Medication Adherence, Ethnicity, and the Influence of Multiple Psychosocial and Financial Barriers

  • John E. ZeberEmail author
  • Alexander L. Miller
  • Laurel A. Copeland
  • John F. McCarthy
  • Kara Zivin
  • Marcia Valenstein
  • Devra Greenwald
  • Amy M. Kilbourne
Original Paper


Medication adherence is critical for patients with bipolar disorder to avoid symptom exacerbation and diminished quality of life. Most analyses consider adherence barriers individually rather than conjointly, while neglecting potential ethnic differences. 435 patients in the Continuous Improvement for Veterans in Care––Mood Disorders study reported multiple financial and psychosocial factors influencing adherence. Logistic regression modeled adherence as a function of perceived barriers, including cost burden, access, binge drinking, poor therapeutic alliance, and medication beliefs. Nearly half the cohort experienced adherence difficulty, averaging 2.8 barriers, with minority veterans reporting lower adherence than white patients, particularly financial burden and treatment access. Total barriers were significantly associated with worse adherence (OR = 1.24 per barrier), notably poor medication beliefs, binge drinking, and difficulty accessing psychiatric specialists (ORs of 2.41, 1.95 and 1.73, respectively). Veterans with bipolar disorder experience numerous adherence barriers, with certain obstacles proving especially pernicious. Fortunately tailored clinical interventions can improve adherence, particularly by addressing modifiable risk factors.


Medication adherence Psychosocial barriers Ethnicity Bipolar disorder Veterans 



Funding for this study was provided by the Department of Veterans Affairs, Health Services Research and Development Service (Merit Review IIR 02-283-2, MREP Career Development Award HSR&D 02269).


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Copyright information

© Department of Veterans Affairs 2010

Authors and Affiliations

  • John E. Zeber
    • 1
    • 2
    Email author
  • Alexander L. Miller
    • 2
  • Laurel A. Copeland
    • 1
    • 2
  • John F. McCarthy
    • 3
    • 4
  • Kara Zivin
    • 3
    • 4
  • Marcia Valenstein
    • 3
    • 4
  • Devra Greenwald
    • 5
  • Amy M. Kilbourne
    • 3
    • 4
  1. 1.Veterans Affairs HSR&D: South Texas Veterans Health Care System (VERDICT)San AntonioUSA
  2. 2.Department of PsychiatryUniversity of Texas Health Science Center at San AntonioSan AntonioUSA
  3. 3.VA Ann Arbor Healthcare System, Serious Mental Illness Treatment Research and Evaluation CenterAnn ArborUSA
  4. 4.Department of PsychiatryUniversity of MichiganAnn ArborUSA
  5. 5.Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare SystemPittsburghUSA

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