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      Treatment Non-adherence Patterns Among Patients With Mental Illness: A Study From the District Mental Health Care Center in India

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      Author(s): 1 , 1 , 2 , 3 ,
      Editor(s): ,
      Publication date (Electronic, pub):
      Publication date (Electronic, collection):
      Journal: Cureus
      Publisher: Cureus
      Keywords: treatment non-compliance, district mental health care center, non-adherence pattern, treatment discontinuation, mental illness

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          Abstract

          Introduction: The success of any medical intervention, including mental health treatment, depends largely on patient adherence to the prescribed regimen. In psychiatric illnesses, one of the biggest problems is getting people to adhere to their treatment schedule, representing a treatment gap that increases the burdens of patients, families, communities, and countries. Globally, it has become necessary for community health organizations to actively work towards reducing this gap and treatment non-adherence. Therefore, in this study, we aimed to examine treatment non-adherence patterns among patients with mental illness.

          Materials and methods: This work used a retrospective study design and consecutive sampling. The data source was secondary data obtained from the healthcare records of patients registered in the outpatient department of the District Mental Health Care Center, India, from January 2022 to December 2022.

          Results: Out of a total of 883 patients recruited for the study, 35.7% (n=315) were on regular follow-up over a duration of more than one year. Among patients with severe mental illness, 46% (n=46) had regular follow-ups and were compliant with therapy. About 49% of patients (n=433) discontinued their treatment after the initial contact with the therapist, with the highest rate among those with substance use disorders (77.0%; n=57). The remaining 15.3% (n=135) of recruited patients discontinued their follow-up appointments over a duration of 1 week to 12 months. Overall, 64.3% (n=568) of the recruited patients discontinued their treatment within one year.

          Conclusion: There was considerable early treatment dropout among patients with mental illness. However, this treatment discontinuation can be avoided because the individual identities of these patients are well-known to the therapist or facility, as they have had at least one interaction with the therapist. In order to improve treatment adherence, patients with mental illnesses must receive consistent support through community outreach programs, home visits, and new strategies to promote treatment compliance.

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          Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys.

          Jose Posada-Villa, Ronny Bruffaerts, Koen Demyttenaere … (2004)
          Little is known about the extent or severity of untreated mental disorders, especially in less-developed countries. To estimate prevalence, severity, and treatment of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders in 14 countries (6 less developed, 8 developed) in the World Health Organization (WHO) World Mental Health (WMH) Survey Initiative. Face-to-face household surveys of 60 463 community adults conducted from 2001-2003 in 14 countries in the Americas, Europe, the Middle East, Africa, and Asia. The DSM-IV disorders, severity, and treatment were assessed with the WMH version of the WHO Composite International Diagnostic Interview (WMH-CIDI), a fully structured, lay-administered psychiatric diagnostic interview. The prevalence of having any WMH-CIDI/DSM-IV disorder in the prior year varied widely, from 4.3% in Shanghai to 26.4% in the United States, with an interquartile range (IQR) of 9.1%-16.9%. Between 33.1% (Colombia) and 80.9% (Nigeria) of 12-month cases were mild (IQR, 40.2%-53.3%). Serious disorders were associated with substantial role disability. Although disorder severity was correlated with probability of treatment in almost all countries, 35.5% to 50.3% of serious cases in developed countries and 76.3% to 85.4% in less-developed countries received no treatment in the 12 months before the interview. Due to the high prevalence of mild and subthreshold cases, the number of those who received treatment far exceeds the number of untreated serious cases in every country. Reallocation of treatment resources could substantially decrease the problem of unmet need for treatment of mental disorders among serious cases. Structural barriers exist to this reallocation. Careful consideration needs to be given to the value of treating some mild cases, especially those at risk for progressing to more serious disorders.
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            The expert consensus guideline series: adherence problems in patients with serious and persistent mental illness.

            Daniel Carpenter, Andy J P Docherty, Dawn I Velligan … (2009)
            Poor adherence to medication treatment can have devastating consequences for patients with mental illness. The goal of this project was to develop recommendations for addressing adherence problems to improve patient outcomes. The editors identified important topics and questions concerning medication adherence problems in serious mental illness that are not fully addressed in the literature. A survey was developed containing 39 questions (521 options) asking about defining nonadherence, extent of adherence problems in schizophrenia and bipolar disorder, risk factors for nonadherence, assessment methods, and interventions for specific types of adherence problems. The survey was completed by 41 (85%) of the 48 experts to whom it was sent. Results of the literature review and survey were used to develop recommendations for assessing and improving adherence in patients with serious mental illness. ASSESSING ADHERENCE: The experts endorsed percentage of medication not taken as the preferred method of defining adherence, with 80% or more of medication taken endorsed as an appropriate cut-off for adherence in bipolar disorder and schizophrenia. Although self- and physician report are the most common methods used to assess adherence in clinical settings, they are often inaccurate and may underestimate nonadherence. The experts recommend that, if possible, clinicians also use more objective measures (e.g., pill counts, pharmacy records, and, when appropriate, serum levels such as are used for lithium). Use of a validated self-report scale may help improve accuracy. The majority of the experts believed the average patient with schizophrenia or bipolar disorder in their practices takes only 51%-70% of prescribed medication. FACTORS ASSOCIATED WITH NONADHERENCE: The experts endorsed poor insight and lack of illness awareness, distress associated with specific side effects or a general fear of side effects, inadequate efficacy with persistent symptoms, and believing medications are no longer needed as the most important factors leading to adherence problems in schizophrenia and bipolar disorder. The experts considered weight gain a side effect that is very likely to lead to adherence problems in patients with schizophrenia and bipolar disorder; sedation was considered a more important contributor to adherence problems in bipolar disorder than schizophrenia. The experts rated persistent positive or negative symptoms in schizophrenia and persistent grandiosity and manic symptoms in bipolar disorder as the most important symptomatic contributors to adherence problems in these illnesses. It is important to identify the specific factors that may be contributing to a patient's adherence problems in order to customize interventions to target those problems. Multiple problems may be involved, requiring a combination of interventions. Adherence problems are complex and multidetermined. The experts recommended customized interventions focused on the underlying causes. (c) Copyright 2009 Physicians Postgraduate Press, Inc.
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              Chronic diseases and injuries in India.

              Vikram Patel, Somnath Chatterji, Dan Chisholm … (2011)
              Chronic diseases (eg, cardiovascular diseases, mental health disorders, diabetes, and cancer) and injuries are the leading causes of death and disability in India, and we project pronounced increases in their contribution to the burden of disease during the next 25 years. Most chronic diseases are equally prevalent in poor and rural populations and often occur together. Although a wide range of cost-effective primary and secondary prevention strategies are available, their coverage is generally low, especially in poor and rural populations. Much of the care for chronic diseases and injuries is provided in the private sector and can be very expensive. Sufficient evidence exists to warrant immediate action to scale up interventions for chronic diseases and injuries through private and public sectors; improved public health and primary health-care systems are essential for the implementation of cost-effective interventions. We strongly advocate the need to strengthen social and policy frameworks to enable the implementation of interventions such as taxation on bidis (small hand-rolled cigarettes), smokeless tobacco, and locally brewed alcohols. We also advocate the integration of national programmes for various chronic diseases and injuries with one another and with national health agendas. India has already passed the early stages of a chronic disease and injury epidemic; in view of the implications for future disease burden and the demographic transition that is in progress in India, the rate at which effective prevention and control is implemented should be substantially increased. The emerging agenda of chronic diseases and injuries should be a political priority and central to national consciousness, if universal health care is to be achieved. Copyright © 2011 Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 19 February 2024
                Publication date (Electronic, collection): February 2024
                Volume: 16
                Issue: 2
                Electronic Location Identifier: e54495
                Affiliations
                [1 ] Department of Healthcare and Pharmaceutical Management, School of Management and Business Studies, Jamia Hamdard, New Delhi, IND
                [2 ] Department of Pathology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, IND
                [3 ] Department of Psychiatry, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, IND
                Author notes
                Article
                DOI: 10.7759/cureus.54495
                PMC ID: 10955436
                PubMed ID: 38516451
                SO-VID: a1e7c2e4-0b63-4e81-be8f-7924b91e14d9
                Copyright © Copyright © 2024, Khan et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date accepted : 19 February 2024
                Funding
                This research is a part of the PhD research work of the first author and funded by Hamdard National Foundation, New Delhi, India, under its PhD fellowship scheme.
                Categories
                Subject: Psychiatry
                Subject: Public Health

                Keywords: treatment non-compliance,district mental health care center,non-adherence pattern,treatment discontinuation,mental illness
                Data availability:
                Keywords: treatment non-compliance, district mental health care center, non-adherence pattern, treatment discontinuation, mental illness

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