Abstract
IntroductionLittle is known about psychological reasons associated with adherence to growth hormone (GH) replacement therapy (GHRx) in adults. As in other chronic diseases, medication-related beliefs, coping strategies and disease impact on quality of life (QoL) might play an important role. We thus explored these psychological factors in relation to adherence in patients with GH deficiency (GHD) in order to find leverage points for the improvement of adherence.Patients and MethodsCross-sectional analysis including 107 adult GHD patients on GHRx who completed self-assessment inventories on health-related QoL (Short-Form SF-36), coping style (Freiburg questionnaire on coping with illness, FKV-LIS) and medication beliefs (Beliefs about Medicine questionnaire, BMQ). Results were correlated to general and GH-specific adherence to medication.ResultsIn the BMQ, 92.5% of the patients (n=99) reported a strong belief in the need for their medication, which correlated significantly with general adherence (rs = 0.325). Active coping was significantly related to general (rs = 0.307) and GH-specific adherence (rs = 0.226). Better mental QoL (rs = 0.210) but worse physical QoL (rs = -0.198; all p < 0.05) were related to higher GH-specific adherence. Older age was associated with a higher degree of active coping, a higher belief in the necessity of medication and worse physical QoL.ConclusionWe provide preliminary data that most GHD patients on GHRx are strongly convinced of their need for medication and that adherence to GHRx is influenced by coping strategies and QoL. Patients with impaired psychological QoL are less able to translate their convictions into good adherence, a phenomenon to be addressed in future research.
Highlights
Little is known about psychological reasons associated with adherence to growth hormone (GH) replacement therapy (GHRx) in adults
In the present study we investigated for the first time the association between psychological factors and adherence to medication in general and to GH replacement in adult patients with hypopituitarism including GH deficiency (GHD)
Despite the relatively high percentage of patients with impaired mental well-being in our group, a comparison of the individual subscales of the SF-36 between the historic cohort mentioned above [view table 3 in their original publication [28]] and the present one indicates a overall better quality of life (QoL) of patients with hypopituitarism on GHRx, which is perhaps related to more routine and confidence with hormonal replacement regimes evolving over time
Summary
Little is known about psychological reasons associated with adherence to growth hormone (GH) replacement therapy (GHRx) in adults. As in other chronic diseases, medication-related beliefs, coping strategies and disease impact on quality of life (QoL) might play an important role. We explored these psychological factors in relation to adherence in patients with GH deficiency (GHD) in order to find leverage points for the improvement of adherence. Growth hormone (GH) deficiency in adults (aGHD) is associated with an adverse cardiovascular risk and plasma lipid profile, abnormal body composition, reduced bone mass, and impaired quality of life (QoL) [1, 2]. We analyzed three major psychological domains outlined below, known to be associated with adherence to medication in other chronic diseases
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