Abstract
Medication non-compliance, a pervasive problem among persons with serious, chronic mental illness, has been linked to increased inpatient resources use in public mental health systems. The objective of this analysis was to determine which factors are associated with medication compliance in this population so that more appropriate screening and intervention programs can be designed. Using knowledge gained from clinical research on compliance in schizophrenia and research testing the Health Belief Model as a conceptual framework in studying compliance behavior, we conducted a secondary analysis of data collected in the Mississippi public mental health system in 1988. The study subjects were schizophrenic patients (n=202), the majority of whom were low-income, African-American males. Data sources included structured interviews with patients and family members, as well as state hospital and community mental health clinic administrative records. Receipt of consistent outpatient mental health treatment and belief that one had a mental illness were significantly associated with higher levels of medication compliance in this population of seriously mentally ill patients. Our results suggest that screening programs to identify those at highest risk for non-compliance in this population might be more productive if they included a review of inpatient and outpatient mental health service utilization patterns, in addition to formal assessment of patients' attitudes and beliefs about their illness. This study illustrates an approach to examining predictors of a policy-relevant health behavior in a minority population within a public mental health system.
Similar content being viewed by others
References
Kane JM (1985) Compliance issues in outpatient treatment. J Clin Psychopharmacol 5:22
Dirks JF, Kinsman RA (1982) Nondichotomous patterns of medication usage: the yes-no fallacy. Clin Pharmacol Ther 31: 413
Johnson DAW, Pasterski G, Ludlow JM, Street K, Taylor RDW (1983) The discontinuance of maintenance neuroleptic therapy in chronic schizophrenic patients: drug and social consequences. Acta Psychiatr Scand 67:339
Davis JM (1975) Overview: maintenance therapy in psychiatry: I. Schizophrenia. Am J Psychiatry 132:237
Sullivan G, Wells KB, Morgenstern H, Leake B (1995) Identifying modifiable risk factors for rehospitalization: a case-control study of seriously mentally ill persons.
Blackwell B (1972) The drug defaulter. Clin Pharmacol Ther 13: 841
Van Putten T (1974) Why do schizophrenic patients refuse to take their drugs? Arch Gen Psychiatry 31:67
Wilson JD, Enoch MD (1967) Estimation of drug rejection by schizophrenic inpatients, with analysis of clinical factors. Br J Psychiatry 112:209
Bartko G, Herczeg I, Sador G (1988) Clinical symptomatology and drug compliance in schizophrenic patients. Acta Psychiatr Scand 77:74
Falloon IRH (1984) Developing and maintaining adherence to long-term drug-taking regimens. Schizophr Bull 10:412
Pristach CA, Smith CM (1990) Medication compliance and substance abuse among schizophrenic patients. Hosp Community Psychiatry 41:1345
Salloum IM, Moss HB, Daley DC (1991) Substance abuse and schizophrenia: impediments to optimal care. Am J Drug Alcohol Abuse 17:321
Kelly GR, Scott JE, Appel F, Mamon JA (1987) Improving medication compliance among outpatients with schizophrenia: Final report. Veterans Administration HSR& D Project #625B
Geller JL (1982) State hospital patients and their medication: do they know what they take? Am J Psychiatry 139:611
Kelly GR, Scott JE (1990) Medication compliance and health education among outpatients with chronic mental disorders. Med Care 28:1181
Eckman TA, Liberman RP, Phipps C, Blair KE (1990) Teaching medication management skills to schizophrenic patients. J Clin Psychopharmacol 10:33
Soskis DA (1978) Schizophrenic and medical inpatients as informed drug consumers. Arch Gen Psychiatry 35:645
Ludwig W, Huber D, Schmidt S, Bender W, Greil W (1990) Assessment of compliance-related attitudes in psychiatry. A comparison of two questionnaires based on the Health Belief Model. Soc Psychiatry Psychiatr Epidemiol 25:298
Frank AF, Gunderson JG (1990) The role of the therapeutic alliance in the treatment of schizophrenia. Arch Gen Psychiatry 47:228
Kapur S, Ganguli R, Ulrich R, Raghu U (1992) Use of randomsequence riboflavin as a marker of medication compliance in chronic schizophrenics. Schizophr Res 6:49
Kane JM, Borenstein M (1985) Compliance in long-term schizophrenia. Psychopharmacol Bull 21:23
Babiker IE (1986) Noncompliance in schizophrenia. Psychiatr Dev 4:329
Becker MH, Drachman RH, Kirscht JP (1974) A new approach to explaining sick-role behavior in low-income populations. Am J Public Health 64:205
Shope JT (1988) Compliance in children and adults: a review of studies. Epilepsy Res Supp 1:23
Zweig S, LeFevre M, Kruse J (1988) The health belief model and attendance for prenatal care. Fam Pract Res J 32
Sullivan G (1989) Rehospitalization of the seriously mentally ill in Mississippi: conceptual models, study design, and implementation. RAND, Santa Monica
Winer BJ, Brown DR, Michels KM (1991) Statistical procedures in experimental design, 3rd edn. McGraw-Hill, New York
Computing Resource Center (1992) Stata reference manual: release 3, 5th edn. Santa Monica
Rosenstock IM (1977) The health belief model and preventive health behavior. Health Educ Monog
Miklowitz DJ, Goldstein MJ, Neuchterlein KH, Snyder KS, Mintz J (1986) Expressed emotion, affective style, lithium compliance and relapse in recent-onset mania. Psychopharmacol Bull 22:628
Handbook of selected data for Mississippi (1983) Mississippi Research and Development Center, Information Services Division, Jackson
Hogan TP, Awad AG, Eastwood R (1983) A self-report scale predictive of drug compliance in schizophrenics: reliability and discriminative validity. Psychol Med 13:177
Haynes RB, Wange E, DaMota-Gomes M (1982) A critical review of interventions to improve compliance with prescribed medications. Patient Educ Counseling 10:155
Mueser Kt, Yarnold PR, Levinson DF, et al (1990) Prevalence of substance abuse in schizophrenia: demographic and clinical correlates. Schizophr Bull 16:31
Cuffel BJ (1992) Prevalence estimates of substance abuse in schizophrenia and their correlates. J Nerv Ment Dis 180:589
Author information
Authors and Affiliations
Additional information
Support for this project was provided by the UCLA Faculty Scholar Program in Mental Health Services Research (NIMH grant no. K12 MH00990). The original project was funded by the Robert Wood Johnson Foundation, the National Center of Health Services Research, the Health Care Financing Administration, and the Mississippi Department of Mental Health. The views and opinions expressed herein do not necessarily reflect those of any of the funding agencies
Rights and permissions
About this article
Cite this article
Nageotte, C., Sullivan, G., Duan, N. et al. Medication compliance among the seriously mentally ill in a public mental health system. Soc Psychiatry Psychiatr Epidemiol 32, 49–56 (1997). https://doi.org/10.1007/BF00788920
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00788920