A. Häge et al., Non-adherence to Psychotropic Medication Among Adolescents – A Systematic Review of the Literature
Data Extraction Data were extracted from full-text articles and included rates of (non)adherence/(non)compliance, definitions and assessments of (non)adherence/(non)compliance, and characteristics of the study and the study sample. Furthermore, (if available) correlates of and factors associated with (non)adherence/(non) compliance were recorded. Data of studies investigating what the authors called “adherence” and those investigating “compliance” were pooled.
Results
Articles identified through database search (n = 607)
Articles screened (n = 607)
Articles excluded by title and/or abstract (n = 588)
Full-text articles assessed for eligibility (n = 19)
Full-text articles excluded, with reasons (n = 6)
Remaining articles included in review (n = 13)
Included
Eligibility
Screening
Identification
A total of 607 articles were collected and screened. Of these articles, 588 were excluded by title and/or abstract based on the inclusion and exclusion criteria (see above). Full-text searches were completed for the remaining articles. Six articles were excluded for the following reasons: (1) Four did not state (non)adherence or (non)compliance rates for adolescents; (2) one included participants older than 18 years of age; (3) one did not de facto examine noncompliance but expected noncompliance in case of hypothetical adverse events under psychopharmacological treatment. The remaining 13 publications were selected for review. One of these studies focused on “adolescents” but did not state an age range but a mean age and standard deviation. This study was not excluded. Two further articles could be added identified through searching reference lists. Figure 1 gives a graphic representation of the study selection.
Figure 1. Flow diagram.
© 2016 Hogrefe
Additional articles identified through other sources (n = 2)
Total number of articles included in review (n = 15)
71
In the 15 identified studies, rates of nonadherence ranged between 6 % and 62 % (median 33 %). The details of each study are presented and summarized in Table 1. The studies are presented in chronological order. For each study, data (e. g., percentages) and terminology are presented in the precise form used in the text of the respective publication.
Definitions of (Non)adherence/ Partial Adherence Definitions of nonadherence varied widely (cf. Table 1). Nevertheless, most authors categorized patients as being either “adherent /compliant“ or “nonadherent/noncompliant” (cf. Table 1). However, DelBello et al. (2007) defined a “partial adherence” category, i. e., medication was taken between 25 % and 75 % of the time as prescribed. A similar subgroup can be identified in the study by Coletti et al. (2005). Patients who had failed to take their medication on at least two – but less than ten – occasions within the previous month were classified as neither “fully adherent” nor “poorly adherent.” Based on the results on a 4-point Likert-type questionnaire, Molteni et al. (2014) distinguished between “excellent compliance” (= always taking the medication), “moderate compliance” (= sometimes forgetting the medication, but less than ones a week), “poor compliance” (= more than once a week) and “the absence of compliance” (= never taking the medication).
Methods of Assessment In ten of the studies, nonadherence was assessed on the basis of questionnaires or interviews with the parents and/ or patients (cf. Table 1). Three studies interviewed patients only. In six studies, the parents or the parents and the adolescents were interviewed. Furthermore, some authors used postal questionnaires, while others used telephone or face-to-face interviews. These authors did not give further information on the structure and character of the interview or the questionnaires, particularly no psychometric information regarding reliability and validity. Three studies assessed adherence using data from a health service database rather than through any direct contact with patients and their families (cf. Table 1). One study used pill counts in addition to interviews with patients whose selfreport was considered unreliable (Patel et al., 2005). In contrast, Woldu et al. (2011) assessed what they termed “nonadherence” via plasma levels (level-dose ratio =LDR) and pill counts (clinician pill counts =CPC) rather than relying on patient or parent reports. They reported varying results: Based on LDR, 36.3 % of the patients were considered as nonadherent vs. 49.2 % based on CPC.
Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie (2018), 46 (1), 69–78