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J Affect Disord. 2009 Jul;116(1-2):51-5. doi: 10.1016/j.jad.2008.11.004. Epub 2008 Dec 19.

Understanding medication non-adherence in bipolar disorders using a Necessity-Concerns Framework.

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Centre for Behavioural Medicine, School of Pharmacy, University of London, UK.



Medication non-adherence is a major problem in patients with severe mental disorders and is associated with poor clinical outcomes and high resource utilization. This study examined the utility of the Necessity-Concerns Framework for understanding patient attitudes towards and levels of adherence with medications prescribed for bipolar disorders.


A convenience sample of 223 individuals currently prescribed medication for bipolar disorders, recruited by advertisement in a Manic Depression Fellowship newsletter, completed the Beliefs about Medication Questionnaire and the Medication Adherence Report Scale.


Low adherence was reported by 30% (n=64) and was predicted by greater doubts about personal need for treatment (OR=.50; 95% CI: .31-.82) and stronger concerns about potential negative effects (OR=2.00; 95% CI: 1.20-3.34). These predictors were independent of current mood state, illness and demographic characteristics.


Participants were a potentially biased sample of volunteers who had been recruited through a patient organisation newsletter. However, clinical characteristics and adherence rates in this study were similar to those reported in other studies conducted in Europe and the USA.


The Necessity-Concerns Framework is a useful theoretical model for understanding key attitudes towards medication in bipolar disorders. Interventions to facilitate adherence should elicit and address patients' beliefs about medication.

[Indexed for MEDLINE]

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