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Comparison of Different Adherence Measures in Adolescent Outpatients with Depressive Disorder

Authors Mok YE, Lee J, Lee M

Received 14 February 2020

Accepted for publication 26 May 2020

Published 24 June 2020 Volume 2020:14 Pages 1065—1072


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Johnny Chen

Young Eun Mok,1 Jong-ha Lee,2 Moon-soo Lee1

1Division of Child and Adolescent Psychiatry, Department of Psychiatry, Korea University Guro Hospital, Guro-gu, Seoul, Republic of Korea; 2Department of Psychiatry, Korea University Ansan Hospital, Ansan, Gyeonggi Province, Republic of Korea

Correspondence: Moon-soo Lee
Division of Child and Adolescent Psychiatry, Department of Psychiatry, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, Republic of Korea
Tel +82 2 2626 3163
Fax +82 2 852 1937

Purpose: Adolescent depression can have a chronic course; hence, the importance of adherence to antidepressant medication for successful treatment outcomes is emphasized. This study aimed to examine different adherence measures and identify clinical factors that influence adherence in adolescent depression.
Patients and Methods: A prospective study was conducted for patients diagnosed with depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition from outpatient psychiatric settings at Korea University Medical Center, Guro Hospital. Patient demographics were obtained from a questionnaire, interview, and review of chart records. Adherence was assessed by four methods (Medication Event Monitoring System [MEMS], pill count, clinical rating scale, and patient’s self-report). The Toronto Side Effect Scale was used to evaluate side effects, and specific depressive symptoms were assessed using the Hamilton Rating Scale for Depression and Childhood Depression Inventory–Korean version. The Multidimensional Scale of Perceived Social Support was administered to analyze social support, and the Parenting Stress Index-Short Form was used to evaluate parental stress levels. We used concordance correlation analysis to evaluate the relationship among the four adherence measures and the relationship between adherence level and clinical factors.
Results: Overall, the study enrolled 48 outpatients (mean age 16.33± 1.93 years). The mean duration of illness was 1.27± 2.17 years. Adherence rates for MEMS, clinician rating scale, pill count, and self-report after conversion to dichotomous measures were 67.5%, 48.9%, 60.0%, and 56.3%, respectively. Only the duration of illness remained significantly correlated with MEMS (r = 0.510, p =0.001).
Conclusion: Pill count exhibited a higher degree of agreement with MEMS adherence than the other two adherence measures, possibly indicating that pill count may be a considerably reliable measure of adherence. Furthermore, MEMS adherence was positively correlated with disease duration, suggesting that the longer the duration of illness, the higher the adherence.

Keywords: medication event monitoring system, pill count, duration of illness, self-report, clinician rating scale, symptom severity, parental stress

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