Abstract
Public mental health service users frequently manage multiple health conditions, and are often prescribed multiple medications. While medications are useful tools in treating diagnosed mental illnesses, they bring management challenges and also can carry complex meanings for the individuals taking them. This study utilized a qualitative methodological approach to examine the experience and meaning of polypharmacy among public mental health services users. This sample of service users (n = 26) who were prescribed multiple medications described three distinct types of challenges they faced in managing medications: related to information, material tasks, and self-stigma. Nevertheless, respondents reported creative and resilient strategies to manage these challenges. Findings build on previous literature and reflect the increasing need to focus on challenges related to polypharmacy. Furthermore, findings indicate that low levels of literacy and high levels of material disadvantage, which are common among public mental health service users, complicate the management and meaning of multiple medications.
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Adams, S., Pill, R., & Jones, A. (1997). Medication, chronic illness and identity: The perspective of people with asthma. Social Science and Medicine,45(2), 189–201.
Adams, W. E., Todorova, I. L. G., Guzzardo, M. T., & Falcón, L. M. (2015). ‘The problem here is that they want to solve everything with pills’: Medication use and identity among Mainland Puerto Ricans. Sociology of Health and Illness,37(6), 904–919. https://doi.org/10.1111/1467-9566.12240.
Armstrong, K. S., & Temmingh, H. (2017). Prevalence of and factors associated with antipsychotic polypharmacy in patients with serious mental illness: Findings from a cross-sectional study in an upper-middle-income country. Brazilian Journal of Psychiatry,39(4), 293–301.
Bentley, K. J. (2010). Psychiatric medication and meaning-making in a residential program for adults with serious mental illness. Qualitative Social Work,9, 479–499.
Carter, S. R., Moles, R., White, L., & Chen, T. F. (2013). Medication information seeking behavior of patients who use multiple medicines: How does it affect adherence? Patient Education and Counseling,92(1), 74–80.
Cheraghi-Sohi, S., Jeffries, M., Stevenson, F., Ashcroft, D. M., Carr, M., Oliver, K., et al. (2015). The influence of personal communities on the self-management of medication taking: A wider exploration of medicine work. Chronic Illness,11(2), 77–92.
Conrad, P. (1985). The meaning of medications: Another look at compliance. Social Science and Medicine,20(1), 29–37.
Corrigan, P. (2004). How stigma interferes with mental health care. American Psychologist,59(7), 614.
Corrigan, P. W., Druss, B. G., & Perlick, D. A. (2014). The impact of mental illness stigma on seeking and participating in mental health care. Psychological Science in the Public Interest,15(2), 37–70.
Deegan, P. E. (2007). The lived experience of using psychiatric medication in the recovery process and a shared decision-making program to support it. Psychiatric Rehabilitation Journal,31(1), 62–69. https://doi.org/10.2975/31.1.2007.62.69.
DiBonaventura, M., Gabriel, S., Dupclay, L., Gupta, S., & Kim, E. (2012). A patient perspective of the impact of medication side effects on adherence: Results of a cross-sectional nationwide survey of patients with schizophrenia. BMC Psychiatry,12(1), 20.
Hjorth, P., Jørgensen, P., & Sørensen, H. (2013). 980—Psychotropic polypharmacy in patients with severe mental illness. A controlled intervention study aimed to reduce the use of psychotropic medication. European Psychiatry,28, 1.
Hodgetts, D., Chamberlain, K., Gabe, J., Dew, K., Radley, A., Madden, H.,…,Nikora, L. W. (2011). Emplacement and everyday use of medications in domestic dwellings. Health and Place, 17(1), 353–360.
Kranke, D. A., Floersch, J., Kranke, B. O., & Munson, M. R. (2011). A qualitative investigation of self-stigma among adolescents taking psychiatric medication. Psychiatric Services,62(8), 893–899.
Lincoln, A. K., Adams, W., Eyllon, M., Garverich, S., Prener, C. G., Griffith, J.,…,Hopper, K. (2017). The double stigma of limited literacy and mental illness: Examining barriers to recovery and participation among public mental health service users. Society and Mental Health, 7(3), 121–141.
Link, B. G., & Phelan, J. C. (2006). Stigma and its public health implications. The Lancet,367(9509), 528–529.
Masnoon, N., Shakib, S., Kalisch-Ellett, L., & Caughey, G. E. (2017). What is polypharmacy? A systematic review of definitions. BMC Geriatrics,17(1), 230.
Nairn, R. (1999). Does the use of psychiatrists as sources of information improve media depictions of mental illness? A pilot study. Australian and New Zealand Journal of Psychiatry,33(4), 583–589.
Olfson, M., Uttaro, T., Carson, W. H., & Tafesse, E. (2005). Male sexual dysfunction and quality of life in schizophrenia. The Journal of Clinical Psychiatry,66, 331–338.
Pattyn, E., Verhaeghe, M., Sercu, C., & Bracke, P. (2014). Public stigma and self-stigma: Differential association with attitudes toward formal and informal help seeking. Psychiatric Services,65(2), 232–238.
Pound, P., Britten, N., Morgan, M., Yardley, L., Pope, C., Daker-White, G., et al. (2005). Resisting medicines: A synthesis of qualitative studies of medicine taking. Social Science and Medicine,61(1), 133–155.
Rambhade, S., Chakarborty, A., Shrivastava, A., Patil, U. K., & Rambhade, A. (2012). A survey on polypharmacy and use of inappropriate medications. Toxicology International,19(1), 68.
Rüsch, N., Müller, M., Ajdacic-Gross, V., Rodgers, S., Corrigan, P., & Rössler, W. (2014). Shame, perceived knowledge and satisfaction associated with mental health as predictors of attitude patterns towards help-seeking. Epidemiology and Psychiatric Sciences,23(2), 177–187.
Schwartz, T., Nihalani, N., Jindal, S., Virk, S., & Jones, N. (2004). Psychiatric medication-induced obesity: A review. Obesity Reviews,5(2), 115–121.
Shoemaker, S. J., & Ramalho de Oliveira, D. (2008). Understanding the meaning of medications for patients: The medication experience (Author abstract) (Report). Pharmacy World and Science,30(1), 86.
Sirey, J. A., Bruce, M. L., Alexopoulos, G. S., Perlick, D. A., Friedman, S. J., & Meyers, B. S. (2001). Stigma as a barrier to recovery: Perceived stigma and patient-rated severity of illness as predictors of antidepressant drug adherence. Psychiatric Services,52(12), 1615–1620.
Sleath, B., Blalock, S. J., Bender, D., Murray, M., Cerna, A., & Cohen, M. G. (2009). Latinos’ sources of medication and medication information in the United States and their home countries. Patient Education and Counseling,75(2), 279–282.
Takeuchi, H., Suzuki, T., Remington, G., & Uchida, H. (2015). Antipsychotic polypharmacy and corrected QT interval: A systematic review. The Canadian Journal of Psychiatry,60(5), 215–222.
Tio, J., LaCaze, A., & Cottrell, W. N. (2007). Ascertaining consumer perspectives of medication information sources using a modified repertory grid technique. Pharmacy World and Science,29(2), 73–80.
Tran, N., & Castle, D. (2012). Outcomes from a regular medication information programme for consumers with a mental illness. Australasian Psychiatry,20(2), 143–147.
Turner, J. P., Jamsen, K. M., Shakib, S., Singhal, N., Prowse, R., & Bell, J. S. (2016). Polypharmacy cut-points in older people with cancer: How many medications are too many? Supportive Care in Cancer,24(4), 1831–1840.
Viswanathan, H., & Lambert, B. L. (2005). An inquiry into medication meanings, illness, medication use, and the transformative potential of chronic illness among African Americans with hypertension. Research in Social and Administrative Pharmacy,1(1), 21–39. https://doi.org/10.1016/j.sapharm.2004.12.007.
Vlasnik, J. J., Aliotta, S. L., & DeLor, B. (2005). Medication adherence: Factors influencing compliance with prescribed medication plans. The Case Manager,16(2), 47–51.
Acknowledgements
We would like to thank the Literacy Project Steering Committee, including our Consumer Consulting Group. This work was supported by NIMH Grant 1R01MH096707-04 (PI: Alisa Lincoln).
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Scoglio, A.A.J., Adams, W.E. & Lincoln, A.K. Meaning and Management of Multiple Medications Among Public Mental Health Service Users. Community Ment Health J 56, 313–321 (2020). https://doi.org/10.1007/s10597-019-00491-9
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DOI: https://doi.org/10.1007/s10597-019-00491-9