[Psychosocial determinants of lithium compliance in patients with bipolar disorder]

Physical, cognitive, and social factors play a central role in the lithium compliance of people with bipolar disorder. However, studies provide only a partial understanding of this phenomenon and there is currently no nursing model that takes into consideration a combination of factors. This study, based on Pender's preventive health beliefs model, was intended to identify the psychosocial determinants of lithium compliance. A random sample (n = 149) of outpatients at a large Montreal psychiatric hospital was used to measure lithium compliance on the basis of 5 criteria: compliance according to the nurse and according to the patient, appointment compliance, and compliance according to two criteria related to hyperuricemia. Polytomous logistic regression analyses were computed by regressing a composite of these criteria on sociodemographic variables and on the variables of the Pender model: susceptibility, seriousness, control over health, motivation to be healthy, perceived benefits and obstacles, and triggering factors. It appears that being female, being elderly, living with a partner, and perceived treatment benefits and obstacles are determining factors in lithium compliance. These results are all the more important in light of Quebec's newly implemented drug insurance plan, which could increase the obstacles to medication. Nurses will have to be increasingly vigilant with respect to these new obstacles and will have to adjust their interventions accordingly.