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Association Between Adherence Barriers, Self-Reported Adherence, and Psychiatric Symptoms Among Adults With Bipolar
Martha Sajatovic1,2, Jennifer B Levin1,2, Clara Adeniyi1
1Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
Bipolar Disorders
|November 12, 2025
Summary
Individuals with bipolar disorder (BD) who struggle with medication adherence show more severe mood symptoms. Key barriers include lifestyle routines and substance use, highlighting the need for targeted interventions to improve adherence.
Area of Science:
- Psychiatry
- Clinical Psychology
- Pharmacology
Background:
- Suboptimal medication adherence is a significant challenge for individuals with bipolar disorder (BD).
- Understanding individual characteristics and specific barriers associated with adherence levels is crucial.
- This study presents interim findings from an ongoing randomized controlled trial (RCT).
Purpose of the Study:
- To examine the associations between patient-reported adherence, adherence barriers, and mood symptoms in individuals with BD.
- To identify specific factors contributing to medication non-adherence in BD.
- To inform the development of targeted interventions for improving adherence in BD.
Main Methods:
- An interim analysis of 129 participants from an RCT involving adults (≥18 years) with BD Type 1 or 2.
- Participants were actively symptomatic and had difficulties with medication adherence.
- Adherence was measured using the Tablets Routine Questionnaire (TRQ), and barriers were assessed using the Oxford Bipolar Knowledge Questionnaire (OBQ), Self-Report Habit Index (SRHI), Communication Styles Scale (CSS), and Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES 8A).
Main Results:
- Poorly adherent individuals with BD exhibited significantly higher scores on the Montgomery Asberg Depression Rating Scale (MADRS) and Brief Psychiatric Rating Scale (BPRS) at both screening and baseline.
- The Self-Report Habit Index (SRHI) was inversely correlated with TRQ at screening and baseline.
- The SOCRATES 8A (Taking steps sub-scale) was also inversely correlated with TRQ at baseline.
Conclusions:
- Individuals with BD experiencing poor adherence present with more severe global psychopathology and depressive symptoms.
- Identified adherence barriers include lifestyle routines hindering regular medication intake and challenges with substance use reduction.
- Adherence promotion efforts should focus on specific, actionable barriers to effectively manage BD.
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