Research on How Compliance with a Mental Health Medication Regimen Improves Recovery

 

Research on How Compliance with a Mental Health Medication Regimen Improves Recovery

 

Compliance with a Mental Health Medication Regimen to Improves Recovery Outcomes

Introduction

For an individual to be considered healthy, there must be harmony in the physical, social, and mental fitness. A correlation can be drawn in relating these three strands of life, necessitating the need to pay attention to mental health as an effect on any one of them leads to the demise of the others. Mental health problems are a burden to costs, families and societies (DiMatteo et al., 2002). Out of the six leading causes of disability in the today population, four of them are related to neuropsychiatric disorders. As many as 450 million are affected by mental health disorders with one million of them committing suicide every year. The massive burden of the medication and reforms sensitizing people on mental health issue project a problem that is escalating every day (Osterberg & Blaschke, 2005).  On the other hand, there is still the association of mental health with stigma, which creates a curtain that hinders medication for the patients, with even the most advanced societies segregating the patients from accessing some of the most basic services necessary for comfortable living (Osterberg  & Blaschke, 2005). Those who have been able to come forth are also facing another problem of compliance with mental health medication. Several factors have been identified to cause the non-compliance but then there has been a knowledge gap on the effects compliance, or non-compliance has to the mental health patient. The research will, therefore, seek to fill these gaps.

Objectives of the Research

  1. Identify Cases of compliance in patients
  2. Identify the effects compliance had on the patients
  3. Recommend strategies to promote compliance with mental medical care regimen among patients.

The hypothesis for the Research

  1. Compliance with a mental health medication regimen improves recovery outcomes, such as independent living.
  2. Reduced psychosomatic risk factors will be linked to compliance with treatment. The threat factors are related to medical non-adherence.
  3. Reduction of the social and environmental risk factors associated with non-compliance will ensure medication adherence by the patients.

Compliance with a mental health medication regimen

In drug prescription, compliance refers to the extent to which the patient follows the medication treatment instructions when taking the drugs. Adherence to medical regimens is a standard issue among several branches of medicine, in mental health issues; it has more challenges and increases the risks. Compliance with the therapeutic regimens is associated with alleviation of the psychotic problems.  A recent study revealed that mental health patients took 58% of the prescribed antipsychotic and 65% of antidepressants. Most of the mental health issues have long treatment periods, and some go to the extent of lifelong medication.

Several factors affect the compliance of the mental health patients to the medical regimen.  One of them is the patient’s characteristics that define the personal attributes of the patients that could change their perspective towards the regimen. It includes attitudes towards mental illness and its medication, the social-economic condition of the patient and the social supervision that is around the patient (DiMatteo et al., 2002).  The treatment setting also affects compliance with the medical regimen. The medical background includes primary care, specialty office and inpatient. Patients would respond differently to adherence when in a different context.  The medical characteristics also affect compliance (Brus et al., 1999). They include the side effects of the drugs, the sensitivity of an individual to the medication, and the complicated or straightforward medication dosage type.  The mental disorder itself would affect the adherence to the regimen. Clinical characterization of the psychological disorder includes chronicity, suspiciousness, substance abuse, depression, feelings of guilt, and corm bid anxiety are the few ones (Osterberg  & Blaschke, 2005).  Finally, the level of the clinical expertise administering the regime will influence the adherence.  The knowledge base of the practitioner, how they instill hope, integration of pharmacology and psychotherapy will directly impact the patient on compliance matters (Brus et al., 1999).

Different psychotropic medications have diverse effects on people, with the side effects of noncompliance affecting various people differently, the impactof the drugs vary from person to person. The common side effects observed in the medical field include wrangling, jitteriness, sleep deprivation, heart ailments, and anticholinergic side effects, (Yarin et al., 2002 ).  The new age psychotropic drugs have been seen to have sexual and weight loss results.  The side effects are not easily predictable or manageable. Arguably, this is because of these effects that there was the need to do research focused on understanding the relationship between compliance with mental health medication and the health outcomes in psychiatric cases. The findings from the study will be instrumental in providing psychotropic practitioners with information to predict their patient’s side effects and problems associated with non-compliance. Arguably, they will also aid in a more accurate prediction into manipulating the chemical structure of the drugs to achieve the same effect, while eliminating the adverse effects they bring. Through the results, they would be able to devise strategies to avoid the consequences by ensuring adherence to the regimen. Consequently, there would be an achievement of better health care for the patients.

Research Question

The research question is the fundamental element of the research that defines the methodology, guides the inquiry procedures, analysis, and the outcome.  It describes the research problem dependent and independent parameters and establishes the relationship they have. In this research, the primary research variables are the compliance to mental health medication regimens and the patient’s recovery. The research question therefore is; does compliance with a mental health medication regimen improve recovery outcomes, such as independent living?

Methodological framework and research methods

Methodological framework of research is the collection of step by step procedures that are tailored to give foresight on the specific functions to be carried out at particular points within the research process (Arksey & O’Malley, 2005).  The methods selected are chosen strategically to fit with the research question and combined to provide optimal solutions at the different research stages.  Research methods are the processes that are used to gather data and information used in the research analysis.

In the research, qualitative and quantitative research methods will be integrated. Qualitative methods will seek to find the side effects and the benefits that the mental health patients accrue to form compliance with their regimen. Quantitative means, on the other hand, will use secondary sources to see the overall impact that the agreement or non-compliance has on the patients.  The primary sources used will include interviews, while the secondary sources integrated into the research will consist of mental health databases and journals with information relevant to the research question.

Primary Data Collection

The chief data collection methods to be used for the study are surveys and interviews; the former will incorporate subjects dealing with different mental health conditions. Selection of the issues will take the following procedures;

Subject recruitment

A longitudinal study approach will be used in the collection of interview data, and also a rangeof participants for the interviews from DTR meetings held in community centers within the local city that offer day treatment to people with mental health-related issues will be selected. Each DTR meeting will constitute of 20 people, and the participants in the meetings informed of the reason for the study, and an invitation extended to those that would have been DTR attendees for more than a month.  Exclusion of patients will be done if they are less than 18years (Fraley & Hudson, 2014). Once the research has enough participants for the interviews, they will be scheduled for an interview depending on their flexibilities so that the whole interview process takes place in a week.  Fixed and flexible guides will be used in the interview process to gather specific necessary information while still opening up the opportunity for more.

Data Recording

Apart from the social demographic data, baseline measures like the Likert scales will measure the patients’ data. The socio-demographic information is recorded in prose text, while the psychiatric symptoms measured using the Colorado Symptom Index, and the scores recorded (Levy &Lemeshow, 2013).  Medical health Confidence Scale will also be used to test the level of personal satisfaction with medication compliance and the recovery process. Treatment motivation Questionnaire would also be given to check on the patients, to gather more data about them; consequently, data affiliated to the characteristics that influence the compliance of the patients will be vital for the research.

Statistical Analysis

The data analysis will be based on the three objectives of the research and the Hypothesis.

Secondary Data Collection

The sources for the secondary data would be mental health databases and peer-reviewed articles and journals. The procedure used will be based on the hypothesis and research question.  In preparation for the secondary data collection, a literature review will be done to identify keywords and terms expected in the secondary sources.  The literature search will define the selection of the datasets, and consequently, the next step will be analysis and comparison of the primary data collected to find similarities and differences (Denzin  & Lincoln, 2005)

Figure 1: Methodological Framework of the Research

After the data obtained from the primary and secondary sources is done, the next step involves identification of the underlying problem through a comprehensive analysis of the data collected, and how it fits with the hypothesis and research question.  A summary of the methodological framework for the research is as in the figure below.

Literature Search

The literature search is a well-organized systematic search of the published material database including scholarly articles, books and other appropriate sources, aimed at identifying quality reference for a research topic. It is essential in the formulation of evidence-based guidelines since it helps create the research question, and also in identification research gaps about the research topic.  There is the medical database containing Journals, articles, statistics, eBooks and other sources related to mental health.  They include; CINHAL, Mind, Open Grey, Ovid-Medline, PsycINFO, PubMed, and Scopus. Other journals reviewed consist of those having relevant mental health information including Journal of Mental Health, American Journal of Psychiatry, The Journal of Clinical Psychiatry, British Journal of Psychiatry, the Lancet and The JAMA Psychiatry among others.

Summary of the Five Articles

The literature search will open up to concepts in the topic of research, new terms, and insight of the ideologies the research would propose; consequently, the principal publications analyzed for the study were the population encompassed, time of paper and the area covered.  The articles that met the threshold were the ones which were peer-reviewed and published within the last ten years.  The following are the articles used:

  1. Haddad, P. M., Brain, C., & Scott, J. (2014). Non-adherence with antipsychotic medication in schizophrenia: challenges and management strategies. Patient Related Outcome Measures, 5, 43.

The article was written by Peter M Haddad of the Neuroscience and Psychiatry unit of The University of Manchester, UK, Cecilia Brian of the Institute of Neuroscience and Psychology, Department of Psychiatry and Neurochemistry. Others include Sahlgrenska Academy, University of Gothenburg, Sweden and Jan Scott from Academic Psychiatry, Institute of Neuroscience, Newcastle University, London, UK. It is published in the Patient-related Outcomes Journal and cited by PMC over the years.

It introduces the effects that noncompliance to the medication has on the patients suffering from one of the common mental disorders, Schizophrenia. The factors that lead to non-compliance are identified to be the stigma, lack of insight, positive and negative symptoms, depression, and cognitive symptoms. The outcomes defined include the increased risk of a relapse, self-harm, re-hospitalization, increased medication costs, and sooner or later lowers the lifeexpectancy for the patient.  The intervention formulated in the article aims to enhance growing compliance, which includes psychological interventions, electronic reminders, long-acting antipsychotic injections, service-based interventions, and giving financial incentives. They further propose specific approaches to the individuals to increase the rates of compliance.

There were two methodsused in measuring compliance to medication: objective and Subjective.  The objective modes include MEMS pill count, medication possession ratio, medication plasma level, biological markers, electronic ingestion markers, and observed intake. Consequently, the subjective adherence measurements were taken to be the patient reports, patients’ diary, questionnaires and clinical view on adherence. Objective measurement methods were more accurate in getting data; however, personal means resulted in a reduced validity and underestimated adherence. The advantages that the article had towards the research are, firstlyit is based on critical works which are the same as the one used in the study, it includes adherence, non-adherence, risk factors, and recommendations. Moreover, the article foundations involve evidence from previous PubMed and PMC articles for the period between2000 and 2013. It was therefore updated and based on the new age medicine associated with schizophrenia.

 

  1. Kane, J. M., Kishimoto, T., &Correll, C. U. (2013). Non‐adherence to medication in patients with psychotic disorders: epidemiology, contributing factors and management strategies. World Psychiatry, 12(3), 216-226.

The article was published online and in the journal World Psychiatry in October 2013. The authors were John M. Kane from Zucker Hillside Hospital, Psychiatry Research, NorthShore. Others include Taishiro Kishimoto from Zucker Hillside Hospital, Feinstein Institute for Medical Research, Manhasset, New York and Christoph U. Corell from Hofstra North Shore LU School of Medicine, Hempstead, New York and Zucker Hillside Hospital, Psychiatry Research, North Shore.

The article adds to the research by introducing the assessment of adherence attitudes and behaviors of patients. They initiate new methods of measuring adherence as opposed to the previously used ones. The methods formerly used involved querying the patients directly, whileindirectly judging compliance based on efficacy.  The means were not effective in measurement and introduced information of poor validity. The new techniques introduce novel technologies that could also be used to probe clinical treatment information. Of the methods proposed in improving compliance, they recommend integration to achieve a more holistic effect on the patient. They prove through research that the traditional methods used to increase adherence are not as effective as previously perceived. The new plans proposed include long-acting injectable antipsychotics and pharmacological strategies. They classified the factors associated with non-adherence to be illness characteristics, patient characteristics, treatment provider characteristics, medication characteristics, and family and caregiver characteristics.

The data collection methods include patients reports, patient self-assessment questionnaire, MEMs cap, electronic pills trays, pill count, clinical response effects, pharmacy prescription refill record, ingestible event marker, hair analysis, observed ingestion, patient diary, and measurement of body fluid or blood.  Several drawbacks witnessed with methods aimed at patient’s data collectioninclude unreliability ofthe patient’s memory, the absence of efficacy in some patients, and some means such as observed ingestion were highly resourced intensive. Studies of epidemiology were carried out on patients with diabetes, infectious disease, eye disorders, cardiovascular disease, skin disorders and cancer. The epidemiology study aim comprisedof comparing the compliance of patients with the diseases or disorders with the other set of patients. The article monopolizes on referencing to other PubMed articles and thus proving the viability of the data it presents.

  1. Thompson, L., & McCabe, R. (2012). The effect of clinician-patient alliance and communication on treatment adherence in mental health care: a systematic review. BMC Psychiatry, 12(1), 87.

The article in a peer-reviewed article published in the BMC Psychiatry journal in 2012. The article’s author is Laura Thompson from the unit for Social and Community Psychiatry, Barts & the London School of Medicine and Dentistry, Queen Mary University of London. Also included is  Rose McCabe from the Unit for Social and Community Psychiatry, Barts & the London School of Medicine and Dentistry and the Newham center for Mental Health in London.

The article seeks to clarify the shift in purpose and role of clinic-patient relationship in influencing the salient care outcomes including medical compliance with prescribed treatment.  Their effects of clinical non-compliance are defined to be the relapse, poor prognosis, and re-hospitalization. Further, based on previous researched, they affirm that noncompliance results to medical inefficacy and some other intolerable effects of the medicine. They project a significant approach to dealing with medical compliance to be the use of the clinical practitioners. They could be involved in non-specific counseling to initiate positive attitudes towards psychiatric medicine. A link of communication between the patient and the clinical officer will ensure further extensive observation that will begin proper regimen prescription changes. When the clinician’spresence to the patient is missing, the expectation of adherence problems to non-adherence heightens.  The main conclusions of the article are the creation of actual communication practices between the patient and clinician as a mechanism to influence adherence.

The study used methods involving rigorous journal screening. The data was based on any electronically registered journal up to 2010.The central databases usedincluded the PubMed, PsycINFO, Web of Science, Cochrane Library, Embase and CINAHL. A hand search was carried out in world top medicine journals among them American Journal of Occupational Therapy, British Journal of Occupational therapy, Journal of Mental Health, British Journal of Psychiatry, and the American Journal of psychiatry. Grey literature used for the search included SINGLE, British National Bibliography for Report Literature, British Library Direct, and the Proquest Digital Dissertations. The critical terms of the search were Communication, interaction, mental health practitioner terms, mental health disorder terms and compliance, adherence, concordance, and their antonyms. The credibility of the article for the studyis proven by the peer-reviewed references and is supported by the Medical Research Council.

  1. Jónsdóttir, H., Opjordsmoen, S., Birkenaes, A. B., Engh, J. A., Ringen, P. A., Vaskinn, A. &Andreassen, O. A. (2010). Medication adherence in outpatients with mental disorders: the relation between self-reports and serum level. Journal of clinical psychopharmacology, 30(2), 169-175.

The article was written by Jonsdottir H., Opjordsmoen, S. Engh J, Ringen, P. Vaskinn and Andreassen all from the Department of Psychiatry, Oslo University Hospital-Ulleval and the Department of Clinical Pharmacology in St. Olavs Hospital, Trondheim. It was submitted and published in the Journal of Clinical Psychopharmacology in April 2010.

The article adds to the research by providing a critical examination to the prescription of medication in outpatients based on self-reporting rating and serum-based measurements of adherence. The analysis follows the Norwegian Thematic organized Psychosis event for the patient with bipolar disorder and Schizophrenia.  It was carried out in the University Hospital of Ohio. It analyses the rates of non-adherence based on the clinical conditions of patients such as in patients with bipolar conditions, they prove the statistics of non-adherence based on primary data collection methods. Direct methods of measuring adherence used include direct observation of patients and measuring blood content of drugs.  The serum method of collecting data however costly is the most effective method. Criticism of the self-reporting methods involves their validity due to their heavy reliance on the patient’s memory.

The methods 280 participants in the study that took place between 2003 and 2006, the requirements for the patients were for them to be in the age bracket of between 18-65 years.  Structural clinical interviews were given to the patients in the first stage of the study, and as the process continued, they administered fasting blood samples taken from the patients as the basis of the serum tests.  Collectively, self-report and serums tests gathered for analysis at the end of the research period were used to conduct an investigation and comparisons made.  The results showed an adherence rate of 61.6% for the outpatients. They also proved that self-reports are reasonably good sources of information for the medical compliance research.

  1. Magura, S., Rosenblum, A., & Fong, C. (2011). Factors associated with medication adherence among psychiatric outpatients at substance abuse risk. The full-blown addiction journal, 4, 58.

The work was peer-reviewed and acknowledged for publication on the PMC Us National Library of Medicine in 2012.  The authors are Stephen Magura (PhD) from The Evaluation Center western Michigan University Kalamazoo, Michigan and Andrew Rosenblum (PhD) and Chunky Fong MA.

The article introduces research that reveals the factors that contribute to compliance in patients. It used patients who had coupled mental health disorders and substance abuse problems;thepsychiatryfacilities included mostly freshlyadmitted subjects. The research has two primary objectives; determining the extent of non-adherence, and determination of the malleable factors causing non-adherence. The conclusions made were that the factors that influenced the compliance were socioeconomic characteristics of the patient, clinical characteristics, nature of the medication, and availability of support for the patient, and personal attributes of the patient.

The setting for the research was the Bronx, psychiatry day program that accepted patients from different mental health and addiction units and clinics.  Community contacts were also used to refer people for the research. It ran for two years beginning 2003.  Data collection methods were personalized interviews, behavior observation and collection of blood toxicology reports. Before admission, the patient’s information on their background history regarding their medication, personality, addictions, socio-economic status and the community around him was collected. Other factors measured during the study through surveys were the readiness to change, self-efficacy and drug avoidance, self-efficacy and mental health recovery; consequently, therewas a consideration into  Environmental factors which included support, friend support and recovery promoting behaviors. The limitations of the study included the small sample size and casual interference of predictors.

Existing Gaps in Literature

Research in the previous years has been instrumental in shedding light on the various issues on medical compliance for the patients with mental challenges. However, there are still several gaps that exist within the field. One of the primary outcomes of non-compliance intensely discussedinclude relapse and re-hospitalization. Other minor factors revealed by research are, self-harm, increased medication costs, and eventually the lower quality of life for the patient.

Much has been covered on the effect of non-compliance, but gaps still exist on the benefits of compliance. Ingersoll & Cohen, J. explain its impacts of the on the patient although they are not consistent in defining the benefits offered to the patients (2008). Cramer et al. (2008) have given a clear introduction to its effect observed in mental health patients; consequently, the benefit accrued from its application when the recovery process is put into consideration, although they are not defining their role in hastening the recovery process.

Another topic within compliance that has not had proper attention on whether it leads to improvement of the quality of life of the patient. Litchman et al. (2008), Llorca (2008) and Mona et al. (2009) all provide for the medical benefit of medical compliance as the improvement of the patient’s mental health. They focus on the medical bit and forget the quality of life of the patient. Kikkert, Koeter, and others (2011) argued that providing housing to homeless patients with mental health problems first, before starting them on a medication regimen increases their levels of compliance. Klingberg, Schneider, Wittorf, Buchkremer, and Wiedemann (2008) study the collaborations between patient and clinical practitioners through communication and motivation centred counselling. They, however, do not include the benefit of the personal life that comes with the communication improvement.

Mental health affects the capability of the patient’sto access amenities such as housing (Meyer, 2013), (Hunt & Eisenberg, 2010), (Schulz & Sherwood, 2008) (Elliott, et a, 2012). Mental health problems are also a factor that affects the employment opportunities of the patients (Dunn et al., 2008) (Bond et al., 2008) (Westerhof& Keyes, 2010) (Fazel et al., 2012). Once the effects of the mental health effects have affected employment and housing of the patient, compliance to medication should be able to help the patient access these services. The research does not, however, reveal to what extent it occurs.

 

 

References

Arksey, H., & O’Malley, L. (2005). Scoping studies: towards a methodological framework. International journal of social research methodology, 8(1), 19-32.

Bond, G. R., Drake, R. E., & Becker, D. R. (2008). An update on randomized controlled trials of evidence-based supported employment. Psychiatric rehabilitation journal, 31(4), 280.

Brus, H., van de Laar, M., Taal, E., Rasker, J., & Wiegman, O. (1999). Determinants of compliance with medication in patients with rheumatoid arthritis: the importance of self-efficacy expectations. Patient education and counseling, 36(1), 57-64.

Cramer, J. A., Roy, A., Burrell, A., Fairchild, C. J., Fuldeore, M. J., Ollendorf, D. A., & Wong, P. K. (2008). Medication compliance and persistence: terminology and definitions. Value in health, 11(1), 44-47.

Denzin, N. K., & Lincoln, Y. S. (2005). Introduction: The discipline and practice of qualitative research.

DiMatteo, M. R., Lepper, H. S., & Croghan, T. W. (2000). Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Archives of internal medicine, 160(14), 2101-2107.

Dunn, E. C., Wewiorski, N. J., & Rogers, E. S. (2008). The meaning and importance of employment to people in recovery from serious mental illness: results of a qualitative study. Psychiatric rehabilitation journal, 32(1), 59.

Elliott, D. S., Huizinga, D., & Menard, S. (2012). Multiple problem youth: Delinquency, substance use, and mental health problems. Springer Science & Business Media.

Fazel, M., Reed, R. V., Panter-Brick, C., & Stein, A. (2012). Mental health of displaced and refugee children resettled in high-income countries: risk and protective factors. The Lancet, 379(9812), 266-282.

Fraley, R. C., & Hudson, N. W. (2014). Review of intensive longitudinal methods: an introduction to diary and experience sampling research.

Haddad, P. M., Brain, C., & Scott, J. (2014). Nonadherence with antipsychotic medication in schizophrenia: challenges and management strategies. Patient Related Outcome Measures, 5, 43.

Hunt, J., & Eisenberg, D. (2010). Mental health problems and help-seeking behavior among college students. Journal of Adolescent Health, 46(1), 3-10.

Ingersoll, K. S., & Cohen, J. (2008). The impact of medication regimen factors on adherence to chronic treatment: a review of literature. Journal of behavioral medicine, 31(3), 213-224.

Jónsdóttir, H., Opjordsmoen, S., Birkenaes, A. B., Engh, J. A., Ringen, P. A., Vaskinn, A. &Andreassen, O. A. (2010). Medication adherence in outpatients with severe mental disorders: relation between self-reports and serum level.Journal of clinical psychopharmacology, 30(2), 169-175.

Kane, J. M., Kishimoto, T., &Correll, C. U. (2013).Non‐adherence to medication in patients with psychotic disorders: epidemiology, contributing factors and management strategies. World Psychiatry, 12(3), 216-226.

Kikkert, M. J., Koeter, M. W., Dekker, J. J., Burti, L., Robson, D., Puschner, B., &Schene, A. H. (2011). The predictive validity of subjective adherence measures in patients with schizophrenia. International journal of methods in psychiatric research, 20(2), 73-81.

Klingberg, S., Schneider, S., Wittorf, A., Buchkremer, G., &Wiedemann, G. (2008). Collaboration in outpatient antipsychotic drug treatment: analysis of potentially influencing factors. Psychiatry Research, 161(2), 225-234.Lichtman, J. H., Bigger, J. T., Blumenthal, J. A., Frasure-Smith, N., Kaufmann, P. G., Lespérance, F., … & Froelicher, E. S. (2008). Depression and coronary heart disease: recommendations for screening, referral, and treatment: a science advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Psychiatric Association. Circulation, 118(17), 1768-1775.

Levy, P. S., &Lemeshow, S. (2013). Sampling of populations: methods and applications. John Wiley & Sons.

Llorca, P. M. (2008). Partial compliance in schizophrenia and the impact on patient outcomes.Psychiatry research, 161(2), 235-247.

Magura, S., Rosenblum, A., & Fong, C. (2011). Factors associated with medication adherence among psychiatric outpatients at substance abuse risk. The open addiction journal, 4, 58.

Meyer, I. H. (2013). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence.

Morin, C. M., Vallières, A., Guay, B., Ivers, H., Savard, J., Mérette, C., …&Baillargeon, L. (2009). Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial. Jama, 301(19), 2005-2015.

Osterberg, L., & Blaschke, T. (2005). Adherence to medication. New England Journal of Medicine, 353(5), 487-497.

Schulz, R., & Sherwood, P. R. (2008). Physical and mental health effects of family caregiving. Journal of Social Work Education, 44(sup3), 105-113.

Thompson, L., & McCabe, R. (2012). The effect of clinician-patient alliance and communication on treatment adherence in mental health care: a systematic review. BMC Psychiatry, 12(1), 87.

Westerhof, G. J., & Keyes, C. L. (2010). Mental illness and mental health: The two continua model across the lifespan. Journal of adult development, 17(2), 110-119.

Yarin, P., Fletcher, R., DiPisa, J., & Vonk, G. P. (2002). U.S. Patent No. 6,380,858. Washington, DC: U.S. Patent and Trademark Office.

 

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