Development of a novel adherence scale for antidepressants in pregnancy: Results from a cross-sectional study

Adherence to antidepressant pharmacotherapy is essential for optimal treatment. Its assessment during pregnancy is challenging, as existing self-report scales are not tailored to pregnancy.

This study aimed to develop a self-report scale to assess antidepressant adherence in pregnancy and evaluate its psychometric properties.

This cross-sectional study used an anonymous online questionnaire administered in Norway between February and March 2022. Participants were pregnant or up-to-12-month postpartum individuals who had used antidepressants during pregnancy. The Medication Adherence Measurement in Pregnancy for Antidepressants (MAMP-AD) scale was developed based on prior research, expert input, and piloting. Exploratory factor analysis (EFA) was used to explore its underlying structure. Reliability was assessed using Cronbach's α. Construct validity was evaluated by examining associations between MAMP-AD scores and depressive and anxiety symptoms, and medication-related beliefs.

Ninety participants who used antidepressants during pregnancy completed the MAMP-AD scale. The final 15-item MAMP-AD scale had a score range of 0 to 48, with higher scores indicating higher adherence. EFA identified three distinct factors: 1) Minimizing exposure, 2) Barriers to antidepressant use, and 3) Benefits of antidepressant use. These explained 81.7% of the total variance in the MAMP-AD scale. The scale showed acceptable reliability (Cronbach's α = 0.80). Higher MAMP-AD scores were negatively associated with depression severity, supporting construct validity.

The MAMP-AD is a newly developed, self-report scale for measuring antidepressant adherence in pregnancy, showing preliminary evidence of acceptable reliability and validity. Further research is needed to confirm the scale's psychometric properties and clinical utility.