Mental illness is a broad term describing a range of disorders that affect one’s thinking, behavior, and mood [1]. It is a condition characterized by severely impaired social life and clinically significant disruption in various aspects of mental functioning. Mental illness includes schizophrenia, paranoid disorder, bipolar disorder, schizoaffective disorder, epileptic mental disorder, and intellectual disability which is considered a global public health problem [1, 2].
The success of medication treatment is determined on a patient’s adherence to the medication regimen. Non-adherence to medical therapy is a known predictor of relapse and re-hospitalization, therefore identifying contributing factors to non-adherence is one of the many challenges in treating mental illness. Non-adherent patients are 70% more likely to be admitted to the hospital than patients with partial adherence, who are 30% more likely to be admitted than adherent patients [3].
Adherence refers to the degree to which patients follow health professionals’ guidance regarding prescribed medication and maintain the indicated treatment as well as continuing to follow their instruction throughout the duration of drug therapy [4, 5]. It’s a concept that expresses the patients’ acceptance and understanding of the need to be treated voluntarily and manifests the degree of their acceptance and understanding with a positive or negative attitude towards drugs [6]. Non-adherence is a complicated phenomenon, with a wide variety of patterns. The patient might either take lower or higher doses of the prescribed medication, follow a schedule other than prescribed, completely quit the treatment or refuse attending regular visits or being admitted to hospital [7, 8].
Non-adherence to medication is a major public health problem that has been called an “invisible epidemic”[9, 10]. Non-adherence to antipsychotic is one of the common challenges to successful treatment of mental illness and is a frequent cause of exacerbations in psychopathology, psychotic relapse and re-hospitalization. Medication non adherence is a growing concern to clinicians, the health care system, and other stakeholders. It compromises the efforts of the health providers in improving the health of populations. It causes wastage of health care resources, and reduce public confidence in health care systems,[9, 11, 12]. It has also a significant impact on the disease course, relapse, future recovery, patients’ quality of life, and the outcome for the patient [1]. It is a frequent cause of impairment, hospitalization,, suicide, loss of job, violence, substance abuse and psychiatric emergences [13].
Mental illnesses have been a significant public health challenge globally. Globally, around half billion people are affected by psychiatric disorders worldwide. It contributes 14% of the overall global morbidity burden, and 30% of the non-fatal diseases burden. Adherence to medication is crucial but challenging in the management of most psychiatric disorders [14–16].
In Africa, Mental disorders account for 5% of the total burden of disease and 19% of all disability. Approximately one out of four people in Africa may experience what the WHO refers to as common mental illness such as depression or anxiety, with depression having the second highest disease burden on the continent. Mental illness has been characterized as a neglected and increasingly burdensome problem affecting all segments of the population in Africa [17].
Non-adherence to medications is considered as one of the common drug related issues stated that non-adherence to medications is a “worldwide problem of striking burden. Problems with medication adherence are important not in themselves, but because of the negative impact they can have on patients’ health and functioning. Poor medication adherence can cause negative health outcomes like worsening disease or even death [18, 19].
The global estimate of non-adherence rates in mental disorder widely ranging from 4–72%. Reports indicate that up to 50% of patients with mental illness do not adhere to their prescribed medications worldwide [20, 21]. Similar studies were conducted in different part of Africa to determine magnitude of antipsychotic drug non adherence on schizophrenia patients. The prevalence of non-adherence in studies conducted in Nigeria was 54.2% [22], and 55.7% [23]. Reports in Ethiopia have shown that non-adherence to antipsychotics medication was varied from 26.5–47.9% [24].
Identifying the risk factors for non-adherence is an essential step toward designing intervention strategies aimed at reducing this phenomenon. Non-adherence risk factors identified up to date include: A number of demographic and clinical factors associated with medication non-adherence have been reported in previous studies, some of which are negative attitude towards medications, poor insight, previous non-adherence, medication regimen complexity, poor therapeutic alliance, illness duration, social support, medication efficacy, side effects of medications, dosage and route of medication administration, and substance abuse [6, 12, 20].
Medication adherence research has increased significantly over the past decades using observational, interventional and implementation researches. Despite these increased research efforts by many disciplines research has not resulted in the much-needed progress to tackle medication non-adherence effectively [25].
Studies conducted previously were focused on clinical determinants of non-adherence rather than looking at the clients’ behavioral aspects and did not include all mental illnesses. Besides, little is known about the level of non-adherence and its associated factors in the study area among all groups of mental illnesses.
Therefore, this study aimed to determine the level of non-adherence and its associated factors among patients with mental illness Visiting St. Amanuel Specialized Psychiatric Hospital.
Medication non-adherence is a significant clinical concern in patients with mental illnesses than other chronic illness patients. Numerous studies have been conducted on medication adherence among patients with mental illness. However, many of these studies are limited by factors like small sample size and focused on schizophrenia alone while neglecting other psychiatric illnesses.
Furthermore, most of the previous studies were conducted in rich industrialized countries, and it is not known how generalizable their findings to settings where health resources are scarce and unequally distributed, as seen in many developing countries including Ethiopia. In addition, the finding of the study would be useful as scientific evidence for local decision-makers and other stake holders to make an informed decision that would address the best interests of a patient with severe mental illness leading to better health and quality of life. Furthermore, the finding of this study will serve as scientific evidence and essential baseline data for researchers and professionals working in the field of psychiatry (Fig. 1).
Figure 1: Conceptual framework of medication non-adherence and associated factors among patients with mental illness.
Objective
General Objective
To assess medication Non-adherence and associated factor among patients with mental illness visited psychiatric outpatient department at St. Amanuel Specialized Psychiatry Hospital, Addis Ababa, Ethiopia, 2022.
Specific Objective
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To determine the magnitude of medication non-adherence among patients with mental illness who visited psychiatric outpatient department at St. Amanuel Specialized Psychiatry Hospital.
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To identify factors associated with medication non-adherence among patients with mental illness who visited psychiatric outpatient department at St. Amanuel Specialized Psychiatry Hospital.