Nicole M. Lanouette|David P. Folsom|Andrés Sciolla|Dilip V. Jeste
Psychotropic Medication Nonadherence Among United States Latinos: A Comprehensive Literature Review
back table contents previous article next article articlefull accesspsychotropic medication nonadherence among united states latinos comprehensive literature reviewnicole lanouette mddavid p folsom md mphandres sciolla mddilip v jeste mdnicole lanouette mddavid p folsom md mphandres sciolla mddilip v jeste mdpublished online13 jan 2015httpsdoiorg101176ps2009602157aboutsectionspdfepub toolsadd favoritesdownload citationstrack citations shareshare onfacebooktwitterlinked inemail medication nonadherence among patients psychiatric disorders schizophrenia bipolar disorder depression major barrier favorable treatment outcomes suboptimal adherence psychotropic medications disorders associated relapse significantly psychiatric hospitalizations emergency room visits poorer mental functioning lower life satisfaction disabilityrelated absences work greater substance use increased suicidal behavior poorer adherence medications comorbid medical conditions higher health care costs 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 unfortunately nonadherence antipsychotics antidepressants mood stabilizers common previous literature reviews noted rates ranging 10 77 mean rates 3560 17 18 19 20 previous studies established risk factors nonadherence including limited insight negative attitude subjective response toward medication shorter duration illness comorbid substance abuse poor therapeutic alliance living alone selfreported side effects limited family support 18 19 20 however many previous studies significantly limited conducted predominantly euroamerican populations ethnic racial disparities adherence noted nonwhite patients found likely lower adherence 3 21 22 23 latinos largest rapidly growing minority group united states constituting 13 population 24 40 foreignborn 75 immigrants children immigrants 25 acculturation process individuals adopt attitudes values customs beliefs behaviors another culture 26 found mixed health effects latinos including mental health effects 27 28 29 prevalence rates psychiatric disorders lower among latinos less acculturated disorder less likely receive mental health treatment 30 31 given health acculturation relationships acculturation could potentially affect adherence via example physicianpatient communication health literacy ethnic differences previously noted latinos number use prescriptions psychotropics 32 33 psychotropic dosing needs 34 response psychotropics 35 tolerability latinos 36 37 however knowledge yet comprehensive review literature examining psychotropic adherence among latinos living united states includes frequency nonadherence factors associated influences language acculturation nonadherence objectives assess rate nonadherence psychotropic medications among latinos living united states compare rate ethnic minority groups euroamericans identify culturally relevant factors influence adherence among latinosmethodsdata sources searched medline psycinfo databases using combinations following keywords antipsychotic mood stabilizer antidepressant lithium neuroleptic psychotropic schizophrenia bipolar disorder depression adherence compliance latino hispanic ethnicity spanish language acculturation searched articles published since 1980 reported studies measured prevalence adherence antipsychotics antidepressants mood stabilizers among latino adults united states reference lists recent reviews 18 19 20 38 39 also examined bibliographies potentially relevant articles study selectionwe identified 518 papers searches one authors nml read every title identified 214 potentially relevant articles screening broad inclusion criteria used excluded studies examined adherence among patients nonpsychiatric illnesses focused nonpsychiatric medications example adherence highly active antiretroviral therapy hivaids also excluded articles english spanish articles reported studies pediatric populations studies conducted outside united states search spanishlanguage literature revealed potentially relevant studies conducted populations outside united statesthe 214 potentially relevant articles read detail one authors included studies us populations including people living puerto rico although studies psychotropic medication adherence included population english spanish studies spanish include latinos measure adherence nonadherence including selfreport medication discontinuation rates antidepressants antipsychotics mood stabilizers prescribed depression schizophrenia schizoaffective disorder bipolar disorder even adherence primary focus study studies also examine ethnicity variable related adherence report adherence rates ethnic groups studies could determine whether significant differences ethnic groups studies included latino participants studies examine adherence factors influencing adherence excluded studies measure separate adherence rates latinos included children adolescents examined medication adherence medications antidepressants antipsychotics mood stabilizers examined adherence antidepressants antipsychotics mood stabilizers prescribed diseases listed example excluded studies anxiety dementia studies also excluded study dropout rates reported rather medication discontinuation adherence rates many factors cause study dropout necessarily cause nonadherence criterion led exclusion widely cited study found latinos likely euroamericans drop clinical trial identified reasons study discontinuation 36 data extraction 214 initially identified articles 193 excluded 21 included final analysis 1 6 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 results one study reported two different articles 52 53 counted articles one study one included study 44 examined adherencerelated factors subset sample another study 43 counted one study used nonadherence rate reported larger sample 43 calculation mean nonadherence rate studies including latinos 21 studies two authors nml dpf examined study design objectives location patient population medications studied participant characteristics including preferred language participants providers reported measures adherence rates adherence overall raceethnicity associations raceethnicity adherence including statistical measures adherencerelevant factors identified consistency use terms adherence nonadherence throughout review replacing terms compliance noncompliance used studies calculation nonadherence rates standardization studies reported adherence rates calculated nonadherence rates report studies examined adherence nonadherence therefore studies provided information additional categories adherence persons partially adherent excess fillers filled prescriptions frequently expected 6 40 58 59 60 report rates provided table 1 however mean nonadherence rate calculations used summed partial adherence nonadherence excess filler rates nonadherence rate one article 40 reported separate adherence rates ethnicity diagnosis article give separate rates table 1 however calculating mean nonadherence rates averaged nonadherence rates patients different diagnoses within ethnic group table 1 studies medication nonadherence sample included us latinos onlytable 1 studies medication nonadherence sample included us latinos onlyenlarge table although measure medication adherence ideal measures demonstrated reliability others patient caregiver reports physician reports adherence shown underestimate adherence 61 62 whereas adherence calculated use medication event monitoring system mems caps electronic bottle caps pharmacy fill records example medication possession ratios mprs cumulative possession ratios cprs shown generally objective measures 3 62 therefore also separately analyzed 11 articles reported studies used typically objective measures 1 6 46 48 51 52 54 56 58 59 60 data analysis statistics studies comparison data available investigators compare adherence rates separate racial ethnic groups used chi square tests test significance differences adherence rates group performed secondary calculations 11 studies nonadherence percentage calculations three studies 51 55 56 chi square tests two studies 50 57 percentage calculations chi square tests six studies 1 40 47 49 58 60 two studies unadjusted adjusted nonadherence rates yielded conflicting results 55 56 included findings used results multivariate analysis comparing rates racial ethnic groups used two methods compare nonadherence rates racial ethnic groups first examined mean nonadherence rates across studies included calculating effect size difference rates latinos euroamericans second counted number studies compared rates among groups report many studies find significant differences calculate effect size used spss version 1201 pool nonweighted nonadherence means standard deviations across studies used online effect size calculator webuccsedulbeckerpsy590escalc3htm used online chi square calculators wwwgraphpadcom wwwquantpsyorg chi square calculations used spss version 1201 descriptive statistics racial ethnic group terminologythe terminology racial ethnic groups literature highly varied purposes review term us latino includes anyone residing united states including puerto rico mexican central american south american puerto rican cuban ancestry use terms african american refer us residents trace ancestry africa euroamerican us residents european ancestry studies used hispanic black caucasian replaced terms latino african american euroamerican respectively standardization country origin participants specified study include information understand definitions limitations group people highly diverse backgrounds studies reported separate adherence rates asian americans racial ethnic groups number asianamerican patients patients groups studies typically small unable compare nonadherence rates risk factors latinos groupsresultsdescription studies prevalence nonadherence 21 studies tables 1 2 met inclusion criteria 1 6 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 showed great heterogeneity terms study design objectives population studied table 1 shows four investigations latino participants table 2 shows 17 studies included latinos ethnic groups table 2 studies medication nonadherence sample included us latinos us ethnic groupstable 2 studies medication nonadherence sample included us latinos us ethnic groupsenlarge table terms study design 13 studies prospective eight retrospective study objectives varied studies focused specifically adherence 1 6 41 44 45 46 47 49 51 52 53 54 55 56 57 58 59 60 others addressed different questions measured adherence part procedures eight studies based california 6 42 43 47 48 50 54 55 two texas 41 51 one new mexico 52 one new york 49 one connecticut 56 one ohio 40 four studies national registries veterans health administration 46 58 59 60 three national studies 1 45 57 twelve studies investigated nonadherence antipsychotics 1 6 41 42 43 46 49 50 51 54 58 59 five examined antidepressants 45 47 52 55 57 two examined mood stabilizers 48 60 two examined combination medications 40 56 ten studies focused schizophrenia schizoaffective disorder 1 6 41 42 43 49 50 51 59 five focused depression 45 47 52 55 57 three focused bipolar disorder 48 58 60 three involved combination diagnoses 40 54 56 total sample size 21 studies ranged 40 44637 meansd602413268 17 studies included latinos racial ethnic groups percentage latino participants ranged 29 56 mean203195 seven studies reported preferred language proportion spanishspeaking participants ranged none 100 mean457350 seven studies country origin ancestry latino participants reported primarily mexico four studies 41 43 50 51 primarily puerto rico two 40 56 mix mexico guatemala el salvador one 42 studies used range adherence measures including patient report 50 55 chart review physician report 41 combination patient family report chart review 43 49 medication discontinuation patient report 45 47 57 pill counts returned pills 46 mems caps 56 calculations pharmacy records including cumulative mean gap ratio cmgr mpr cpr 1 6 48 51 52 58 59 60 urine testing metabolites 54 two studies describe adherence measure 40 42 nineteen studies reported time period adherence examined ranged one week 48 months mean102103 months nonadherence rates three four studies included latinos 41 43 45 table 1 reported nonadherence rates ranged 330 550 mean440110 fourth 42 explored risk factors nonadherence among latinos detail rates discussed 17 studies included latinos racial ethnic groups table 2 12 1 6 40 47 49 50 51 52 56 57 58 60 provided data allowing comparison nonadherence rates latinos euroamericans mean nonadherence rates latinos euroamericans 394157 292165 respectively yielding overall effect size 64 ten studies also data available african americans 1 6 47 49 50 51 56 57 58 60 nonadherence rates studies follows latinos range 172631 mean410163 euroamericans range 100572 mean313172 african americans range 227651 mean432169 one study reported separate rates ethnicity diagnosis 40 showed difference nonadherence rates latinos schizophrenia compared euroamericans schizophrenia nonsignificant trend p055 toward higher nonadherence rates among latinos compared euroamericans patients depression comparison rates racial ethnic groups sixteen studies evaluated differences nonadherence rates latinos euroamericans addition 12 studies reported nonadherence rates latinos euroamericans four studies measured compared nonadherence rates two groups provide details 16 studies six found statistically significant differences 1 40 46 48 49 54 nine found latino patients significantly higher nonadherence rates 6 47 50 51 52 57 58 59 60 one found monolingual spanishspeaking patients bilingual patients likely nonadherent euroamerican patients 56 ten 14 studies african americans significantly greater nonadherence rates euroamericans 1 6 46 49 51 54 56 58 59 60 whereas four found difference 47 48 50 57 seven ten studies compared rates latinos african americans found difference 1 47 49 50 51 three found latinos lower nonadherence rates 54 58 60 objective measures adherence eleven studies 1 6 46 48 51 52 54 56 58 59 60 used mems caps calculations pharmacy data including mprs cprs cmgrs urine testing none studies included latinos used methods six 11 studies reported rates group 1 6 51 56 58 60 studies mean nonadherence rate 437187 latinos 365189 euroamericans 495177 african americans outcomes factors related latino nonadherence five 21 studies 41 42 43 44 45 56 included majority latino participants examined outcomes risk protective factors nonadherence specifically latinos table 3 table 3 factors potentially related psychotropic medication adherence among us latinos reference numbers studies investigated themtable 3 factors potentially related psychotropic medication adherence among us latinos reference numbers studies investigated themenlarge table one study 56 made crosscultural comparisons risk factors investigating significant factors group thus unable answer question relative importance identified factors latinos compared groups except comparisons previously published reviews also little overlap reports terms factors examined therefore direct comparisons relative importance identified factors possible one study made crosscultural comparisons identified older age among monolingual spanishspeaking latinos years previous treatment fewer depressive symptoms among euroamericans predictors higher adherence 56 nonadherence found predict worse illness course two studies examined healthrelated outcomes nonadherence 42 43 language acculturation nonadherence two studies explored relationship patients preferred language nonadherence found monolingual spanish speakers significantly likely nonadherent 45 56 even controlling important cofactors age number symptoms two studies evaluated interaction acculturation nonadherence one found acculturation related adherence 41 one found less acculturated patients significantly less adherent 42 language used proxy acculturation 63 64 65 66 three 42 45 56 four studies 41 42 45 56 found higher nonadherence less acculturated latinos socioeconomic status likely particularly important potential cofactor relationship nonadherence language acculturation examined whether studies controlled socioeconomic status studies found monolingual spanish speakers likely nonadherent one study controlled socioeconomic status controlling education health insurance status 45 study patients similar socioeconomic status access services 56 studies examined acculturation one controlled socioeconomic status 41 found socioeconomic status acculturation significantly associated nonadherence control socioeconomic status majority participants similarly lower socioeconomic groups 42 providers language ethnicity nonadherence one study assessed effect providers language found latino patien