Clinical Features Associated With Poor Pharmacologic Adherence in Bipolar Disorder: Results From the STEP-BD Study

Roy H. Perlis, MD, MSc; Michael J. Ostacher, MD, MPH; David J. Miklowitz, PhD; Aleena Hay, BA; Andrew A. Nierenberg, MD; Michael E. Thase, MD; and Gary S. Sachs, MD

Published: March 15, 2010

Article Abstract

Background: Poor medication adherence is common among bipolar patients.

Method: We examined prospective data from 2 cohorts of individuals from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study (1999-2005) with bipolar disorder. Clinical and sociodemographic features associated with missing at least 25% of doses of at least 1 medication were assessed using logistic regression, and a risk stratification model was developed and validated.

Results: Of 3,640 subjects with 48,287 follow-up visits, 871 (24%) reported nonadherence on 20% or more study visits. Clinical features significantly associated (P < .05) with poor adherence included rapid cycling, suicide attempts, earlier onset of illness, and current anxiety or alcohol use disorder. Nonadherence during the first 3 months of follow-up was associated with less improvement in functioning at 12-month follow-up (P < .03). A risk stratification model using clinical predictors accurately classified 80.6% of visits in an independent validation cohort.

Conclusion: Risk for poor medication adherence can be estimated and may be useful in targeting interventions.

J Clin Psychiatry 2010;71(3):296-303

Submitted: July 7, 2009; accepted September 16, 2009 (doi:10.4088/JCP.09m05514yel).

Corresponding author: Roy H. Perlis, MD, MSc, Bipolar Clinic and Research Program, 50 Staniford St, 5th Floor, Boston, MA 02114 (

Volume: 71

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