Ninety-four patients were involved in the study; the mean age was 33.6, 54 (57.4%) were female, and the others were male. Demographic data and psychiatric history of the participants are shown in Table 1&2.
Table 1
Demographic data of participants
Variable | | Frequency (%) |
Employment | Employees | 41(43.6) |
| College students | 10(10.6) |
| Unemployed | 43(45.7) |
Education | Under diploma | 21(22.3%) |
| Diploma and higher | 43(45.8) |
| Bachelor's degree | 21(22.3% |
| Master's degree or higher | 9(9.6%) |
Marital status | Single | 49(52.1%) |
| Married | 32(34%) |
| Divorced | 12(12.8%) |
Medication Adherence | Poor | 46(48.9%) |
| Moderate | 18(19.1%) |
| Good | 30(31.9%) |
Psychotherapy Adherence | Poor | 21(22.3%) |
| Partial | 31(33%) |
| Good | 42(44.7%) |
Table 2
Participants’ psychiatric history
History | Frequency (%) |
Psychiatric Hospitalization | 21(22.3%) |
Family history of psychiatric illness | 34(36.2%) |
Legal problems | 15(16%) |
Self-injury | 30(31.9) |
Suicide attempt | 40(42.6) |
Illegal substance use | 42(44.7) |
Table 1. Demographic data of participants
Table 2. Participants’ psychiatric history
Answers to the researcher made questionnaire about the attitude of patients toward pharmacological and non-pharmacological treatment and therapeutic adherence are shown in Table 3 and reasons for poor/partial drug compliance are shown in Table 4.
Table 3
Insight and tendency for treatment (First part of the questionnaire)
Number | Questions | Answer | | Frequency (%) |
1 | I am sick and need treatment | Yes | | 65(69.1) |
| No | | 29(30.9) |
2 | Lack of treatment can disrupt my life and the lives of those around me | Yes NO | | 59(62.8) 35(37.2) |
3 | Lack of treatment can cause problems in my relationships with others | Yes | | 67(71.3) |
| No | | 27(28.7) |
4 | My illness is treatable | Yes No | | 73(77.7) 21(22.3) |
5 | Medication has not helped my condition | Yes | | 49(52.1) |
| No | | 45(47.9) |
6 | Psychotherapy or counselling did not help my condition | Yes | | 38(40.4) |
| No | | 56(59.6) |
Table 4
Reasons for poor/partial drug compliance (Second part of the questionnaire)
Number | Questions | Answer | | Frequency (%) |
1 | I did not continue the treatment due to the cost of the doctor's visit. | Yes NO | | 12(18.8) 52(18.2) |
2 | I did not go to another center due to travel expenses. | Yes NO | | 10(15.6) 54(84.4) |
3 | Because I was not satisfied with my doctor, I did not see him again. | Yes NO | | 26(40.6) 38(59.4) |
4 | Because I could not easily make an appointment, I did not return. | Yes NO | | 18(28.1) 46(71.9) |
5 | The misbehavior of others and their talk about my illness caused me to stop taking my medication. | Yes NO | | 12(18.8) 52(81.3) |
6 | Drug side effects caused me to stop my medication. | Yes NO | | 34(53.1) 30(46.9) |
7 | I stopped taking the medicine because of the cost of the medicine. | Yes NO | | 13(20.3) 51(79.7) |
8 | Because the duration of my medication was long, I did not take any more medications. | Yes NO | | 21(32.8) 43(67.2) |
9 | I stopped taking it for fear of drug dependence. | Yes NO | | 26(40.6) 38(59.4) |
10 | I stopped psychotherapy due to the cost of psychotherapy. | Yes NO | | 21(32.8) 43(67.2) |
11 | For a long time, my psychotherapy was the reason for interrupting psychotherapy sessions | Yes NO | | 13(20.3) 51(79.4) |
Table 3. Insight and tendency for treatment (First part of the questionnaire)
Table 4. Reasons for poor/partial drug compliance (Second part of the questionnaire)
Moreover, regarding the DAI-10 total score, 54 patients (57.4%) had a negative attitude, and 40 patients (42.6%) had a positive attitude towards the medication.
There was no relationship among gender (P = 0.335), job (P = 0.16), education (P = 0.710), marital status (P = 0.378), history of psychiatric hospitalization (P = 0.812), history of self-injury (P = 0.833), suicide history (P = 0.541), history of substance use (P = 0.857), comorbidity with psychiatric disorders (P = 0.630), family history of mental illness (P = 0.778) and medication adherence.
There was no relationship among gender (P = 0.626), job (P = 0.303), marital status (P = 0.759), history of self-injury (P = 0.364), suicide history (P = 0.649), history of substance use (P = 0.577), comorbidity with psychiatric disorders (P = 0.230), family history of mental illness (P = 0.524) and type of medication used (P = 0.063) and psychotherapy adherence. There was a statistical significant difference between education level and psychotherapy adherence (P = 0.029). The best adherence to psychotherapy was obtained in postgraduate education (with 66% good adherence among this subgroup) and the worst medication adherence in undergraduate education (with 22% good adherence among this subgroup) (P = 0.04). In terms of history of psychiatric hospitalization, there was a significant difference between people with different psychotherapy adherence (P = 0.01); those who had a history of hospitalization had better adherence to psychotherapy than non-hospitalized patients (66% vs. 36.9% of the relevant subgroup).
Regression analysis between medication adherence and significant variables, patients' belief that their disorder is treatable, lack of treatment disrupts their lives and those around them are inversely related to poor and relative medication adherence. Patients with a negative medication attitude are 1.3 times more likely to have poor medication adherence and 2.8 times more likely to have relative medication adherence. Regression analysis between psychotherapy adherences and significant variables showed, patients with postgraduate education are 2.2 times more likely to have good psychotherapy adherence and patients with diploma education are 1.2 times more likely to have poor psychotherapy adherence.
There was a significant relationship between attitudes toward medication and the belief that "lack of treatment disrupts relationships with others". 87.5% of patients with a positive attitude stated that lack of treatment could disrupt their relationships with others. 81.5% of patients who disagreed with this view had a negative medication attitude (P = 0.03). There was a significant relationship between attitudes toward medication and the belief that "their disorder can be treated". 95% of patients with a positive medication attitude believed that their disorder could be treated (P = 0.001). 72.2% of patients who had a negative attitude toward medication, believed that the medication side effects had interrupted their treatment (P = 0.022).