Trajectory And Influencing Factors Of Medication Non-Adherence In Outpatients With Depression At Acute Stage

Background and objectiveDepression is a serious mental disorder that poses a huge burden on global public health.Drug therapy is the main treatment for acute depression,but medication adherence among depressed patients is generally low and non-adherence is common.Medication adherence varies with time and situation,and traditional modeling can only identify the overall change trajectory of medication adherence among depressed patients,but cannot explore group heterogeneity.Quantitative research cannot explore the essence of influencing factors.Therefore,this study used latent growth mixture model and phenomenological method to conduct longitudinal follow-up survey and in-depth interview on outpatients with acute depression,and explored the subgroups of medication non-adherence trajectory and its influencing factors among outpatients with acute depression,providing reference for developing targeted medication non-adherence intervention measures.Subjects and methodsStudy 1:Using convenience sampling method,259 outpatients with acute depression from a tertiary comprehensive hospital in Guangdong Province were included.Follow-up was conducted at 2,4,and 8 weeks after medication to assess medication adherence of patients,and patients with medication non-adherence were selected.The latent class growth mixture model was used to identify subgroups of medication non-adherence trajectory.Study 2:Semi-structured in-depth interviews were conducted with patients from different medication non-adherence trajectory subgroups in Study 1 to explore the influencing factors of medication non-adherence.Colaizzi’s seven-step analysis method was used to organize and analyze the interview data,and themes were formed for each subgroup.ResultsStudy 1:(1)There was an overall linear decline in medication adherence at acute stage in outpatients with depression who were medication non-adherent(P<0.01).(2)Four subgroups were identified for the trajectory of medication nonadherence development:rising group(20.1%),gentle group(9.7%),slowly declining group(10.4%),and quickly declining group(59.8%).Study 2:The four subgroups were influenced by a total of two themes:facilitators and barriers;among the sub-themes were:medication reminders/forgetting to take medication,positive/negative attitudes toward taking medication,false medication beliefs,side effects,self-knowledge,good/poor perceived benefits of taking medication,good/lack of social support,good/poor doctor-patient relationship,financial burden,stigma,and other external factors.Conclusion(1)The overall trajectory of medication non-adherence in outpatients with depression at the acute stage was on a decreasing trend.(2)There was heterogeneity in the trajectory of the medication non-adherence on acute phase in outpatients with depression,which was divided into rising group,gentle group,slowly declining group,and quickly declining group.(3)Positive attitudes toward medication taking,good perceived benefits of medication taking,and good social support promoted medication adherence,while false beliefs,side effects,negative attitudes toward medication taking,and lack of social support hindered medication adherence.(4)Forgetting to take medication was the common cause of non-adherence in the early stage in all subgroups;positive medication attitudes in the rising group contributed to a steady increase in adherence;the gentle group was able to maintain incomplete medication adherence with a balance of side effects and false beliefs and good perceived benefits of taking medication;the slowly declining group was protected by positive factors such as perceived benefits of taking medication in the early stage but led to medication non-adherence due to false beliefs in the later stage;The quickly declining group was protected from early discontinuation by multiple barriers such as false beliefs about medication,side effects,and perceived lack of medication benefit.