Exploring the role of temperament and a single-session psychoeducation on medication adherence in bipolar disorder in...

Bipolar disorder presents unique challenges in diagnosis and treatment may influence both the course of the illness and medication adherence. In Lebanon - a country facing severe economic constraints that hinder continuity of psychiatric care - adherence difficulties are frequent. Although psychoeducation is known to improve adherence, most interventions require multiple sessions. This study explored the relationship between irritable temperament and medication adherence and assessed whether a brief, single-session psychoeducation could improve adherence among Lebanese patients with bipolar disorder. Despite growing evidence supporting psychoeducation in bipolar disorder, there is limited empirical research examining the impact of ultra-brief psychoeducational interventions and temperament-adherence relationships in Middle Eastern populations, particularly in contexts marked by healthcare disruption.

A quasi-experimental pre-post one-group design was used with 130 euthymic participants diagnosed with bipolar disorder (aged 18-65 years; 64% female) recruited from a private mental facility in Beirut. Following a convenience sampling strategy, participants completed the Mini International Neuropsychiatric Interview (MINI), Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto questionnaire (TEMPS-A), and Medication Adherence Rating Scale (MARS). A subsample of 16 participants with high irritability scores and low adherence (MARS <7) attended a 60 min individual psychoeducational session.

Irritable temperament was not significantly associated with adherence (Mann-Whitney U = 755, p > 0.05), although a tendency toward lower adherence was observed among irritable individuals (M = 3.61 ± 0.49 vs. 3.75 ± 0.43). In contrast, adherence scores increased significantly following psychoeducation (MARS-10: 5.38 ± 1.31 → 6.94 ± 1.73, p < 0.01, Cohen's d = 0.87, 95% CI (0.29, 1.43); MARS-4: 2.19 ± 1.11 → 3.13 ± 0.89, p < 0.05, d = 0.70, 95% CI (0.14, 1.23). Effect sizes (Cohen's d) and their 95% confidence intervals were calculated based on paired-samples t statistics.

In this Lebanese sample, irritable temperament did not significantly predict medication adherence. Nevertheless, even a single psychoeducational session was associated with a statistically and clinically meaningful improvement in adherence over six months. Given the small intervention subgroup, findings should be interpreted with caution. The results highlight the feasibility of brief, culturally adapted psychoeducation for enhancing adherence in low-resource Middle Eastern settings and support further controlled trials with larger samples.