Predicting Medication Adherence in Youths With Severe Mental Illness

child holding pills
child holding pills
These data provide insight into the specific risk factors for nonadherence in youths with mental disorders.

Medication nonadherence rates are high in youths with severe mental illness, according to study results published in the Journal of Child and Adolescent Psychopharmacology.

Investigators conducted a systematic literature review of peer-reviewed studies assessing psychopharmacologic treatment adherence in youths aged ≤18 with a primary psychotic disorder, bipolar disorder, depression, recent suicide attempt, or psychiatric hospitalization. Researchers assessed sociodemographic factors, comorbidities, and medication regimens for predictive influence on medication adherence. Heterogeneity between study methods was mediated per subgroup analyses and meta-regression.

A total of 28 studies were identified per inclusion criteria, providing data for a total of 180,783 youths (mean age, 12.3; 45.4% women). Across the combined study populations, 543 youths had psychotic disorders, 1744 had depressive disorders, 6170 had bipolar disorders, and 172,413 had mixed psychiatric conditions. Across these patients, just 65.9% were medication-adherent. Comorbid alcohol use (P =.008), substance use (P =.020), attention-deficit/hyperactivity disorder (P =.008), and medical illness (P =.033) were each predictive of medication non-adherence. Meta-analyses also identified several interpersonal factors predicting medication adherence, including positive patient (P =.001) and family (P =.001) attitudes towards care, higher patient insight levels (P =.003), and positive clinician-patient relationships (P =.002). Sociodemographic analyses identified increased illness severity (P <.0010) as a risk factor for nonadherence. Patients adhering to psychotherapy were more likely to adhere to pharmacologic treatment (P <.001). Of note, medication type was not predictive of adherence, nor was regimen complexity. However, youths treated with medications with high adverse event profiles were at higher risk for nonadherence (P =.029).

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These data provide insight into the specific risk factors for nonadherence in youths with mental disorders. Attention by clinicians to these risk profiles could increase medication uptake and adherence in vulnerable populations. 


Edgcomb JB, Zima B. Medication adherence among children and adolescents with severe mental illness: a systematic review and meta-analysis [published online July 24, 2018]. J Child Adolesc Psychopharmacol. doi:10.1089/cap.2018.0040