Medication adherence and its determinants in patients with schizophrenia: A cross-sectional observational study.

Abstract

Background: Medication adherence is critical for optimal clinical outcomes in schizophrenia. Non-adherence contributes to symptom relapse, increased hospitalizations, and poor functional recovery. Identifying the factors associated with adherence may guide targeted interventions.

Objectives: To assess the level of medication adherence among patients with schizophrenia and to identify sociodemographic and clinical factors associated with poor adherence.

Methods: This cross-sectional observational study was conducted on 100 patients diagnosed with schizophrenia attending the psychiatry outpatient department of a tertiary care hospital. Medication adherence was measured using the Medication Adherence Rating Scale (MARS). Sociodemographic data, clinical history, and relevant correlates such as insight, substance use, and family support were recorded. Statistical analyses included chi-square tests, t-tests.

Results: Among the 100 patients, 37% exhibited high adherence, 26% showed moderate adherence, and 37% had low adherence, with a mean MARS score of 5.6 ± 2.3. Poor adherence was more frequent among unemployed and less-educated individuals, whereas no significant associations were noted with age or marital status. Clinically, poor adherence was significantly linked to longer illness duration (p = 0.002), poor insight (p < 0.001), absence of family support (p = 0.001), and concurrent substance use (p = 0.003). Multivariate analysis further confirmed poor insight (AOR = 5.61, p < 0.001), illness duration beyond five years (AOR = 2.84, p = 0.015), substance abuse (AOR = 2.91, p = 0.023), and lack of family support (AOR = 3.42, p = 0.025) as independent predictors of poor adherence.

Conclusions: The findings highlight a high burden of non-adherence in schizophrenia, predominantly influenced by modifiable psychosocial and clinical factors. Interventions must be tailored to improve insight, support systems, and address substance use.

Recommendations: Early psychoeducation, active caregiver engagement, and dual diagnosis interventions are essential strategies to enhance adherence and prevent relapse among patients with chronic schizophrenia.