Interrupting the Cycle: Association of Parental Stress and Child/Youth Psychotropic Medication Nonadherence

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Abstract

Efficacy of psychotropic medication depends in large part on successful adherence to prescribed regimens. This study investigated child/youth nonadherence in relation to family dynamics and informal support. The participants were 10,225 children and youth prescribed psychotropic medication and receiving services from 50 Ontario mental health agencies, assessed with the interRAI™ Child and Youth Mental Health (ChYMH) and ChYMH-Developmental Disability (ChYMH-DD) tools. Findings suggest a cycle of parental stress and child/youth medication nonadherence possibly leading to or even perpetuated by worsening psychiatric symptoms. Informal supports do not appear to moderate this cycle. While the present data cannot speak to causes of medication nonadherence in children/youth or where the cycle begins, the results are consistent with the extant literature calling for attention to parental wellbeing to support children/youth for optimal therapeutic benefits. Understanding home dynamics related to nonadherence can assist care planning that engages the family to achieve best possible child/youth outcomes.

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The impact of parenting stress: a meta-analysis of studies comparing the experience of parenting stress in parents of children with and without autism spectrum disorder.

Stephanie Hayes, Shelley L Watson (2013)

Researchers commonly report that families of children with autism spectrum disorder (ASD) experience more parenting stress than families of typically developing (TD) children or those diagnosed with other disabilities [e.g., Down syndrome (DS), cerebral palsy, intellectual disability]. The authors reexamined the research using comparison groups to investigate parenting stress and conducted a meta-analysis to pool results across studies. The experience of stress in families of children with ASD versus families of TD children resulted in a large effect size. Comparisons between families of children of ASD and families with other disabilities also generated a large effect size however, this result should be interpreted with caution as it may be associated with the specific experience of parenting a child with DS.

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Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: a systematic review and meta-analysis

Agumasie Semahegn, Kwasi Torpey, Adom Manu … (2020)

Background Major psychiatric disorders are growing public health concern that attributed 14% of the global burden of diseases. The management of major psychiatric disorders is challenging mainly due to medication non-adherence. However, there is a paucity of summarized evidence on the prevalence of psychotropic medication non-adherence and associated factors. Therefore, we aimed to summarize existing primary studies’ finding to determine the pooled prevalence and factors associated with psychotropic medication non-adherence. Methods A total of 4504 studies written in English until December 31, 2017, were searched from the main databases (n = 3125) (PubMed (MEDLINE), Embase, CINAHL, PsycINFO, and Web of Science) and other relevant sources (mainly from Google Scholar, n = 1379). Study selection, screening, and data extraction were carried out independently by two authors. Observational studies that had been conducted among adult patients (18 years and older) with major psychiatric disorders were eligible for the selection process. Critical appraisal of the included studies was carried out using the Newcastle Ottawa Scale. Systematic synthesis of the studies was carried out to summarize factors associated with psychotropic medication non-adherence. Meta-analysis was carried using Stata 14. Random effects model was used to compute the pooled prevalence, and sub-group analysis at 95% confidence interval. Results Forty-six studies were included in the systematic review. Of these, 35 studies (schizophrenia (n = 9), depressive (n = 16), and bipolar (n = 10) disorders) were included in the meta-analysis. Overall, 49% of major psychiatric disorder patients were non-adherent to their psychotropic medication. Of these, psychotropic medication non-adherence for schizophrenia, major depressive disorders, and bipolar disorders were 56%, 50%, and 44%, respectively. Individual patient’s behaviors, lack of social support, clinical or treatment and illness-related, and health system factors influenced psychotropic medication non-adherence. Conclusion Psychotropic medication non-adherence was high. It was influenced by various factors operating at different levels. Therefore, comprehensive intervention strategies should be designed to address factors associated with psychotropic medication non-adherence. Systematic review registration PROSPERO CRD42017067436

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Adherence to treatment with antipsychotic medication and health care costs among Medicaid beneficiaries with schizophrenia.

Laurie Lindamer, Christian R Dolder, David P. Folsom … (2004)

The authors' goal was to evaluate the relationship between adherence to treatment with antipsychotic medication and health expenditures. A secondary objective was to identify risk factors predictive of nonadherence. Data included Medicaid eligibility and claims data from 1998 to 2000 for San Diego County, Calif. Pharmacy records were used to assess adherence to treatment with antipsychotic medication according to the cumulative possession ratio (the number of days medications were available for consumption divided by the number of days subjects were eligible for Medi-Cal). Regression models were used to examine risk factors, hospitalizations, and costs associated with nonadherence, partial adherence, adherence, and excess fills of antipsychotic medication. Forty-one percent of Medicaid beneficiaries with schizophrenia were found to be adherent to treatment with their antipsychotic medications: 24% were nonadherent, 16% were partially adherent, and 19% were excess fillers. Rates of psychiatric hospitalization were lower for those who were adherent (14%) than for those who were nonadherent (35%), partially adherent (24%), or had excess fills (25%). Rates of medical hospitalization were lower for those who were adherent (7%) than for those who were nonadherent (13%) or had excess fills (12%). Those who were adherent had significantly lower hospital costs than the other groups; pharmacy costs were higher among those who were adherent than among those who were nonadherent or partially adherent and were highest for excess fillers. Total costs for excess fillers (14,044 US dollars) were substantially higher than total costs for any other group. Despite the widespread use of atypical antipsychotic medications, alarmingly high rates of both underuse and excessive filling of antipsychotic prescriptions were found in Medicaid beneficiaries with schizophrenia. The high rates of antipsychotic nonadherence and associated negative consequences suggest interventions on multiple levels.

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Author and article information

Contributors

Laura Theall:

ORCID: http://orcid.org/0000-0002-6483-5870

laura.theall-honey@ontario.ca

Journal

Journal ID (nlm-ta): Child Psychiatry Hum Dev

Journal ID (iso-abbrev): Child Psychiatry Hum Dev

Title: Child Psychiatry and Human Development

Publisher: Springer US (New York )

ISSN (Print): 0009-398X

ISSN (Electronic): 1573-3327

Publication date (Electronic): 28 October 2022

Publication date PMC-release: 28 October 2022

Pages: 1-7

Affiliations

[1 ]Applied Research & Education, Child and Parent Resource Institute, 600 Sanatorium Road, N6H 3W7 London, ON Canada

[2 ]GRID grid.39381.30, ISNI 0000 0004 1936 8884, Division of Child and Adolescent Psychiatry, , Western University, Parkwood Institute Mental Health Care Building, ; F4-430, N6C 0A7 London, ON Canada

[3 ]GRID grid.39381.30, ISNI 0000 0004 1936 8884, Faculty of Education, , Western University, ; 1151 Richmond Street, N6A 3K7 London, ON Canada

Author information

Laura Theall http://orcid.org/0000-0002-6483-5870

Article

Publisher ID: 1448

DOI: 10.1007/s10578-022-01448-y

PMC ID: 9614754

PubMed ID: 36306028

SO-VID: b18ac219-5515-4919-8806-262b9e4c8f43

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Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 30 March 2022

Date revision received : 14 September 2022

Date accepted : 16 September 2022

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Interrupting the Cycle: Association of Parental Stress and Child/Youth Psychotropic Medication Nonadherence

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Most cited references 29

The impact of parenting stress: a meta-analysis of studies comparing the experience of parenting stress in parents of children with and without autism spectrum disorder.

Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: a systematic review and meta-analysis

Adherence to treatment with antipsychotic medication and health care costs among Medicaid beneficiaries with schizophrenia.

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