Non-adherence to Antidepressant Treatment and its Predictors among Outpatients with Depressive Disorders, a Hospital-based Ccross-sectional Study in Addis Ababa, Ethiopia
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Date
2020-10
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Addis Abeba University
Abstract
BACKGROUND: In Ethiopia, there is inadequate information on non-adherence to
antidepressant treatment in patients with depressive disorders. Having awareness of the pattern of
adherence is important in future prognosis, quality of life and functionality in these patients. This
study will be conducted to assess the prevalence of Non-Adherence to Antidepressant treatment
and its predictors among Psychiatry Outpatients with Depressive Disorders.
METHODS: A hospital-based cross-sectional quantitative study was conducted at the psychiatry
clinic of Tikur Anbessa Specialized Hospital. A sample of 216 consecutive outpatients with
Depressive disorders who visited the Psychiatry clinic since June 2019 and who had at least two
visits prior to their last visit were enrolled. Data was collected using questionnaires through inperson
and
phone
call interviews. The eight-item Morisky scale, a scale extensively used in the
Ethiopian setting, was used to assess the pattern of medication adherence. Other specially
developed tools were used to obtain sociodemographic and clinical information from electronic
medical records and patient interviews. Data was analyzed using the Statistical Package for the
Social Sciences (SPSS), Version - 25. Univariate and multivariable analyses were carried out to
assess factors associated with non-adherence.
RESULTS: Ninety percent of the participants who were taking antidepressant medication were
found to have a primary diagnosis of Major Depressive Disorder. Based on the 8-item Morisky
Medication Adherence Scale, the prevalence of non-adherence was found to be 84.7%. Living
distance between 11 to 50 kms from hospital (AOR= 11, 95% CI (29,46.6)), post-secondary level
of education (AOR= 8.3, 95% CI (1, 64.4)), taking multiple medications (AOR= 6.1, 95% CI (1,
34.9)) were found to have significantly increased odds of non-adherence.
CONCLUSION: The prevalence of non-adherence is very high among patients with depressive
disorders. Non-adherence was significantly associated with factors such as increased living
distance from the hospital, relatively higher educational level, and polypharmacy. Proper and
patent centered psychoeducation to patients, addressing the communication gap between patients
and doctors, clinicians’ adherence to prescribing guidelines, avoiding polypharmacy unless
indicated, and working on accessibility of treatment for common mental disorders is essential to
decrease non-adherence. Larger analytical studies to further establish causal relationships to nonadherence
and
its
impact
on depression
treatment
outcomes
are
recommended.
Description
Keywords
Medication Adherence, Depressive disorders, Tikur Anbessa Specialized Hospital, Ethiopia