiatric disorders.

    “Previous systematic reviews have indicated that medication non-adherence is a common challenge in the treatment of psychiatric disorders [72, 73].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [72] Colom F, Vieta E, Tacchic M, Sanchez-Moreno J, Scott J. Identifying and improving non-adherence in bipolar disorder Identifying and improving non-adherence in bipolar disorders. Bipolar Disord. 2005;7(Suppl 5):24–31. source

      Not checked in the free run.

    • cites [73] Chapman SCE, Horne R. Medication nonadherence and psychiatry: review. Curr Opin Psychiatry. 2013;26(5):446–52. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Another earlier systematic review has shown that the level of medication non-adherence was 60%.

    “Another earlier systematic review has shown that the level of medication non-adherence was 60% [74].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [74] Kreyenbuhl J, Record EJ, Palmer-bacon J. A review of behavioral tailoring strategies for improving medication adherence in serious mental illness. Clin Res. 2016;18(2):191–201.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    This meta-analysis finding is consistent with a systematic review that revealed an overall medication adherence level of 58% (ranged from 24 to 90%), and medication adherence to antidepressants was 65%.

    “This meta-analysis finding is consistent with a systematic review revealed an overall medication adherence level of 58% (ranged from 24 to 90%), and medication adherence to antidepressants was 65% [6].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] Cramer JA, Rosenheck R. Compliance with medication regimens for mental and physical disorders. Psychiatr Serv. 1998;49(2):196–201. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The present meta-analysis finding is a bit lower than a finding from a systematic review which revealed that adherence in psychiatric patients ranged from 10.7 to 38%.

    “Nevertheless, the present meta-analysis finding is a bit lower than a finding from a systematic review which revealed that adherence in psychiatric patients ranged from 10.7 to 38% [76].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [76] Smith D, Lovell J, Weller C, Kennedy B, Winbolt M, Young C, et al. A systematic review of medication non-adherence in persons with dementia or cognitive impairment. PLoS One. 2017;12(2):e0170651. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Patients' individual behavior, lack or poor social/family support, treatment and illness-related clinical conditions, and the health system barriers are influencing factors of psychotropic medication non-adherence among patients with major psychiatric disorders.

    “Patients’ individual behavior, lack or poor social/family support, treatment and illness-related clinical conditions, and the health system barriers are influencing factors of psychotropic medication non-adherence among patients with major psychiatric disorders.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The present systematic review and meta-analysis finding is consistent with a finding from a comprehensive systematic review on schizophrenia which reported that a mean rate of non-adherence was 41.2%.

    “The present systematic review and meta-analysis finding is consistent with a finding from a comprehensive systematic review on schizophrenia which reported that a mean rate of non-adherence was 41.2%.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] Dunn LB, Leckband S, Dolder CR, Pharm D, Leckband SG, Ph R, et al. Prevalence of and risk factors for medication nonadherence in patients with schizophrenia. J Clin Psychiatry. 2002;63(10):892–909. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Premisecitation

    Non-adherence contributes enormously to poor health outcome and needs substantial work to improve treatment outcomes.

    “Non-adherence contributes enormously to poor health outcome and needs substantial work to improve treatment outcomes [80].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [80] Barkhof E, Meijer CJ, De Sonneville LMJ, Linszen DH, De Haan L. Interventions to improve adherence to antipsychotic medication in patients with schizophrenia – a review of the past decade. Eur Psychiatry. 2012;27:9–18. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Another systematic review has shown that psychotropic medication non-adherence was 44%.

    “and another systematic review has shown that psychotropic mediation non-adherence was 44% [75].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [75] Lanouette NM, Folsom DP, Sciolla A, Jeste DV. Psychotropic medication nonadherence among United States Latinos : a comprehensive literature review. Psychiatr Serv. 2009;60(2):157–74. source

      Not checked in the free run.

39 of 39

  • The paper relies on this without support.

    There has not been any systematic review and meta-analysis carried out to inform policy on psychotropic medication non-adherence among patients with major psychiatric disorders.

    “Although several primary studies have been conducted on this issue, there has not been any systematic review and meta-analysis carried out to inform policy.”

  • The paper relies on this without support.

    Medication non-adherence measured by different scales and definitions can be pooled into a single prevalence estimate.

    “Medication non-adherence was measured either as direct report from studies or indirectly by subtracting adherence report from total observations (sample size). Studies’ reported non-adherence in another way such as medication non-compliance, non-persistence, dropout, discontinuation, missing, and other alternatives was considered.”

  • The paper relies on this without support.

    Research evidence on the level of psychotropic medication non-adherence and its associated factors is essential to design appropriate interventions.

    “Research evidence on the level of psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders is essential to design appropriate interventions to achieve desired treatment goals for both patients and health care providers.”

  • The paper relies on this without support.

    A large amount of heterogeneity in the definition and measurement methods used to assess medication adherence exists across studies.

    “A large amount of heterogeneity in the definition and measurement methods used to assess medication adherence have been reported in some reviews.”

  • The paper relies on this without support.

    Improving adherence to psychotropic medications could have a positive impact on patients and society.

    “Evidence showed that improving adherence to psychotropic medications could have a positive impact on patients and society.”
5 of 5

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Figure 4 labels non-adherence results as adherence

    Minor

    The text describes the 16-study estimate as medication non-adherence, but the corresponding figure caption calls it medication adherence.

1 of 1

The citation lists haven’t been fetched yet

References 77 · Cited by 555

Research works printed but not linked: 4

  1. Rekha R, Masroor J, Sushma K, et al. Reasons for drug non-compliance of psychiatric patients. J Indian Acad Appl Psychol. 2005;31(1):24–8.
  2. Semahegn A, Torpey K, Manu A, Assefa N, Tesfaye G, Ankomah A. Psychotropic medication non-adherence and associated factors among adult patients with major psychiatric disorders: a protocol for a systematic review. BMC Syst Rev. 2018;7:10. · DOI
  3. Roy R, Jahan M, Kumari S. Reasons for drug non-compliance of psychiatric patients: a centre-based study. J Indian Acad Appl Psychol. 2005;31(1):24–8.
  4. Nega M, Semahegn A, Demissie M. Psychotropic medication non-adherence and associated factors among patients with severe psychiatric disorders attending psychiatry clinics in selected hospitals, eastern Ethiopia: a cross-sectional study. Unpubl Thesis 2016

Authors
Semahegn, A., Torpey, K., Manu, A., Assefa, N., Tesfaye, G., & Ankomah, A.
Affiliations
  • University of Ghana (GH)
  • Haramaya University (ET)
  • Population Council (IN)
Corresponding author
Semahegn, Agumasie
ORCID
Venue
Systematic Reviews
Publisher
Springer Science and Business Media LLC
Published
2020-01-16
Volume
9
Issue
1
Pages
17-17
ISSN
2046-4053 (ISSN-L)
DOI
10.1186/s13643-020-1274-3
PMC
PMC6966860
OpenAlex
W2999391921
Semantic Scholar
11c35e1810edbeefaaf93b04d159c61ac2956b82
Cited by
555
References
77
Citations by year
2026: 85 · 2025: 113 · 2024: 162 · 2023: 89 · 2022: 52 · 2021: 41 · 2020: 13
FWCI
10.30
Type
journal article
Language
en
Open access
Licence
Locations
  • Systematic Reviews (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
World Health Organization (B40300)
Topics
  • Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Keywords
severe mental illness, schizophrenia, major depressive disorder, bipolar disorder, associated factors, social support, health system factors, treatment adherence interventions
MeSH terms
Behavior, Bipolar Disorder, Major Depressive Disorder, Psychotropic Drugs, Schizophrenia, Social Support, Drug Monitoring

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

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