Factors Associated With Medication Adherence in African American and White Patients With Bipolar Disorder
J Clin Psychiatry 2005;66(5):646-652
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: African American patients may be
less likely than white patients to adhere to maintenance
pharmacotherapy for bipolar disorder. The purpose of this study
was to examine rates of medication nonadherence, self-perceived
reasons for nonadherence, and attitudes associated with
nonadherence in these ethnic groups.
Method: 20 African American and 30 white
subjects with DSM-IV bipolar I disorder participated in this
study. At a single follow-up visit with patients at least 4
months after their first hospitalization for acute mania, we
assessed demographics, symptom severity, degrees of adherence,
reasons for nonadherence, and self-perceptions regarding factors
previously associated with nonadherence using a visual analog
scale (VAS). The cross-sectional data that are the subject of
this report were obtained from July 1, 2002, through June 30,
Results: Over 50% of participants in each group
were currently either fully or partially nonadherent with
medications. Greater than 20% of participants in each group
denied having bipolar disorder and described physical side
effects from medications as contributing to nonadherence. In
principal components analysis of the VAS, 2 components were
identified. The first component contained patient-related factors
associated with nonadherence, while the second contained a
combination of illness- and medication-related factors. African
American participants were more likely to endorse patient-related
factors associated with nonadherence relative to white
participants. Specifically, African Americans self-endorsed a
fear of becoming addicted to medications and feeling that
medications were symbols of mental illness.
Conclusion: Findings suggest that both African
American and white patients with bipolar disorder demonstrate
poor medication adherence that they attribute to
illness/medication-related factors (denial of illness, physical
side effects). However, patient-related factors (fear of
addiction, medication as a symbol of illness) accounted for
ethnic differences on self-perceived ratings of nonadherence
factors. Differences in the reasons for nonadherence relative to
culturally biased self-perceptions may help explain nonadherence
behaviors in the African American community.