Medication Adherence Among Children and Adolescents with Severe Mental Illness: A Systematic Review and Meta-Analysis

Abstract

Medication nonadherence among youth with SMI is highly prevalent. Children and adolescents with more severe illness and higher comorbidity burden are at greater risk for nonadherence. Positive interpersonal care processes and adherence to nonpharmacological treatment may be protective. These findings inform development of a risk profile for nonadherence among youth with SMI. Future prospective research is needed to address the shortcomings in the existing literature and inform interventions to improve adherence.

Longitudinal course and risk factors associated with psychosis in bipolar youths

“…These developmental changes may be impacted by the onset of BD, and perhaps more severely if the BD is accompanied by psychosis. Also, factors such as lack of adherence to treatment, side effects of medications, and stigma, which are relevant to all mental health problems and especially to psychosis, could also contribute to the poorer outcome …”

“…Also, factors such as lack of adherence to treatment, side effects of medications, and stigma, which are relevant to all mental health problems and especially to psychosis, could also contribute to the poorer outcome. 37,41,42 Given that our study included youths with BD who developed first lifetime onset of psychosis during follow-up, we were able, for the first time in the BD literature, to evaluate the risk factors that predate the onset of psychosis. Increased risk of developing psychosis was associated with low SES, living with only one biological parent, BD-I/II subtypes, comorbid anxiety, and family history of suicidality and mania.…”

<p>Self-Report for Measuring and Predicting Medication Adherence: Experts’ Experience in Predicting Adherence in Stable Psychiatric Outpatients and in Pharmacokinetics</p>

“…57 Moreover, tolerability and efficacy of psychiatric drugs and, therefore, outcomes of mental disorders are not only determined by the medication's pharmacological profile but also through the interaction of additional factors, including the doctor-patient relationship and the patients' attitudes toward their illnesses and toward their prescribed medications. 58 Although the literature does not provide consistent findings of which variables may predict adherence in psychiatric patients, 59 we have tried to summarize the findings in Table 2, [60][61][62][63][64] by including 5 systematic reviews and/or meta-analyses that have attempted to identify predictors of treatment adherence in psychiatric disorders. In order to review these predicting variables, we have classified them into four subsections: sociodemographic variables, clinical variables in mental disorders, medication variables, and self-reported health beliefs.…”

“…Once substance abuse has ceased, the treatment of the severe mental illness and medication adherence can become the focus. The third more consistent clinical variable is that measures of increased severity within a disorder may decrease adherence; this appears to happen in patients with depression, 60 children 62 and patients with schizophrenia and bipolar disorder. 63 Interestingly, we could not find any systematic review that compared adherence across the three severe mental illnesses: schizophrenia, bipolar disorder and depression.…”

“… ↑ Adherence with: ↑ age, and White race ↓ Adherence with: medical comorbidities, substance abuse, and race (Hispanic patients or minority groups) Sendt et al 61 Systematic review of 13 observational studies of patients with schizophrenia using antipsychotics. ↑ Adherence with: ↑ positive attitude to medication, and ↑ insight into illness Edgcomb and Zima 62 Systematic review and meta-analysis of 28 studies of predictors of adherence to psychopharmacological treatment among children (<19 years old) with a primary psychotic disorder, bipolar disorder, depression, recent suicide attempt, or psychiatric hospitalization. Strength of association was measured by adjusted OR (CI).…”