Abstract
Although there is accumulating evidence on the potential influencing factors of medication adherence, the knowledge about patients' attitudes and beliefs toward treatment is only partly utilized in adherence-improving strategies. Several internal and external factors determining adherence have been described regarding many chronic somatic diseases but in recent research, insight on psychiatric patients has been exclusively lacking. As a result, there is a scarcity of effective adherence-improving interventions. Identification of any specific differences or similarities between the attitudes toward treatment of psychiatric and non-psychiatric patients would help to support adherent behavior.We recruited 189 participants from four departments of general psychiatry (GEN PSYCH, n = 106), addictology (ADDICT, n = 42) and somatic diseases (NON PSYCH, n = 41). The Patient's Health Belief Questionnaire on Psychiatric Treatment (PHBQPT) was performed to assess the patients' attitude toward drug treatment, perceived health locus of control, and psychological reactance.The most robust difference of the PHBQT scores occurred between the GEN PSYCH and ADDICT subgroups. ADDICT patients scored significantly higher on the internal and external health locus of control and on the Psychological Reactance subscale as well. While GEN PSYCH subjects provided higher scores on the Positive Aspect of Medication compared to ADDICT persons. Interestingly, the only difference between the GEN PSYCH and NON-PSYCH groups was the more pronounced mistrust in physicians in the case of psychiatric patients.Our data suggest that mistrust toward medication does not differ in psychiatric and non-psychiatric samples, while the acceptance of the doctor's competency may be stronger in the non-psychiatric sample. The analysis of these factors provides information which could help us better understand this important issue and to develop more efficient interventions for improving adherence.
Highlights
Medication non-adherence is one of the most challenging problems of healthcare
Detailed reviews are available about the factors influencing adherence [3,4,5,6,7,8] and there are some interesting data on the mediating role of depression on adherence in chronic somatic diseases, such as hypertension [9], cardiovascular disease [2], diabetes [10], and chronic kidney disease [11]
According to the results of one study, psychiatric patients’ attitudes toward medication could be negatively influenced by educational level, patients with a higher educational level have been shown to be more skeptical about the usefulness of psychoactive drugs [16]. In this pilot study we investigated the role of beliefs and health locus of control in influencing the attitude toward pharmacological treatment in samples of patients with general psychiatric, addictive, and somatic disorders
Summary
In the case of patients requiring psychiatric treatment, non-adherence is considered to be one of the major factors which influence the course of illness and the outcome. According to a report from the WHO, about 50% of patients with a chronic disease are non-adherent to their medication [1] and some authors suggest that improving adherence at a population level may have a higher influence on health than the discovery of a new compound [2]. Further evidence suggested that health-related locus of control can moderate the relationship between a serious somatic disease causing disability and the consecutive occuring depressive symptoms. Authors emphasized the importance of assessment of control beliefs of patients undergoing treatment for serious somatic illness in order to facilitate the recovery process [12]
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