Medication nonadherence and its associated factors in psychiatric patients in India: A systematic review and meta-analysis

Parthasarathy Ramamurthy; Arya Jayasree; Susan Solomon; Vishnu V Rudravaram; Vikas Menon; Pradeep Thilakan

doi:10.4103/indianjpsychiatry.indianjpsychiatry_249_22

Medication nonadherence and its associated factors in psychiatric patients in India: A systematic review and meta-analysis

Indian J Psychiatry. 2023 May;65(5):506-525. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_249_22. Epub 2023 May 15.

Authors

Parthasarathy Ramamurthy¹, Arya Jayasree², Susan Solomon¹, Vishnu V Rudravaram³, Vikas Menon⁴, Pradeep Thilakan¹

Affiliations

¹ Department of Psychiatry, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry, India.
² Department of Pharmacology, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry, India.
³ Department of Statistics, Pondicherry University, Kalapet, Puducherry, India.
⁴ Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantari Nagar, Puducherry, India.

PMID: 37397842
PMCID: PMC10309262
DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_249_22

Abstract

Medication nonadherence (MNA) poses a significant challenge in the management of major psychiatric disorders. The present study was undertaken to determine the prevalence of MNA among patients with psychiatric disorders in India and to identify the factors associated with MNA. The following databases were searched systematically: PubMed, Directory of Open Access Journals, and Google scholar. Articles originating from India published in peer reviewed English language journals before May 15, 2021 reporting the prevalence of MNA and associated factors among patients with psychiatric disorders were retrieved and the relevant data were abstracted. The pooled prevalence of MNA was calculated using the inverse variance method. Factors associated with MNA were synthesized and described. A total of 42 studies (pooled N = 6,268) were included in the systematic review. Among these, 32 studies (pooled N = 4,964) reported the prevalence of MNA and hence were eligible for meta analysis. The pooled prevalence of MNA was 0.44 (95% confidence interval [CI] 0.37-0.52). The pooled prevalence of MNA for psychotic disorders, bipolar disorders, and depressive disorders were 0.37 (95% CI, 0.28-0.46), 0.47 (95% CI, 0.23-0.72), and 0.70 (95% CI 0.60-0.78), respectively. Negative attitude toward medications, polypharmacy, greater severity of illness, lack of insight, and cost of medications were associated with MNA. Quality appraisal of the included studies revealed that most studies did not categorize and address nonresponders and did not provide any information on nonresponders. To conclude, about half of the patients with psychiatric disorders in India are nonadherent to their psychotropic medications. Evidence based interventions to improve medication adherence in these patients need to be developed and implemented proactively keeping in mind the factors associated with MNA.

Keywords: Anxiety disorder; depressive disorder; medication nonadherence; medication noncompliance; mental disorder; psychotic disorder.

Publication types

Review