Association Between Symptom Severity and Medication Adherence in Adolescents with Bipolar Disorder Demonstrating Suboptimal Adherence

Martha Sajatovic; Jennifer B Levin; Avani Modi; Molly McVoy; Larry F Forthun; Raechel Cooley; Jessica Black; Carla Conroy; Kaylee Sarna; Farren B Briggs; Melissa DelBello

Association Between Symptom Severity and Medication Adherence in Adolescents with Bipolar Disorder Demonstrating Suboptimal Adherence

Psychopharmacol Bull. 2023 Aug 11;53(3):8-21.

Authors

Affiliations

¹ Sajatovic, Department of Psychiatry and Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
² Levin, Department of Psychiatry and Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
³ Modi, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
⁴ McVoy, MD, Department of Psychiatry and Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
⁵ Forthun, Family, Youth and Community Sciences, University of Florida, Gainesville, FL, USA.
⁶ Cooley, Department of Psychiatry, University of Cincinnati, College of Medicine, Cincinnati, OH, USA.
⁷ Black, Department of Psychiatry and Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
⁸ Conroy, Department of Psychiatry and Mood Disorders Program, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
⁹ Sarna, Department of Psychiatry and Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
¹⁰ Briggs, PhD, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
¹¹ DelBello, Department of Psychiatry, University of Cincinnati, College of Medicine, Cincinnati, OH, USA.

PMID: 37601085
PMCID: PMC10434309

Abstract

Objective: While medication non-adherence is common in bipolar disorder (BD), few studies have specifically assessed non-adherent BD adolescents and young adults (AYAs). This analysis, using screening and baseline data from an ongoing randomized controlled trial, examined the relationship between BD symptoms and adherence in poorly adherent AYAs.

Methods: AYAs ages 13-21 had sub-optimal adherence defined as missing ⩾ 20% of prescribed BD medication. Mean sample (N = 36) age was 19.1 years (SD = 2.0), 66.7 % (N = 24) female, 25.0 % (n = 9) non-white. Adherence was measured via: 1) self-reported Tablets Routine Questionnaire (TRQ) and 2) electronic monitoring (SimpleMed pillbox). Symptoms were measured with the Hamilton Depression Rating Scale (HAM-D), the Young Mania Rating Scale (YMRS), and the Clinical Global Impression Scale (CGI).

Results: Mean percentage of missed BD medications using TRQ was 34.9 (SD = 28.9) at screening and 30.6 (SD = 33.0) at baseline. Mean percentage of missed medication using SimpleMed at baseline was 42.1 (SD = 37.0). The correlation between TRQ and SimpleMed was r = 0.36 (p = 0. 13). Neither CGI nor age were correlated with adherence. Neither TRQ nor SimpleMed were significantly related to HAM-D. YMRS was positively associated with worse adherence for TRQ (r = 0.36, p = 0.03), but not significantly associated with SimpleMed. Adherence did not differ by other demographic attributes.

Conclusion: Adherence levels varied widely in AYA with BD. Adherence monitoring increased adherence by approximately 4.5%, and use of electronic pill monitoring identified a greater proportion of missed medication vs. self-report. BD symptoms may not consistently identify AYA with adherence challenges.

Keywords: adherence; adolescent; bipolar disorder; compliance; youth.

Publication types

Randomized Controlled Trial

MeSH terms

Adolescent
Adult
Bipolar Disorder* / drug therapy
Female
Humans
Medication Adherence
Self Report
Young Adult