Factors influencing medication adherence and quality of life in outpatients attending Department of Psychiatry in a tertiary health care centre

Background: Nearly one third of people who suffer major psychiatric disorders end up with a long- term disability and dependency. They are most likely to be non-adherent to medication due to various reasons including lack of knowledge or insight about their illness and treatment which in turn leads to exacerbation of their illness, reduce treatment effectiveness, or make them less responsive to subsequent treatment, multiple hospitalizations and poor quality of life. Materials and methods: A cross sectional study was carried out in outpatients attending the Psychiatry OPD using the consecutive sampling technique. Subjects meeting the ICD-10 Diagnostic criteria for psychiatric disorders, age 18 year and above, subjects willing to participate in the study were included. A structured proforma, the Drug attitude inventory and the WHO-QOL-BREF questionnaires were used for assessment. Results: Mean age of subjects = 38.07 + 11.07 years. Mean medication cost = Rs. 917.82 + 397.89. 87 subjects participated in the study and of them 48% were adherent to medication and 52% were non-adherent. 56% of males and 43% females were adherent to medication. There was significant association between the occupation and the type of family of the subjects and medication adherence (p<0.05). Majority of patients with medication non-adherence were seen in schizophrenia, delusional disorder, bipolar disorder, generalized anxiety disorder, obsessive-compulsive disorder and substance related disorder. Majority (44.5%) of them reported fear of side effects, followed by stopping the medication when feeling better (35.5%) as the reasons for non-adherence followed by cost, embarrassment, etc. There was significant association between the psychological and social quality of life and medication adherence (p<0.05). Conclusions: This study implicates the importance of psycho education about the diagnosis, prognosis, need for medication and the expected adverse effects which should be clearly explained to the patient. The therapeutic alliance is the most effective component in helping the patient maintain medication adherence and subsequently better quality of life.

Positive Orientation and Psychological Distress: An Examination with Psychiatric Outpatients

@#Introduction: This research was conducted to extend the theoretical construct of positive orientation (PO) to psychiatric outpatients. This research also examined the effect of PO on alleviating stress, anxiety, and depression among psychiatric outpatients. Methods: This cross-sectional survey recruited 301 psychiatric outpatients online. As these respondents have a short attention span, short measures were used to measure PO-related variables (life satisfaction, optimism, self-esteem) and indicators of psychological distress (depression, anxiety, and stress). These outpatients are at the legal age to provide consent for themselves (M = 30.12, SD= 8.11). The majority of them have been identified as male (80.07%). Similarly, the ethnic distribution was unequal, with the majority of these outpatients identified as Malay (85.05%), followed by those who were identified as Chinese (7.31%), Indian (4.32%), and from other ethnic groups (3.32%). Results: Generalized structured component analysis (GSCA) supported that satisfaction with life, optimism, and self-esteem reflect the construct of PO. Furthermore, PO predicted depression, anxiety, and depression negatively. Conclusion: It is possible to replicate the construct of PO with psychiatric outpatients using single item measures for life satisfaction, optimism, and self-esteem. PO is beneficial to psychiatric outpatients as it reduces the severity of depression, anxiety, and stress.

Reliability and validity of the Farsi version of the Patient Health Questionnaire-9 (PHQ-9) with Iranian psychiatric outpatients / Confiabilidade e validade da versão persa do Patient Health Questionnaire-9 (PHQ-9) em pacientes psiquiátricos ambulatoriais iranianos

Abstract Introduction: The Patient Health Questionnaire-9 (PHQ-9) is a brief screening and diagnostic tool for depression. It has been used in research and clinical practice in primary care and other clinical and non-clinical settings. The PHQ-9 has not had its validity examined in psychiatric and psychological settings in Iran. Methods: A cross-sectional study was conducted to investigate the validation of the Farsi version of the PHQ-9. A convenience sample of 130 Iranian volunteer psychiatric outpatients was selected from psychiatric and psychological clinics. They completed the PHQ-9, the Patient Health Questionnaire-15 (PHQ-15), the World Health Organization-five Well-Being Index (WHO-5), and the short form of the Beck Depression Inventory-13 (BDI-13). Data were analyzed by descriptive statistics, Cronbach's α, Pearson correlation coefficient, principal component analysis, exploratory factor analysis, and confirmatory factor analysis. Results: Mean score of the PHQ-9 was 12.83 (standard deviation = 6.25), indicating moderately severe depression in the sample. Cronbach's α coefficient for PHQ-9 was 0.88, and one-week test-retest reliability 0.79. The PHQ-9 correlated 0.64 with PHQ-15, −0.35 with WHO-5, and 0.70 with BDI-13, indicating good construct and criterion-related validity. The results of the factor analysis of PHQ-9 items identified and confirmatory factor analysis confirmed a single factor labeled general depression. Conclusions: The PHQ-9 appears to have a unidimensional structure, adequate validity and reliability, and can be useful in epidemiological/research settings. Based on previous literature and on the present findings, the PHQ-9 may have applicability to other contexts in the studied population, but this needs to be confirmed by other studies.

Resumo Introdução: O Patient Health Questionnaire-9 (PHQ-9) é uma ferramenta breve de triagem e diagnóstico para depressão. Tem sido usado em pesquisa e na prática clínica primária e em outros contextos clínicos e não clínicos. O PHQ-9 não teve sua validade examinada em contextos psiquiátricos e psicológicos no Irã. Métodos: Um estudo transversal foi conduzido para investigar a validação da versão persa do PHQ-9. Uma amostra de conveniência de 130 pacientes psiquiátricos ambulatoriais iranianos foi selecionada em clínicas psiquiátricas e psicológicas. Os pacientes completaram o PHQ-9, Patient Health Questionnaire-15 (PHQ-15), the World Health Organization-five Well-Being Index (WHO-5) e a forma abreviada do Beck Depression Inventory-13 (BDI-13). Os dados foram analisados por estatística descritiva, α de Cronbach, coeficiente de correlação de Pearson, análise de componentes principais e análise fatorial exploratória e confirmatória. Resultados: O escore médio do PHQ-9 foi 12,83 (desvio padrão=6,25), indicando depressão moderadamente severa na amostra. O α de Cronbach para PHQ-9 foi 0,88, e a confiabilidade teste-reteste de uma semana 0,79. O PHQ-9 apresentou correlação de 0,64 com PHQ-15, −0,35 com WHO-5 e 0,70 com BDI-13, indicando boa validade do construto e dos critérios relacionados. Os resultados da análise fatorial dos itens do PHQ-9 identificaram, e a análise fatorial confirmatória confirmou, um único fator, chamado depressão geral. Conclusões: O PHQ-9 parece ter uma estrutura unidimensional, validade e confiabilidade adequadas, e pode ser útil em contextos epidemiológicos e de pesquisa. Com base na literatura prévia e neste estudo, o PHQ-9 pode ter aplicabilidade em outros contextos na população estudada, mas isso precisa ser confirmado.

Reliability, validity, and factorial structure of the World Health Organization-5 Well-Being Index (WHO-5) in Iranian psychiatric outpatients / Confiabilidade, validade e estrutura fatorial do World Health Organization-5 Well-Being Index (WHO-5) em pacientes psiquiátricos ambulatoriais iranianos

Abstract Introduction: The association between psychological well-being and physical and mental health has been shown in the literature. Psychological well-being is a multifaceted concept. The World Health Organization-5 Well-Being Index (WHO-5) is a 5-item instrument used to screen for depression. However, the validity of the WHO-5 has not been investigated in Iranian psychiatric or psychological settings. Objective: To investigate the validation of the Farsi version of the WHO-5 in a sample of Iranian psychiatric outpatients. Methods: A cross-sectional study was conducted with a convenience sample of 116 Iranian volunteer psychiatric outpatients selected from the psychiatric and psychological clinics at the School of Behavioral Sciences and Mental Health - Tehran Institute of Psychiatry, Iran University of Medical Sciences. Patients completed the WHO-5, the Patient Health Questionnaire-9 (PHQ-9), the Patient Health Questionnaire-15 (PHQ-15), and the short form of the Beck Depression Inventory-13 (BDI-13). Results: The mean score of the WHO-5 was 8.95 (standard deviation [SD] = 5.49). Cronbach's α for the WHO-5 was 0.91. The WHO-5 negatively correlated with PHQ-9 (-0.358), PHQ-15 (-0.328), and BDI-13 (-0.475), indicating good validity. Factor analysis of the WHO-5 items identified one factor labeled psychological well-being. Conclusions: The WHO-5 has a single dimensional structure and acceptable psychometric parameters. The results of this study suggest that WHO-5 can be used in a clinical context in Iran.

Resumo Introdução: A associação entre bem-estar psicológico e saúde física e mental tem sido demonstrada na literatura. Bem-estar psicológico é um conceito multifacetado. O World Health Organization-5 Well-Being Index (WHO-5) é um instrumento composto por 5 itens utilizado para avaliar depressão. No entanto, a validade do WHO-5 não foi investigada em contextos psiquiátricos ou psicológicos iranianos. Objetivo: Investigar a validade da versão persa do WHO-5 em uma amostra de pacientes psiquiátricos ambulatoriais iranianos. Métodos: Um estudo transversal foi conduzido com uma amostra de conveniência composta por 116 pacientes psiquiátricos ambulatoriais iranianos voluntários selecionados nas clínicas psiquiátrica e psicológica da School of Behavioral Sciences and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences. Os pacientes completaram o WHO-5, o Patient Health Questionnaire-9 (PHQ-9), o Patient Health Questionnaire-15 (PHQ-15) e a versão abreviada do Beck Depression Inventory-13 (BDI-13). Resultados: O escore médio obtido no WHO-5 foi de 8,95 (desvio padrão = 5,49). O alfa de Cronbach para o WHO-5 foi 0,91. O WHO-5 se correlacionaram negativamente com o PHQ-9 (-0,358), o PHQ-15 (-0,328) e o BDI-13 (-0,475), indicando validade adequada. A análise fatorial dos itens do WHO-5 identificaram um único fator, a saber, bem-estar psicológico. Conclusão: O WHO-5 tem uma estrutura dimensional única e parâmetros psicométricos aceitáveis. Os resultados deste estudo sugerem que o WHO-5 pode ser usado em contextos clínicos no Irã.