Medication Non-adherence and Associated Factors Among Patients with Mental Illness at St. Amanuel Specialized Psychiatric Hospital, Addis Ababa, Ethiopia; A Cross Sectional Study

Medication Non-adherence and Associated Factors Among Patients with Mental Illness at St. Amanuel Specialized Psychiatric Hospital, Addis Ababa, Ethiopia; A Cross Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Medication Non-adherence and Associated Factors Among Patients with Mental Illness at St. Amanuel Specialized Psychiatric Hospital, Addis Ababa, Ethiopia; A Cross Sectional Study Adugnaw Adane, Diborah Zerihun, Adisu Warkaw, Samuel Misganaw, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3909394/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Adherence is the degree to which patients follow health professionals’ recommendations regarding prescribed medication and maintain the indicated treatment. Medication non-adherence is a global problem worldwide. Medication non-adherence is a significant clinical concern in patients with mental illnesses than other chronic illness patients. Objectives To assess medication non-adherence and associated factor among patients with mental illness who visited St. Amanuel Specialized Psychiatric Hospital, Addis Ababa. Methods Institution-based cross-sectional study design was employed at St. Amanuel Specialized Psychiatric Hospital, Ethiopia from August 20, 2022 to September 30, 2022. The data was collected by interviewer administered structured questionnaire and document review. Medication non-adherence was assessed by using standardized Morisky medication adherence scale. The collected data was entered into EPI data version 4.5 and exported to SPSS version 26 for statistical analysis. After descriptive data was presented; Binary logistic regression was used to assess association. The significance level was set at P < 0.05 and Odds ratio was used to assess the strength of association. Result A total of 374 patients were included, of this 32.6% were found to have poor adherence. The predictors of poor adherence were male sex [AOR = 1.841, 95% CI; 1.136–2.984, p = 0.013], substance use [AOR = 2.088, 95% CI; 1.222–3.569, p = 0.008], unemployment [AOR = 2.593, 95% CI; 1.446–4.649, p = 0.021], perceived spiritual causation [AOR = 1.743, 95% CI; 1.026–2.959 p = 040], poor level of support [AOR = 3.277, 95% CI; 1.432–7.496, p = 0.005]. Conclusion The magnitude of medication non-adherence was found to be high. Male sex, unemployment, substance use, perceived, and poor level of support were significant predictors of medication non-adherence among patients with mental illness. Adherence Mental illness Morisky medication adherence scale Psychotropic drug Figures Figure 1 Figure 2 Figure 3 Introduction Mental illness is a broad term describing a range of disorders that affect one’s thinking, behavior, and mood [ 1 ]. It is a condition characterized by severely impaired social life and clinically significant disruption in various aspects of mental functioning. Mental illness includes schizophrenia, paranoid disorder, bipolar disorder, schizoaffective disorder, epileptic mental disorder, and intellectual disability which is considered a global public health problem [ 1 , 2 ]. The success of medication treatment is determined on a patient’s adherence to the medication regimen. Non-adherence to medical therapy is a known predictor of relapse and re-hospitalization, therefore identifying contributing factors to non-adherence is one of the many challenges in treating mental illness. Non-adherent patients are 70% more likely to be admitted to the hospital than patients with partial adherence, who are 30% more likely to be admitted than adherent patients [ 3 ]. Adherence refers to the degree to which patients follow health professionals’ guidance regarding prescribed medication and maintain the indicated treatment as well as continuing to follow their instruction throughout the duration of drug therapy [ 4 , 5 ]. It’s a concept that expresses the patients’ acceptance and understanding of the need to be treated voluntarily and manifests the degree of their acceptance and understanding with a positive or negative attitude towards drugs [ 6 ]. Non-adherence is a complicated phenomenon, with a wide variety of patterns. The patient might either take lower or higher doses of the prescribed medication, follow a schedule other than prescribed, completely quit the treatment or refuse attending regular visits or being admitted to hospital [ 7 , 8 ]. Non-adherence to medication is a major public health problem that has been called an “invisible epidemic”[ 9 , 10 ]. Non-adherence to antipsychotic is one of the common challenges to successful treatment of mental illness and is a frequent cause of exacerbations in psychopathology, psychotic relapse and re-hospitalization. Medication non adherence is a growing concern to clinicians, the health care system, and other stakeholders. It compromises the efforts of the health providers in improving the health of populations. It causes wastage of health care resources, and reduce public confidence in health care systems,[ 9 , 11 , 12 ]. It has also a significant impact on the disease course, relapse, future recovery, patients’ quality of life, and the outcome for the patient [ 1 ]. It is a frequent cause of impairment, hospitalization,, suicide, loss of job, violence, substance abuse and psychiatric emergences [ 13 ]. Mental illnesses have been a significant public health challenge globally. Globally, around half billion people are affected by psychiatric disorders worldwide. It contributes 14% of the overall global morbidity burden, and 30% of the non-fatal diseases burden. Adherence to medication is crucial but challenging in the management of most psychiatric disorders [ 14 – 16 ]. In Africa, Mental disorders account for 5% of the total burden of disease and 19% of all disability. Approximately one out of four people in Africa may experience what the WHO refers to as common mental illness such as depression or anxiety, with depression having the second highest disease burden on the continent. Mental illness has been characterized as a neglected and increasingly burdensome problem affecting all segments of the population in Africa [ 17 ]. Non-adherence to medications is considered as one of the common drug related issues stated that non-adherence to medications is a “worldwide problem of striking burden. Problems with medication adherence are important not in themselves, but because of the negative impact they can have on patients’ health and functioning. Poor medication adherence can cause negative health outcomes like worsening disease or even death [ 18 , 19 ]. The global estimate of non-adherence rates in mental disorder widely ranging from 4–72%. Reports indicate that up to 50% of patients with mental illness do not adhere to their prescribed medications worldwide [ 20 , 21 ]. Similar studies were conducted in different part of Africa to determine magnitude of antipsychotic drug non adherence on schizophrenia patients. The prevalence of non-adherence in studies conducted in Nigeria was 54.2% [ 22 ], and 55.7% [ 23 ]. Reports in Ethiopia have shown that non-adherence to antipsychotics medication was varied from 26.5–47.9% [ 24 ]. Identifying the risk factors for non-adherence is an essential step toward designing intervention strategies aimed at reducing this phenomenon. Non-adherence risk factors identified up to date include: A number of demographic and clinical factors associated with medication non-adherence have been reported in previous studies, some of which are negative attitude towards medications, poor insight, previous non-adherence, medication regimen complexity, poor therapeutic alliance, illness duration, social support, medication efficacy, side effects of medications, dosage and route of medication administration, and substance abuse [ 6 , 12 , 20 ]. Medication adherence research has increased significantly over the past decades using observational, interventional and implementation researches. Despite these increased research efforts by many disciplines research has not resulted in the much-needed progress to tackle medication non-adherence effectively [ 25 ]. Studies conducted previously were focused on clinical determinants of non-adherence rather than looking at the clients’ behavioral aspects and did not include all mental illnesses. Besides, little is known about the level of non-adherence and its associated factors in the study area among all groups of mental illnesses. Therefore, this study aimed to determine the level of non-adherence and its associated factors among patients with mental illness Visiting St. Amanuel Specialized Psychiatric Hospital. Medication non-adherence is a significant clinical concern in patients with mental illnesses than other chronic illness patients. Numerous studies have been conducted on medication adherence among patients with mental illness. However, many of these studies are limited by factors like small sample size and focused on schizophrenia alone while neglecting other psychiatric illnesses. Furthermore, most of the previous studies were conducted in rich industrialized countries, and it is not known how generalizable their findings to settings where health resources are scarce and unequally distributed, as seen in many developing countries including Ethiopia. In addition, the finding of the study would be useful as scientific evidence for local decision-makers and other stake holders to make an informed decision that would address the best interests of a patient with severe mental illness leading to better health and quality of life. Furthermore, the finding of this study will serve as scientific evidence and essential baseline data for researchers and professionals working in the field of psychiatry (Fig. 1). Figure 1: Conceptual framework of medication non-adherence and associated factors among patients with mental illness. Objective General Objective To assess medication Non-adherence and associated factor among patients with mental illness visited psychiatric outpatient department at St. Amanuel Specialized Psychiatry Hospital, Addis Ababa, Ethiopia, 2022. Specific Objective To determine the magnitude of medication non-adherence among patients with mental illness who visited psychiatric outpatient department at St. Amanuel Specialized Psychiatry Hospital. To identify factors associated with medication non-adherence among patients with mental illness who visited psychiatric outpatient department at St. Amanuel Specialized Psychiatry Hospital. Methodology Study setting The study was conducted in St. Amanuel specialized psychiatry hospital. The hospital is one of the pioneer Ethiopian Hospitals which was established in 1938. The hospital was supposed to serve as quarantine for people with mental illness. Now it is the only mental hospital in the country which engaged in giving core mental clinical services, conducting research and trainings of professionals. It has both inpatient and outpatient units. The hospital has 300 beds which provide specialized psychiatric service with 11 psychiatrists, 14 general practitioners, 29 public health officers, 111 nurses including clinical and psychiatric nurses, 22 pharmacy professionals and laboratory professionals for patients from all corners of the country. Among the 300 beds, 23 are for emergency and 277 are for cold cases. Study design and period Institution-based cross-sectional study design was employed among patients with mental illness at St. Amanuel Specialized Psychiatric Hospital, Ethiopia from August 20, 2022 to September 30, 2022. Population Source population All patients with mental illness who visit psychiatric OPD of St. Amanuel specialized psychiatric hospital. Study Population All patients with mental illness who visit psychiatric OPD of St. Amanuel specialized psychiatric hospital during the study period. Sample population Systematically selected patient with mental illness who visit psychiatric OPD of St. Amanuel specialized psychiatric hospital during the study period. Inclusion and Exclusion Criteria Inclusion criteria: Patients with mental disorder who had at least two or more regular follow up at St. Amanuel Specialized Psychiatric Hospital were included in the study. Patient aged 18 and above years Exclusion criteria: Patients who were acutely agitated or severely retarded, disoriented, and unable to communicate Sample size Determination & sampling procedures Sample size The sample size was calculated using a single population proportion formula taking highest prevalence from the previous studies done in Ethiopia. The prevalence of medication non-adherence among adult psychiatric outpatient at Harar [ 26 ] was 61.2%, taking the margin of error 5%, 95% confidence interval with a non-response rate of 10% which gives a total of 401 study participants. n= \(\frac{{Z}^{2}\left(P\right(1-P)}{{d}^{2}}\) = \(\frac{{\left(1.96\right)}^{2}\left(0.612\right(0.388)}{{0.05}^{2}}\) = \(\frac{3.842\left(0.237\right)}{0.0025}\) = \(\frac{0.910}{0.0025}\) = n = 364.18 + 36.418 (10% non-response rate); n = 400.598 = 401 Therefore, 401 patients with mental illness was included in present study. Where: n = sample size; d = margin of error (5%); P = prevalence rate, p was taken as 61.2% from Harar study. z = Critical value of standard normal distribution (Z-statistic) at 5% level (1.96); Confidence level (CI) = 95% Sample size for the second objective The sample size for the second objective was calculated by using EPI INFO version 7 for those factors that can influence medication non adherence. During calculation 95% CI, 80% power, percent of unexposed with outcome, and adjusted odds ratio on substance use and poor attitude toward medication are used (Table 1 ). Table 1 Sample size calculation for factors associated with medication non-adherence among mental illness patients. Variables AOR % Outcome in unexposed group Ratio (Unexposed: Exposed) Calculated sample size (including 10% non-response rate) Substance use 2.6 21.4% 0.72 149 Poor attitude toward medication 3.0 45.5% 4.15 203 Female Patients 2.3 44.4% 3.17 261 The calculated samples for both objectives were compared to obtain the maximum sample. Since the sample size calculated for the first objective by using single population proportion was large, it was taken as a final sample. Therefore, the final sample size was 401. Sampling technique Systematic random sampling technique was used to select each study participants. The average number of patients with mental illness who attained psychiatric outpatient department at St. Amanuel specialized psychiatric hospital in the previous two month were 2102. Therefore, K was calculated as; K = N/n K = 2102/401 = 5.24 = 5 Where: K = the number of intervals between samples; N = total number of patients who had attained psychiatric OPD at St. Amanuel specialized in the previous two months; n = calculated sample size Therefore, every 5th patient was included in the present study. The first patient was selected randomly and the others were selected systematically based on the ‘k th ’ value. In case of a patient who will re-visit during the study period, the patient’s identification number was cross-checked against from previously collected questionnaires. Variables of the study Dependent variable Medication adherence status (Poor adherence = 1/ Adequate adherence = 0) Independent variable Age ,Sex, Educational level, Religion, Residence, Marital status, Working/employment status, Occupation, Income, Type of drug, Dosage frequency, Presence of side effects, Psychiatric diagnosis, Duration of mental illness, Alcohol consumption, Substance use, Comorbidity Operational definition Adherence to medication The level of drug adherence was measured based on MMAS-8 score. Accordingly, Poor-adherent: MMAS-8 score of ≤ 6 Good-adherent: MMAS-8 scores of > 6 Data collection procedures Interviewer administered structured questionnaire including socio-demographic characteristics, socioeconomic characteristics, patient related factors, health care related factors and other factors associated with medication non-adherence was collected by face-to-face interview of the participants. Data regarding the type of major psychiatric disorder diagnosis, the type of drug/s, frequency of drug taken, drug regimen and co-morbidities (if any) was reviewed from patient document. Adherence was assessed by using the Morisky medication adherence questionnaire. The questionnaire consisted of eight items (in a yes-or-no answer format) asking about forgetting to take medication, carelessness about taking medication and stoppage of medication when feeling better and when feeling worse. Data was collected by three psychiatric nurses through face-to-face interview method and record review. Close supervision was held on the data collection process by primary investigator and one supervisors who have Master of Science degree in integrated clinical. The data collectors were four nurses who are working in the oncology unit of the hospitals. Two supervisors (public health experts) were assigned for supervising the data collectors in each of the oncology units. The data collectors were four nurses who are working in the oncology unit of the hospitals. Two supervisors (public health experts) were assigned for supervising the data collectors in each of the oncology units. Data quality management and control measures A one-day formal and standardized training was given to the data collectors and supervisor about the purpose of the study, data collection tool, collection techniques, consent taking and confidentiality and ethical issues during the collection of data. Pretest was done prior to data collection on 40 (10%) patients with mental illness at St Paulos Specialized Hospital to ensure the data quality by assessing its clarity, understandable and completeness. The questionnaire was modified depending on the identified gaps. The investigator and supervisor made spot checking and reviewing the completed questionnaires on daily basis to ensure completeness and consistency of the information to be collected. Each information collected from the patient medical file was checked twice and recorded appropriately in the tool. The reliability and validity of 8-item MMAS was evaluated first in hypertensive patients by five experts in USA. It has a sensitivity and specificity of 93% and 53%, respectively [ 9 ]. The sensitivity indicates that the scale is good at identifying patients who have low medication adherence. Whereas the specificity indicates moderate performance of the scale in identifying patients who do not have problems with medication adherence. Later on the content validity of the 8-item MMAS in psychiatric patients was evaluated by two experts in Spain and the Cronbach’s alpha coefficient was 0.75 [ 27 ]. Data processing and analysis After the questioner and recorded data are checked for completeness, data was entered into EPI data version 4.6 and exported to SPSS version 26 for statistical analysis. Descriptive statistics was carried out and presented with narration, tabulation, and graphical presentation to present the socio-demographic, clinical characteristics and psychiatric medication adherence status of study participants. Factor specific descriptive statistics (mean, standard deviation, minimum, maximum, frequencies) were used to characterize the adherence status of patients with mental illness. Binary logistics regression was fitted done after dichotomizing the dependent variables. To explore and identify factors associated with Psychiatric medication non- adherence. Those variables with a p-value less than 0.25 in the bivariable analysis were considered eligible for multivariable logistic regression analysis. The level of significance was set at a P-value of < 0.05 at 95% CI, and Odds Ratio was used to quantify the strength of association for each independent variable with the dependent variable. Hosmer and Lemeshow statistics was used to preform model fitness test and construct the final model. Result From the total sample recruited in this study, (407), nearly 92% (374) participated in this study and included in the statistical analyses. This makes the Non-response rate to be 8%. The age of respondents is from minimum, 17 to maximum 88 years. The participants have mean age of 36.4 ± 14.6. More than half (61.8%) of respondents were Males. Based on age category, 44.7% of respondents were in age group 36–45 years. More than half of respondents were Unmarried and Urban dwellers (54.3%, 52.9%) respectively. Nearly two-third participants responded to be unemployed. Where around 60% were primary and below in educational level (Table 2 ). Table 2 Sociodemographic characteristics of respondents in assessment of medication adherence and associated factor among patients with mental illness who visited psychiatric outpatient department at St. Amanuel Specialized psychiatry Hospital, Addis Ababa, Ethiopia, 2022. Variable Category Frequency Percent Sex Female 143 38.2 Male 231 61.8 Age ≤ 25 80 21.4 26–35 167 44.7 36–45 51 13.6 46–55 19 5.1 ≥ 56 57 15.2 Residence Rural 176 47.1 Urban 198 52.9 Marital status Unmarried 203 54.3 Ever married 171 45.7 Ethnicity Amhara 219 58.6 Oromo 107 28.6 Tigre 33 4.0 Others 15 8.8 Religion Orthodox 165 44.1 Muslim 94 25.1 Protestant 81 21.7 Catholic 21 5.6 Others 13 3.5 Educational status Illiterate 101 27.0 Primary 126 33.7 Secondary 70 18.7 College and above 77 20.6 Employment No 284 75.9 Yes 90 24.1 Table 2 : Sociodemographic characteristics of respondents in assessment of medication non-adherence and associated factor among patients with mental illness who visited psychiatric outpatient department at St. Amanuel Specialized psychiatry Hospital, Addis Ababa, Ethiopia, 2022. Treatment related characteristics The participants were having the treatment duration lasting minimum 2 month, while maximum was 9 years with mean duration of the disease 4.28 years and 2.7 standard deviation. Regarding the disease type reported by the participants 149 (39.8%) had schizophrenia whereas Bipolar account for 91(24.3%) (Fig. 2). Figure 2. The disease status among study participants with mental illness who visited psychiatric outpatient department at St. Amanuel Specialized Psychiatry Hospital, Addis Ababa, Ethiopia, 2022. About tow third of participants (77.5%) are found taking single drug and more than 60% were taking antipsychotic drug regimen (36.9% and 30.2%. which are Typical and atypical drugs respectively. Majority (57.8%) of the study participants believes in spiritual causation as their cause for their illness. About 180(48.1%) and 108(28.9%) of the patients had intermediate and poor support from their loved ones, respectively (Table 3 ). Table 3 Treatment related characteristics of respondents in assessment of medication adherence and associated factor among patients with mental illness who visited psychiatric outpatient department at St. Amanuel Specialized Psychiatry Hospital, Addis Ababa, Ethiopia, 2022. Variable Category Frequency Percent Substance Use No 239 63.9 Yes 135 36.1 Perceived Causation Biological/Psychological 158 42.2 Spiritual causation 216 57.8 Level of support Good 86 23 Intermediate 180 48.1 Poor 108 28.9 Disease Status Schizophrenic 149 39.8 Bipolar 91 24.3 Mood Disorder 80 21.4 Major Depressive Disorder 50 13.4 Others 4 1.1 Number of drug used Taking one drug 290 77.5 Taking More than one drug 84 22.5 Type of Drug used Typical antipsychotic 138 36.9 Atypical antipsychotic 113 30.2 Antidepressant 24 6.4 Mood Stabilizer 15 4.0 Combination drugs 84 22.5 Comorbidity Yes 33 8.8 No 341 91.2 Table 3 : Treatment related characteristics of respondents in assessment of medication adherence and associated factor among patients with mental illness who visited psychiatric outpatient department at St. Amanuel Specialized Psychiatry Hospital, Addis Ababa, Ethiopia, 2022. Drug Adherence status More than half (68.2%) of study participants forget their medication sometimes. About 44.4% and 46.3% of the patients stop taking their medication due to symptom worsening and symptom improvement, respectively. 169 (45.2%) of the study participants feel hassled about sticking to their treatment plan (Table 4 ). Table 4 Morisky adherence scale eight-item questions. Variable Category Frequency Percent Forget medication sometime No 119 31.8 Yes 255 68.2 Miss medication other than forgetting No 345 92.2 Yes 29 7.8 Stopping medication due to worsen symptom No 208 55.6 Yes 166 44.4 Stopping medication due to improved symptom No 201 53.7 Yes 173 46.3 Forgetting medication due to travel or when you leave home No 157 42.0 Yes 217 58.0 Feeling hassled about sticking to your treatment plan No 205 54.8 Yes 169 45.2 Do you take your medication yesterday Yes 351 93.9 No 23 6.1 Frequency of having difficulty remembering to take drugs Never/Rarely 135 36.1 Once in a while 164 43.9 Sometimes 51 13.6 Usually 24 6.4 Taking the Morisky adherence scale for drug adherence determination, those who scored below the cut point to be said they are poorly adhered, 122 (32.6%) ( 95% CI, 28.0%-37.5%) were found to have poor adherence, whereas 252 (67.4%) had good adherence based on Morisky scale for drug adherence (Fig. 3). Figure 3: Magnitude of poor medication adherence among patients with mental illness who visited psychiatric outpatient department at St. Amanuel Specialized Psychiatry Hospital, 2022. Factors associated with psychiatric medication adherence Among socio-demographic, clinical and treatment-related variables entered into a bivariable logistic regression, some of them were associated with poor medication adherence. Sex, residence, age, educational status, employment status, substance use, comorbidity, psychiatric diagnosis type, perceived causation, level of support, number of drug, and treatment duration were taken as candidate variables for multivariable logistic regression at a p-value ≤ 0.25. The output from multivariable logistic regression showed that sex, employment status, substance use, psychiatric diagnosis type, perceived causation, and level of support were the final independent variables associated with psychiatric medication adherence at p-value < 0.05 after adjustment to confounding variables. The odds of having poor medication adherence in male patients were 1.841 times (AOR = 1.841, 95% CI; 1.136–2.984, p = 0.013) higher than female patients, provided that the other variables were kept constant. Patients who have history of substance use (including the present) had 2.088 times (AOR = 2.088, 95% CI; 1.222–3.569, p = 0.008) higher odds of having poor medication adherence than patients who have no history of substance use. Similarly patients who are currently unemployed had 2.593 times (AOR = 2.593, 95% CI; 1.446–4.649, p = 0.021) higher odds of having poor medication compared to those who are currently employed. According to the current study, patients who believe in spiritual causes as their cause for their illness had 1.743 times (AOR = 1.743, 95% CI; 1.026–2.959 p = 040) higher odds of having poor medication adherence than those patients who believes in biological or psychological causes as their cause for their illness. Comparing the different level of support that the patient receive from their loved ones, those patients who have poor and intermediate support had 3.277 and 4.987 higher odds of poor medication adherence than those patients who receive good support from their loved ones, respectively. After analyzing the different types of psychiatric diagnosis that the patient had, it was revealed that mental illness patients who had diagnosed with schizophrenia were more at risk for poor drug adherence than patients with bipolar or mood disorder. Whereas there was no statistically significant difference between patients with schizophrenia and MDD diagnosis. Keeping the other variables constant, patients with schizophrenia were 36.9% and 37.8% at higher risk of having poor medication adherence than bipolar (AOR = 0.369, 95% CI; 0.186–0.733, p = 0.038) and mood disorder (AOR = 0.378, 95% CI; 0.181–0.791, p < 0.001), respectively (Table 5 ). Table 5 Bi-variable and multivariable binary logistic regression for psychiatric medication adherence with predictor variables among mental illness patients at Amanuel specialized psychiatry hospital, Addis Ababa, Ethiopia. Variable Category COR (95% CI) AOR (95% CI) Residence Rural 1 1 Urban 0.690(0.447–1.065) 0.703(0.398–1.242) Age Numeric 0.975(0.659–1.910) 0.958(0.589–1.827) Sex Female 1 1 Male 1.971(1.209–3.212)** 1.841( 1.136–2.984)* Educational Status Illiterate 1 1 Primary 0.684(0.395–1.184) 0.867(0.443–1.701) Secondary 0.610(0.317–1.173) 0.598(0.265–1.347) Tertiary 0.650(0.346–1.220) 0.770(0.341–1.735) Employment status Employed 1 1 Unemployed 2.649(1.631–4.303)** 2.593(1.446–4.649)* Substance use No 1 Yes 1.858(1.191–2.898)** 2.088(1.222–3.569)** Comorbidity No 1 1 Yes 0.419(0.204–0.861)* 0.782(0.334–1.831) Psychiatric Diagnosis Schizophrenia 1 1 Bipolar 0.531(0.304–0.929)* 0.369(0.186–0.733)* Mood Disorder 0.332(0.176–0.628)*** 0.378(0.181–0.791)*** MDD 0.569(0.287–1.131) 0.501(0.227–1.105) Others(epilepsy, addiction) 0.443(0.045–4.356) 0.437(0.029–6.632) Perceived causation Biological/Psychological 1 1 Spiritual 2.010(1.274–3.171)** 1.743(1.026–2.959)* Level of support Good 1 1 Medium 3.35(1.756–6.390)** 4.987(2.330-10.677)** Poor 2.68(1.335–5.380)*** 3.277(1.432–7.496)** Number of Drug Monotherapy 1 1 Polytherapy 1.461(0.883–2.419) 1.231(0.653–2.32) Duration of treatment No 1 1 Yes 0.905(0.839–0.997)* 0.924(0.847–1.007) “***” significant at p-value < 0.001 “**” significant at p-value 0.01 “*” significant at p-value 0.05 Hosmer and Lemeshow Goodness of fit test p-value = 0.928, X 2 = 3.102 Table 5 : Bivariable and multivariable binary logistic regression for psychiatric medication non-adherence with predictor variables among mental illness patients at Amanuel specialized psychiatry hospital, Addis Ababa, Ethiopia. Discussion This study has attempted to assess the Non-adherence to medications amongst mental illness outpatients in Amanuel comprehensive specialized psychiatric hospital and assess factors associated with poor medication adherence. The study revealed that 32.6% of the study participants had poor medication adherence. This was comparable with study in France (30%)[ 28 ], Ethiopia, Jimma (39.3%)[ 9 ] and Nigeria (39.6%)[ 4 ]. Comparing the prevalence rate between the different studies showed that, the current prevalence were lower than most of the previous studies such as South Africa (37%) [ 5 ], India (38%)[ 29 ], Nigeria (48% and 39.6%.) [ 4 , 20 ], and Jordan 64.2% [ 30 ]. Whereas it was higher than studies from France (30%) and Ethiopia, Mekelle (26.5%). This result was also lower than previous studies in Bahir Dar, Ethiopia (55.2% ) [ 10 ]. Another study at Two Hospitals in Eastern Ethiopia found 61.2% were non adherent to psychotic drugs [ 26 ]. Previous study done in Amanuel mental health Hospital among schizophrenic patients showed that the magnitude of medication non-adherence was found to be 48.4% [ 31 ]. The finding in this study is relatively lower than other literatures. This may be due to the reason that most studies were done selecting a single disease conditions among mental illnesses. Another reason may be the study design used as in the case of study in Nigeria [ 20 ] which used cohort study design, affect the magnitude of the prevalence whereas this study uses cross sectional study design. Furthermore measuring medication adherence in patients with mental illness is difficult and lacks a gold standard. Consequently, a great number of different methods and instruments proposed, and this may be responsible for the difference in the rate of non-adherence. Furthermore, the difference in prevalence may be due to the inclusion of all mental illnesses in this study, which may affect the level of adherence to medication as those with mild disease status and good orientation could have good adherence while those with sever disease may have poor adherence. So, the total adherence level, which is the average of all the disease conditions in mental illness, found to be lower than the findings in specific mental disease. Finally there may be also, time gap between the researches, sociodemographic changes and difference, level of support and advancements in mental health, and health system progress that may alter the non-adherence level. According to the finding of this study, male patients were 1.841 times (AOR = 1.841) more likely to be non-adherent than female patients. Similar findings were found in a study conducted in Ethiopia-Tigray by Demoz et al., which found that female patients had 2.34 higher odds of having better adherence than male patients [ 1 ]. The higher adherence rate discovered in females could be attributed to the patriarchal nature of the study setting in which females are socially and culturally expected to be compliant. This may have a favorable impact on their adherence in the therapeutic alliance. However, it was against to a study done in Germany [ 32 ] which reports being female as negative determinant for better medication adherence. Whereas against to our finding the Chinese study didn’t discover a statistical significant association between medication adherence and sex of the participant [ 2 ]. Patients who have history of substance use (including the present) had 2.088 times (AOR = 2.088) higher odds of having poor medication adherence than patients who have no history of substance use. This was supported by the finding from systematic review which was done by P.M. Ljungdalh in Denmark [ 3 ] and Ethiopia, Tigray[ 33 ]. Possible reasons for this might include substance use can have negative impacts on persons internal condition, causing increased cognitive problems, unpleasant withdrawal symptoms, increased risk of social withdrawal and eventually lack of social of social support. According to the present study, patients who are currently unemployed had 2.593 times (AOR = 2.593) higher odds of having poor medication compared to those who are currently employed. This finding was in agreement with a Chinese [ 2 ] and Germanize [ 32 ] study. However it oppose with the study done in Nigeria that discovers currently employed participants have higher odds of poor medication adherence than currently unemployed participants [ 20 ]. Contrary to all above studies the South African study discovers that there was no statistical significant association between non adherence and employment status [ 5 ]. The possible explanation for the higher odds of non-adherence among unemployed could be due to the fact that employed patients have money to buy medication and they are less stigmatized than with those of unemployed patients. Also, employed patients were likely to be free of stress which comes due to unemployment and may reinforced to take their medication as they feel better. The current study revealed, patients who believe in spiritual causes as their cause for their illness had 1.743 times (AOR = 1.743) higher odds of having poor medication adherence than those patients who believes in biological or psychological causes as their cause for their illness. This was concurrent with adewuya et al. [ 20 ] that states patients who perceive spiritual causation had 3.74 higher odds of poor medication adherence than patients who believe in biological causation [ 20 ]. This might be driven on by our community's strong religious roots and insufficient patient communication regarding the status of their illnesses. Additionally, a belief in spiritual causation may lead patients and their loved ones to think that a spiritual cure is preferable to medication for treating their mental health issues. Patients who received poor and intermediate levels of support from their loved ones had, respectively, 3.277 and 4.987 times higher odds of poor medication adherence than patients who received good support from their loved ones. This was in agreement with studies done in German [ 32 ], India [ 29 ] Nigeria [ 6 , 20 ], Jimma, Ethiopia [ 34 ] and Bahir Dar [ 10 ]. Having social or family support encourage patients to take their medication on time, reducing fear associated to medication side effects, and educating them about the risks of medication non-adherence may all contribute to this. It also due to the fact that family members supervised the medicine intake at home and brought the patients for regular follow-ups. Mental illness patients who had diagnosed with schizophrenia were more at risk for poor drug adherence than patients with bipolar or mood disorder. Patients with schizophrenia had 36.9% and 37.8% higher risk of having poor medication adherence than bipolar (AOR = 0.369) and mood disorder (AOR = 0.378), respectively. This was supported by the Pakistani study [ 35 ] which reports the non-adherence rate among schizophrenia patients were 41.2% which was higher than bipolar patients (26.1%). Similarly an Indian study states, patients with schizophrenia (50.32%) were more likely to be non-adherent than patients with bipolar (33.3%) and MDD (16.33%) [ 29 ]. The probable explanation for the higher prevalence rate among schizophrenic patients could be due to the multiple and complex or combination of medications prescribed for psychosis patients However there was no statistically significant association between poor medication adherence with age, and educational status. This finding was in line with study conducted in Nigeria [ 6 ]. However it was against to the study done in Germany [ 32 ], china [ 2 ], India [ 29 ], South Africa [ 5 ] and Ethiopia, Tigray [ 1 ] which reports age and educational status as a significant predictor of medication adherence. Furthermore, some of the treatment related factors like comorbidity, duration of treatment, type of drug and presence of side effect were not significant predictors of poor medication adherence in this study. Which was totally in contrary to what is found in previous studies [ 36 , 37 ]. Strength and limitation The study used a standard method (8-item Morisky adherence scale) to assess medication adherence. The study also tries to include all the outpatients considering the different psychiatric diagnosis and type of medication. The hospital based cross-sectional nature of this study design might not establish cause and effect relationship as well as the temporality effect on medication adherence might not be shown. Therefore, its application to the general population should be done with caution. Conclusion and Recommendation Conclusion The magnitude of medication non-adherence was found to be 32.6%. Although the finding is lower than the findings reviewed, this is not to mean the adherence level is good, because antipsychotic drugs and mental illness requires full adherence and attention to bring the desired medical outcome. This research also revealed that sex, employment status, substance use, psychiatric diagnosis type, perceived causation, and level of support were significantly associated with poor medication adherence among patients with mental illness. Being male, unemployed, schizophrenic, having poor or intermediate level of social support and believe in spiritual causation were the significant predicators for poor medication adherence among patients with mental illness. The study finding will give an insight to any concerned bodies about the level of major psychiatric patients’ medication non-adherence and associated factors. This implies the need for more, health education, adherence promotion and strategies, mental health policies. Recommendation Health care providers should promote family and social support which is necessary for minimizing medication non-adherence among psychiatric patients. It is also recommended to provide health care and community based health education about medication adherence for all patients. We suggest researchers should undertake further longitudinal studies in different settings using analytical study design to establish causal relationships of psychiatric medication non-adherence and associated factors. Abbreviations AOR ; Adjusted Odds Ratio, BPR ; Brief Psychiatric Rating Scale, COR; Crude Odds Ratio, MDD ; Major Depressive disorder, MMAS; Morisky Medication Adherence Scale, OPD ; Outpatient Department WHO ; World Health Organization. Declarations Ethical consideration The study proposal was reviewed and approved by the Department of Research and Ethical Review Committee of, Addis city health bureau. The college provided an ethical clearance letter for conducting the research project (Ref. A/A /2907/227). Permission for collecting data from patients and accessing medical records was requested from St. Amanuel specialized psychiatric hospital. Informed written consent was obtained from the patients to be involved in the research. Patients with severe agitation and difficult to communicate including under age 18 were excluded from the study. For some stable patients with minor disability parents /guardians were requested to sign. A code number was given for each questionnaire to ensure the confidentiality of the participant’s information. The information collected from each study participant was kept confidential and used solely for research purposes. Only the principal investigator and data collectors have access to the patient's medical file during data collection. Consent for publication Not applicable Data and materials availability We described all the relevant information in the manuscript but the refined dataset can be obtained from the corresponding author upon reasonable request. Competing interests All Authors declared that have no conflict of interest. Funding In conducting this research, there was no funding obtained from any organization. Contributions of Authors AA: Conceptualization, methodology, software, validation, formal analysis, investigation, resources, data curation, writing - original manuscript draft, writing - review & editing, visualization, supervision, project administration. DZ: Took part in methodology, software, validation, formal analysis, investigation, writing - review & editing, visualization. AW: Methodology, software, validation, formal analysis, investigation, writing - review & editing, visualization. SM: Methodology, software, validation, formal analysis, investigation, writing - review & editing, visualization. SM: Took part in methodology, software, validation, resources, data curation, writing - original manuscript draft, formal analysis, investigation, writing - review & editing, visualization. Acknowledgment We would like to acknowledge Addis Ababa Medical and Business College, we would also like to thank to our colleagues who provide their positive and constructive ideas during the write up. Finally, we express our gratitude to the data collectors and staff members of the outpatient department of St Amanuel specialized psychiatric hospital. References Demoz, Z., et al., Medication adherence and its determinants among psychiatric patients in an Ethiopian referral hospital. Patient preference and adherence, 2014. 8 : p. 1329. Dou, L., et al., Factors Associated with Medication Adherence Among Patients with Severe Mental Disorders in China: A Propensity Score Matching Study. Patient preference and adherence, 2020. 14 : p. 1329-1339. Ljungdalh, P., Non-adherence to pharmacological treatment in schizophrenia and schizophrenia spectrum disorders–An updated systematic literature review. The European Journal of Psychiatry, 2017. 31 (4): p. 172-186. Chukwujekwu, C.D. and O.K. Adesokun, Prevalence of medication non-adherence among psychiatric patients in a tertiary hospital in Nigeria. Journal of Biosciences and Medicines, 2017. 5 (04): p. 1. Mahaye, S., et al., Medication adherence of psychiatric patients in an outpatient setting. African Journal of pharmacy and pharmacology, 2012. 6 (9): p. 608-612. Adelufosi, A.O., et al., Medication adherence and quality of life among Nigerian outpatients with schizophrenia. Gen Hosp Psychiatry, 2012. 34 (1): p. 72-9. Kane, J.M., Compliance issues in outpatient treatment. Journal of Clinical Psychopharmacology, 1985. 5 (3 Suppl): p. 22S-27S. Perkins, D.O., Predictors of noncompliance in patients with schizophrenia. Journal of Clinical Psychiatry, 2002. 63 (12): p. 1121-1128. Abdisa, E., et al., Self-stigma and medication adherence among patients with mental illness treated at Jimma University Medical Center, Southwest Ethiopia. International Journal of Mental Health Systems, 2020. 14 (1): p. 56. Gebeyehu, D.A., et al., Psychotropic medication non-adherence among patients with severe mental disorder attending at Bahir Dar Felege Hiwote Referral hospital, north west Ethiopia, 2017. BMC Research Notes, 2019. 12 (1): p. 102. Teferra, S., et al., Perspectives on reasons for non-adherence to medication in persons with schizophrenia in Ethiopia: a qualitative study of patients, caregivers and health workers. BMC Psychiatry, 2013. 13 : p. 168. Lacro, J.P., et al., Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: a comprehensive review of recent literature. J Clin Psychiatry, 2002. 63 (10): p. 892-909. Acosta, F.J., et al., Medication adherence in schizophrenia. World journal of psychiatry, 2012. 2 (5): p. 74-82. Semahegn, A., et al., Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: a systematic review and meta-analysis. Systematic Reviews, 2020. 9 (1): p. 17. Farooq, S. and F. Naeem, Tackling nonadherence in psychiatric disorders: current opinion. Neuropsychiatric disease and treatment, 2014. 10 : p. 1069-1077. World Bank Group and, W. Out of the shadows: making mental health a global development priority organized by World Bank Group&WHO. 2016 [cited 2022 April 09]; Available from: http://www.worldbank.org/en/events/2016/03/09/out-of-the-shadows-making-mental-health-a-global-priority. Monteiro, N.M., Addressing mental illness in Africa: Global health challenges and local opportunities. Community Psychology in Global Perspective, 2015. 1 (2): p. 78-95. Tan, X., I. Patel, and J. Chang, Review of the four item Morisky medication adherence scale (MMAS-4) and eight item Morisky medication adherence scale (MMAS-8). INNOVATIONS in pharmacy, 2014. 5 (3): p. 5. Velligan, D.I., et al., Adherence problems in patients with serious and persistent mental illness. The Journal of clinical psychiatry, 2009. 70 (suppl 4): p. 455. Adewuya, A.O., et al., Prevalence and correlates of poor medication adherence amongst psychiatric outpatients in southwestern Nigeria. Gen Hosp Psychiatry, 2009. 31 (2): p. 167-74. Coldham, E., J. Addington, and D. Addington, Medication adherence of individuals with a first episode of psychosis. Acta Psychiatrica Scandinavica, 2002. 106 (4): p. 286-290. Kassis, I.T., et al., Treatment non-compliance of psychiatric patients and associated factors: are patients satisfied from their psychiatrist? British Journal of Medicine and Medical Research, 2014. 4 (2): p. 785. Ibrahim, A.W., et al., Prevalence and predictors of sub-optimal medication adherence among patients with severe mental illnesses in a tertiary psychiatric facility in Maiduguri, North-eastern Nigeria. Pan African Medical Journal, 2015. 21 (1). Tareke, M., et al., Antipsychotic medication non-adherence among schizophrenia patients in Central Ethiopia. The South African Journal of Psychiatry : SAJP : the Journal of the Society of Psychiatrists of South Africa, 2018. 24 . De Geest, S., et al., ESPACOMP Medication Adherence Reporting Guideline (EMERGE). Ann Intern Med, 2018. 169 (1): p. 30-35. Nega, M., et al., Psychotropic Medication Non-Adherence among Psychiatric Patients at Two Hospitals in Eastern Ethiopia. East African Journal of Health and Biomedical Sciences, 2018. 2 (2): p. 45-54. De Las Cuevas, C. and W. Peñate, Psychometric properties of the eight-item Morisky Medication Adherence Scale (MMAS-8) in a psychiatric outpatient setting. International journal of clinical and health psychology : IJCHP, 2015. 15 (2): p. 121-129. Dassa, D., et al., Factors associated with medication non-adherence in patients suffering from schizophrenia: a cross-sectional study in a universal coverage health-care system. Aust N Z J Psychiatry, 2010. 44 (10): p. 921-8. Sharma, S., et al., Prevalence and factors associated with medication compliance in Indian patients suffering from mental disorders. Trop Doct, 2012. 42 (1): p. 28-31. Mukattash, T.L., et al., Prevalence of non-adherence among psychiatric patients in Jordan, a cross sectional study. Int J Pharm Pract, 2016. 24 (3): p. 217-21. Girma, S., E. Abdisa, and T. Fikadu, Prevalence of Antipsychotic Drug Non Adherence and Associated Factors Among Patients with Schizophrenia Attending at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia: Institutional Based Cross Sectional Study. Health Science Journal, 2017. 11 (4). Stentzel, U., et al., Predictors of medication adherence among patients with severe psychiatric disorders: findings from the baseline assessment of a randomized controlled trial (Tecla). BMC Psychiatry, 2018. 18 (1): p. 155. Eticha, T., et al., Factors Associated with Medication Adherence among Patients with Schizophrenia in Mekelle, Northern Ethiopia. PLOS ONE, 2015. 10 (3): p. e0120560. Tesfay, K., et al., Medication non-adherence among adult psychiatric out-patients in Jimma University specialized hospital, Southwest Ethiopia. Ethiopian journal of health sciences, 2013. 23 (3): p. 227-236. Taj, F., et al., Factors associated with non-adherence among psychiatric patients at a tertiary care hospital, Karachi, Pakistan: a questionnaire based cross-sectional study. Journal of the Pakistan Medical Association, 2008. 58 (8): p. 432. El-Mallakh, R.S., Medication adherence and the use of long-acting antipsychotics in bipolar disorder. Journal of Psychiatric Practice®, 2007. 13 (2): p. 79-85. Valenstein, M., et al., Poor antipsychotic adherence among patients with schizophrenia: medication and patient factors. Schizophrenia bulletin, 2004. 30 (2): p. 255-264. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3909394","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":275608602,"identity":"1cf6f5a2-924c-461b-b679-faf237f8bbad","order_by":0,"name":"Adugnaw 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Hospital","correspondingAuthor":false,"prefix":"","firstName":"Diborah","middleName":"","lastName":"Zerihun","suffix":""},{"id":275608604,"identity":"52ee54a5-ad77-4732-9473-2a137fed6477","order_by":2,"name":"Adisu Warkaw","email":"","orcid":"","institution":"Hawassa University","correspondingAuthor":false,"prefix":"","firstName":"Adisu","middleName":"","lastName":"Warkaw","suffix":""},{"id":275608605,"identity":"43e04d17-6676-45ed-bcc5-54789bd2f4bd","order_by":3,"name":"Samuel Misganaw","email":"","orcid":"","institution":"Hawassa University","correspondingAuthor":false,"prefix":"","firstName":"Samuel","middleName":"","lastName":"Misganaw","suffix":""},{"id":275608606,"identity":"5b1d093c-e258-4f90-8a2a-83b120ffbda0","order_by":4,"name":"Solomon Mulualem","email":"","orcid":"","institution":"Hawassa University","correspondingAuthor":false,"prefix":"","firstName":"Solomon","middleName":"","lastName":"Mulualem","suffix":""}],"badges":[],"createdAt":"2024-01-29 19:59:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3909394/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3909394/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":52026020,"identity":"0a8d89f3-a8bd-4fea-ab79-7f36d5f4c6d9","added_by":"auto","created_at":"2024-03-05 15:50:29","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":109058,"visible":true,"origin":"","legend":"\u003cp\u003eConceptual framework of medication non-adherence and associated factors among patients with mental illness.\u003c/p\u003e","description":"","filename":"Fig.1.png","url":"https://assets-eu.researchsquare.com/files/rs-3909394/v1/0a94d3cf236904b0ddd5c255.png"},{"id":52026019,"identity":"f8757857-5ee5-41e3-955d-2e6bff1d7157","added_by":"auto","created_at":"2024-03-05 15:50:29","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":13145,"visible":true,"origin":"","legend":"\u003cp\u003eThe disease status among study participants with mental illness who visited psychiatric outpatient department at St. Amanuel Specialized Psychiatry Hospital, Addis Ababa, Ethiopia, 2022.\u003c/p\u003e","description":"","filename":"Fig.2.png","url":"https://assets-eu.researchsquare.com/files/rs-3909394/v1/2e0ae8593923366522cb933c.png"},{"id":52026018,"identity":"6a55e2e1-f573-4d67-b57f-6d79b67341b4","added_by":"auto","created_at":"2024-03-05 15:50:29","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":55066,"visible":true,"origin":"","legend":"\u003cp\u003eMagnitude of poor medication adherence among patients with mental illness who visited psychiatric outpatient department at St. Amanuel Specialized Psychiatry Hospital, 2022\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Fig.3.png","url":"https://assets-eu.researchsquare.com/files/rs-3909394/v1/24bfb67f62f60c85bc5f31e9.png"},{"id":52027574,"identity":"d219dd1b-13e1-4a65-8a7d-ef76fc0ad429","added_by":"auto","created_at":"2024-03-05 16:06:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":767036,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3909394/v1/4d3a44ab-7573-4be1-bffd-698b2acf8d15.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Medication Non-adherence and Associated Factors Among Patients with Mental Illness at St. Amanuel Specialized Psychiatric Hospital, Addis Ababa, Ethiopia; A Cross Sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMental illness is a broad term describing a range of disorders that affect one\u0026rsquo;s thinking, behavior, and mood [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is a condition characterized by severely impaired social life and clinically significant disruption in various aspects of mental functioning. Mental illness includes schizophrenia, paranoid disorder, bipolar disorder, schizoaffective disorder, epileptic mental disorder, and intellectual disability which is considered a global public health problem [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe success of medication treatment is determined on a patient\u0026rsquo;s adherence to the medication regimen. Non-adherence to medical therapy is a known predictor of relapse and re-hospitalization, therefore identifying contributing factors to non-adherence is one of the many challenges in treating mental illness. Non-adherent patients are 70% more likely to be admitted to the hospital than patients with partial adherence, who are 30% more likely to be admitted than adherent patients [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdherence refers to the degree to which patients follow health professionals\u0026rsquo; guidance regarding prescribed medication and maintain the indicated treatment as well as continuing to follow their instruction throughout the duration of drug therapy [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. It\u0026rsquo;s a concept that expresses the patients\u0026rsquo; acceptance and understanding of the need to be treated voluntarily and manifests the degree of their acceptance and understanding with a positive or negative attitude towards drugs [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Non-adherence is a complicated phenomenon, with a wide variety of patterns. The patient might either take lower or higher doses of the prescribed medication, follow a schedule other than prescribed, completely quit the treatment or refuse attending regular visits or being admitted to hospital [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNon-adherence to medication is a major public health problem that has been called an \u0026ldquo;invisible epidemic\u0026rdquo;[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Non-adherence to antipsychotic is one of the common challenges to successful treatment of mental illness and is a frequent cause of exacerbations in psychopathology, psychotic relapse and re-hospitalization. Medication non adherence is a growing concern to clinicians, the health care system, and other stakeholders. It compromises the efforts of the health providers in improving the health of populations. It causes wastage of health care resources, and reduce public confidence in health care systems,[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. It has also a significant impact on the disease course, relapse, future recovery, patients\u0026rsquo; quality of life, and the outcome for the patient [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is a frequent cause of impairment, hospitalization,, suicide, loss of job, violence, substance abuse and psychiatric emergences [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMental illnesses have been a significant public health challenge globally. Globally, around half billion people are affected by psychiatric disorders worldwide. It contributes 14% of the overall global morbidity burden, and 30% of the non-fatal diseases burden. Adherence to medication is crucial but challenging in the management of most psychiatric disorders [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Africa, Mental disorders account for 5% of the total burden of disease and 19% of all disability. Approximately one out of four people in Africa may experience what the WHO refers to as common mental illness such as depression or anxiety, with depression having the second highest disease burden on the continent. Mental illness has been characterized as a neglected and increasingly burdensome problem affecting all segments of the population in Africa [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNon-adherence to medications is considered as one of the common drug related issues stated that non-adherence to medications is a \u0026ldquo;worldwide problem of striking burden. Problems with medication adherence are important not in themselves, but because of the negative impact they can have on patients\u0026rsquo; health and functioning. Poor medication adherence can cause negative health outcomes like worsening disease or even death [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe global estimate of non-adherence rates in mental disorder widely ranging from 4\u0026ndash;72%. Reports indicate that up to 50% of patients with mental illness do not adhere to their prescribed medications worldwide [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Similar studies were conducted in different part of Africa to determine magnitude of antipsychotic drug non adherence on schizophrenia patients. The prevalence of non-adherence in studies conducted in Nigeria was 54.2% [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], and 55.7% [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Reports in Ethiopia have shown that non-adherence to antipsychotics medication was varied from 26.5\u0026ndash;47.9% [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIdentifying the risk factors for non-adherence is an essential step toward designing intervention strategies aimed at reducing this phenomenon. Non-adherence risk factors identified up to date include: A number of demographic and clinical factors associated with medication non-adherence have been reported in previous studies, some of which are negative attitude towards medications, poor insight, previous non-adherence, medication regimen complexity, poor therapeutic alliance, illness duration, social support, medication efficacy, side effects of medications, dosage and route of medication administration, and substance abuse [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMedication adherence research has increased significantly over the past decades using observational, interventional and implementation researches. Despite these increased research efforts by many disciplines research has not resulted in the much-needed progress to tackle medication non-adherence effectively [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStudies conducted previously were focused on clinical determinants of non-adherence rather than looking at the clients\u0026rsquo; behavioral aspects and did not include all mental illnesses. Besides, little is known about the level of non-adherence and its associated factors in the study area among all groups of mental illnesses.\u003c/p\u003e \u003cp\u003eTherefore, this study aimed to determine the level of non-adherence and its associated factors among patients with mental illness Visiting St. Amanuel Specialized Psychiatric Hospital.\u003c/p\u003e \u003cp\u003eMedication non-adherence is a significant clinical concern in patients with mental illnesses than other chronic illness patients. Numerous studies have been conducted on medication adherence among patients with mental illness. However, many of these studies are limited by factors like small sample size and focused on schizophrenia alone while neglecting other psychiatric illnesses.\u003c/p\u003e \u003cp\u003eFurthermore, most of the previous studies were conducted in rich industrialized countries, and it is not known how generalizable their findings to settings where health resources are scarce and unequally distributed, as seen in many developing countries including Ethiopia. In addition, the finding of the study would be useful as scientific evidence for local decision-makers and other stake holders to make an informed decision that would address the best interests of a patient with severe mental illness leading to better health and quality of life. Furthermore, the finding of this study will serve as scientific evidence and essential baseline data for researchers and professionals working in the field of psychiatry (Fig.\u0026nbsp;1).\u003c/p\u003e \u003cp\u003eFigure 1: Conceptual framework of medication non-adherence and associated factors among patients with mental illness.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eObjective\u003c/h2\u003e \u003cdiv id=\"Sec3\" class=\"Section3\"\u003e \u003ch2\u003eGeneral Objective\u003c/h2\u003e \u003cp\u003eTo assess medication Non-adherence and associated factor among patients with mental illness visited psychiatric outpatient department at St. Amanuel Specialized Psychiatry Hospital, Addis Ababa, Ethiopia, 2022.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSpecific Objective\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eTo determine the magnitude of medication non-adherence among patients with mental illness who visited psychiatric outpatient department at St. Amanuel Specialized Psychiatry Hospital.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTo identify factors associated with medication non-adherence among patients with mental illness who visited psychiatric outpatient department at St. Amanuel Specialized Psychiatry Hospital.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStudy setting\u003c/h2\u003e \u003cp\u003eThe study was conducted in St. Amanuel specialized psychiatry hospital. The hospital is one of the pioneer Ethiopian Hospitals which was established in 1938. The hospital was supposed to serve as quarantine for people with mental illness. Now it is the only mental hospital in the country which engaged in giving core mental clinical services, conducting research and trainings of professionals. It has both inpatient and outpatient units. The hospital has 300 beds which provide specialized psychiatric service with 11 psychiatrists, 14 general practitioners, 29 public health officers, 111 nurses including clinical and psychiatric nurses, 22 pharmacy professionals and laboratory professionals for patients from all corners of the country. Among the 300 beds, 23 are for emergency and 277 are for cold cases.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and period\u003c/h2\u003e \u003cp\u003eInstitution-based cross-sectional study design was employed among patients with mental illness at St. Amanuel Specialized Psychiatric Hospital, Ethiopia from August 20, 2022 to September 30, 2022.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePopulation\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eSource population\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eAll patients with mental illness who visit psychiatric OPD of St. Amanuel specialized psychiatric hospital.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy Population\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eAll patients with mental illness who visit psychiatric OPD of St. Amanuel specialized psychiatric hospital during the study period.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSample population\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eSystematically selected patient with mental illness who visit psychiatric OPD of St. Amanuel specialized psychiatric hospital during the study period.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eInclusion and Exclusion Criteria\u003c/h2\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eInclusion criteria:\u003c/h2\u003e \u003cp\u003e \u003c/p\u003e\u003cul\u003e \u003cli\u003e \u003cp\u003ePatients with mental disorder who had at least two or more regular follow up at St. Amanuel Specialized Psychiatric Hospital were included in the study.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePatient aged 18 and above years\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eExclusion criteria:\u003c/h2\u003e \u003cp\u003ePatients who were acutely agitated or severely retarded, disoriented, and unable to communicate\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSample size Determination \u0026amp; sampling procedures\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eSample size\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eThe sample size was calculated using a single population proportion formula taking highest prevalence from the previous studies done in Ethiopia. The prevalence of medication non-adherence among adult psychiatric outpatient at Harar [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] was 61.2%, taking the margin of error 5%, 95% confidence interval with a non-response rate of 10% which gives a total of 401 study participants.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003en=\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\frac{{Z}^{2}\\left(P\\right(1-P)}{{d}^{2}}\\)\u003c/span\u003e\u003c/span\u003e = \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\frac{{\\left(1.96\\right)}^{2}\\left(0.612\\right(0.388)}{{0.05}^{2}}\\)\u003c/span\u003e\u003c/span\u003e = \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\frac{3.842\\left(0.237\\right)}{0.0025}\\)\u003c/span\u003e\u003c/span\u003e = \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\frac{0.910}{0.0025}\\)\u003c/span\u003e\u003c/span\u003e =\u003c/p\u003e \u003cp\u003en = 364.18 + 36.418 (10% non-response rate); n = 400.598 = 401\u003c/p\u003e \u003cp\u003eTherefore, 401 patients with mental illness was included in present study.\u003c/p\u003e \u003cp\u003eWhere: n = sample size; d = margin of error (5%); P = prevalence rate, p was taken as 61.2% from Harar study. z = Critical value of standard normal distribution (Z-statistic) at 5% level (1.96); Confidence level (CI) = 95%\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSample size for the second objective\u003c/h2\u003e \u003cp\u003eThe sample size for the second objective was calculated by using EPI INFO version 7 for those factors that can influence medication non adherence. During calculation 95% CI, 80% power, percent of unexposed with outcome, and adjusted odds ratio on substance use and poor attitude toward medication are used (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSample size calculation for factors associated with medication non-adherence among mental illness patients.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAOR\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e% Outcome in unexposed group\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRatio (Unexposed: Exposed)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCalculated sample size (including 10% non-response rate)\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubstance use\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.4%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e149\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor attitude toward medication\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45.5%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.15\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e203\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale Patients\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44.4%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.17\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e261\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003eThe calculated samples for both objectives were compared to obtain the maximum sample. Since the sample size calculated for the first objective by using single population proportion was large, it was taken as a final sample. Therefore, the final sample size was 401.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eSampling technique\u003c/h2\u003e \u003cp\u003eSystematic random sampling technique was used to select each study participants. The average number of patients with mental illness who attained psychiatric outpatient department at St. Amanuel specialized psychiatric hospital in the previous two month were 2102. Therefore, K was calculated as; K = N/n K = 2102/401 = 5.24 = 5\u003c/p\u003e \u003cp\u003eWhere: K = the number of intervals between samples; N = total number of patients who had attained psychiatric OPD at St. Amanuel specialized in the previous two months; n = calculated sample size\u003c/p\u003e \u003cp\u003eTherefore, every 5th patient was included in the present study. The first patient was selected randomly and the others were selected systematically based on the ‘k\u003csup\u003eth\u003c/sup\u003e’ value. In case of a patient who will re-visit during the study period, the patient’s identification number was cross-checked against from previously collected questionnaires.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eVariables of the study\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eDependent variable\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eMedication adherence status (Poor adherence = 1/ Adequate adherence = 0)\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eIndependent variable\u003c/h2\u003e \u003cp\u003eAge ,Sex, Educational level, Religion, Residence, Marital status, Working/employment status, Occupation, Income, Type of drug, Dosage frequency, Presence of side effects, Psychiatric diagnosis, Duration of mental illness, Alcohol consumption, Substance use, Comorbidity\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eOperational definition\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eAdherence to medication\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eThe level of drug adherence was measured based on MMAS-8 score. Accordingly,\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cul\u003e \u003cli\u003e \u003cp\u003ePoor-adherent: MMAS-8 score of ≤ 6\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eGood-adherent: MMAS-8 scores of \u0026gt; 6\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eData collection procedures\u003c/h2\u003e \u003cp\u003e Interviewer administered structured questionnaire including socio-demographic characteristics, socioeconomic characteristics, patient related factors, health care related factors and other factors associated with medication non-adherence was collected by face-to-face interview of the participants. Data regarding the type of major psychiatric disorder diagnosis, the type of drug/s, frequency of drug taken, drug regimen and co-morbidities (if any) was reviewed from patient document. Adherence was assessed by using the Morisky medication adherence questionnaire. The questionnaire consisted of eight items (in a yes-or-no answer format) asking about forgetting to take medication, carelessness about taking medication and stoppage of medication when feeling better and when feeling worse.\u003c/p\u003e \u003cp\u003eData was collected by three psychiatric nurses through face-to-face interview method and record review. Close supervision was held on the data collection process by primary investigator and one supervisors who have Master of Science degree in integrated clinical.\u003c/p\u003e \u003cp\u003eThe data collectors were four nurses who are working in the oncology unit of the hospitals. Two supervisors (public health experts) were assigned for supervising the data collectors in each of the oncology units. The data collectors were four nurses who are working in the oncology unit of the hospitals. Two supervisors (public health experts) were assigned for supervising the data collectors in each of the oncology units.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eData quality management and control measures\u003c/h2\u003e \u003cp\u003eA one-day formal and standardized training was given to the data collectors and supervisor about the purpose of the study, data collection tool, collection techniques, consent taking and confidentiality and ethical issues during the collection of data.\u003c/p\u003e \u003cp\u003ePretest was done prior to data collection on 40 (10%) patients with mental illness at St Paulos Specialized Hospital to ensure the data quality by assessing its clarity, understandable and completeness. The questionnaire was modified depending on the identified gaps. The investigator and supervisor made spot checking and reviewing the completed questionnaires on daily basis to ensure completeness and consistency of the information to be collected. Each information collected from the patient medical file was checked twice and recorded appropriately in the tool.\u003c/p\u003e \u003cp\u003eThe reliability and validity of 8-item MMAS was evaluated first in hypertensive patients by five experts in USA. It has a sensitivity and specificity of 93% and 53%, respectively [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The sensitivity indicates that the scale is good at identifying patients who have low medication adherence. Whereas the specificity indicates moderate performance of the scale in identifying patients who do not have problems with medication adherence. Later on the content validity of the 8-item MMAS in psychiatric patients was evaluated by two experts in Spain and the Cronbach’s alpha coefficient was 0.75 [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eData processing and analysis\u003c/h2\u003e \u003cp\u003eAfter the questioner and recorded data are checked for completeness, data was entered into EPI data version 4.6 and exported to SPSS version 26 for statistical analysis. Descriptive statistics was carried out and presented with narration, tabulation, and graphical presentation to present the socio-demographic, clinical characteristics and psychiatric medication adherence status of study participants. Factor specific descriptive statistics (mean, standard deviation, minimum, maximum, frequencies) were used to characterize the adherence status of patients with mental illness.\u003c/p\u003e \u003cp\u003eBinary logistics regression was fitted done after dichotomizing the dependent variables. To explore and identify factors associated with Psychiatric medication non- adherence. Those variables with a p-value less than 0.25 in the bivariable analysis were considered eligible for multivariable logistic regression analysis. The level of significance was set at a P-value of \u0026lt; 0.05 at 95% CI, and Odds Ratio was used to quantify the strength of association for each independent variable with the dependent variable. Hosmer and Lemeshow statistics was used to preform model fitness test and construct the final model.\u003c/p\u003e \u003c/div\u003e"},{"header":"Result","content":"\u003cp\u003eFrom the total sample recruited in this study, (407), nearly 92% (374) participated in this study and included in the statistical analyses. This makes the Non-response rate to be 8%. The age of respondents is from minimum, 17 to maximum 88 years. The participants have mean age of 36.4 ± 14.6. More than half (61.8%) of respondents were Males. Based on age category, 44.7% of respondents were in age group 36–45 years. More than half of respondents were Unmarried and Urban dwellers (54.3%, 52.9%) respectively. Nearly two-third participants responded to be unemployed. Where around 60% were primary and below in educational level (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics of respondents in assessment of medication adherence and associated factor among patients with mental illness who visited psychiatric outpatient department at St. Amanuel Specialized psychiatry Hospital, Addis Ababa, Ethiopia, 2022.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e143\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38.2\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e231\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e61.8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e≤ 25\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26–35\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e167\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36–45\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46–55\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e≥ 56\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.2\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e176\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e47.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e198\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e52.9\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e203\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e54.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEver married\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEthnicity\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmhara\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e219\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e58.6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOromo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28.6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTigre\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOrthodox\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProtestant\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCatholic\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducational status\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIlliterate\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27.0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollege and above\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEmployment\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e284\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e75.9\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e: Sociodemographic characteristics of respondents in assessment of medication non-adherence and associated factor among patients with mental illness who visited psychiatric outpatient department at St. Amanuel Specialized psychiatry Hospital, Addis Ababa, Ethiopia, 2022.\u003c/p\u003e\u003ch2\u003eTreatment related characteristics\u003c/h2\u003e\u003cp\u003eThe participants were having the treatment duration lasting minimum 2 month, while maximum was 9 years with mean duration of the disease 4.28 years and 2.7 standard deviation. Regarding the disease type reported by the participants 149 (39.8%) had schizophrenia whereas Bipolar account for 91(24.3%) (Fig.\u0026nbsp;2).\u003c/p\u003e\u003cp\u003eFigure 2. The disease status among study participants with mental illness who visited psychiatric outpatient department at St. Amanuel Specialized Psychiatry Hospital, Addis Ababa, Ethiopia, 2022.\u003c/p\u003e\u003cp\u003eAbout tow third of participants (77.5%) are found taking single drug and more than 60% were taking antipsychotic drug regimen (36.9% and 30.2%. which are Typical and atypical drugs respectively. Majority (57.8%) of the study participants believes in spiritual causation as their cause for their illness. About 180(48.1%) and 108(28.9%) of the patients had intermediate and poor support from their loved ones, respectively (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTreatment related characteristics of respondents in assessment of medication adherence and associated factor among patients with mental illness who visited psychiatric outpatient department at St. Amanuel Specialized Psychiatry Hospital, Addis Ababa, Ethiopia, 2022.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSubstance Use\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e239\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63.9\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePerceived Causation\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBiological/Psychological\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e158\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.2\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpiritual causation\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e216\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eLevel of support\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntermediate\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.9\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eDisease Status\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSchizophrenic\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e149\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBipolar\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMood Disorder\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMajor Depressive Disorder\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNumber of drug used\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTaking one drug\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e290\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77.5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTaking More than one drug\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eType of Drug used\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTypical antipsychotic\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.9\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAtypical antipsychotic\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.2\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAntidepressant\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMood Stabilizer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCombination drugs\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eComorbidity\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e341\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91.2\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e: Treatment related characteristics of respondents in assessment of medication adherence and associated factor among patients with mental illness who visited psychiatric outpatient department at St. Amanuel Specialized Psychiatry Hospital, Addis Ababa, Ethiopia, 2022.\u003c/p\u003e\u003ch2\u003eDrug Adherence status\u003c/h2\u003e\u003cp\u003eMore than half (68.2%) of study participants forget their medication sometimes. About 44.4% and 46.3% of the patients stop taking their medication due to symptom worsening and symptom improvement, respectively. 169 (45.2%) of the study participants feel hassled about sticking to their treatment plan (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMorisky adherence scale eight-item questions.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eForget medication sometime\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31.8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e255\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e68.2\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMiss medication other than forgetting\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e345\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e92.2\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStopping medication due to worsen symptom\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e208\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55.6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e166\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStopping medication due to improved symptom\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e201\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e173\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eForgetting medication due to travel or when you leave home\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e157\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42.0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e217\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e58.0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFeeling hassled about sticking to your treatment plan\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e205\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e54.8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45.2\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDo you take your medication yesterday\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e351\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e93.9\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eFrequency of having difficulty remembering to take drugs\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever/Rarely\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOnce in a while\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e164\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.9\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUsually\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eTaking the Morisky adherence scale for drug adherence determination, those who scored below the cut point to be said they are poorly adhered, 122 (32.6%) ( 95% CI, 28.0%-37.5%) were found to have poor adherence, whereas 252 (67.4%) had good adherence based on Morisky scale for drug adherence (Fig.\u0026nbsp;3).\u003c/p\u003e\u003cp\u003eFigure 3: Magnitude of poor medication adherence among patients with mental illness who visited psychiatric outpatient department at St. Amanuel Specialized Psychiatry Hospital, 2022.\u003c/p\u003e\u003ch2\u003eFactors associated with psychiatric medication adherence\u003c/h2\u003e\u003cp\u003eAmong socio-demographic, clinical and treatment-related variables entered into a bivariable logistic regression, some of them were associated with poor medication adherence. Sex, residence, age, educational status, employment status, substance use, comorbidity, psychiatric diagnosis type, perceived causation, level of support, number of drug, and treatment duration were taken as candidate variables for multivariable logistic regression at a p-value ≤ 0.25. The output from multivariable logistic regression showed that sex, employment status, substance use, psychiatric diagnosis type, perceived causation, and level of support were the final independent variables associated with psychiatric medication adherence at p-value \u0026lt; 0.05 after adjustment to confounding variables.\u003c/p\u003e\u003cp\u003eThe odds of having poor medication adherence in male patients were 1.841 times (AOR = 1.841, 95% CI; 1.136–2.984, p = 0.013) higher than female patients, provided that the other variables were kept constant. Patients who have history of substance use (including the present) had 2.088 times (AOR = 2.088, 95% CI; 1.222–3.569, p = 0.008) higher odds of having poor medication adherence than patients who have no history of substance use. Similarly patients who are currently unemployed had 2.593 times (AOR = 2.593, 95% CI; 1.446–4.649, p = 0.021) higher odds of having poor medication compared to those who are currently employed.\u003c/p\u003e\u003cp\u003eAccording to the current study, patients who believe in spiritual causes as their cause for their illness had 1.743 times (AOR = 1.743, 95% CI; 1.026–2.959 p = 040) higher odds of having poor medication adherence than those patients who believes in biological or psychological causes as their cause for their illness. Comparing the different level of support that the patient receive from their loved ones, those patients who have poor and intermediate support had 3.277 and 4.987 higher odds of poor medication adherence than those patients who receive good support from their loved ones, respectively.\u003c/p\u003e\u003cp\u003eAfter analyzing the different types of psychiatric diagnosis that the patient had, it was revealed that mental illness patients who had diagnosed with schizophrenia were more at risk for poor drug adherence than patients with bipolar or mood disorder. Whereas there was no statistically significant difference between patients with schizophrenia and MDD diagnosis. Keeping the other variables constant, patients with schizophrenia were 36.9% and 37.8% at higher risk of having poor medication adherence than bipolar (AOR = 0.369, 95% CI; 0.186–0.733, p = 0.038) and mood disorder (AOR = 0.378, 95% CI; 0.181–0.791, p \u0026lt; 0.001), respectively (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBi-variable and multivariable binary logistic regression for psychiatric medication adherence with predictor variables among mental illness patients at Amanuel specialized psychiatry hospital, Addis Ababa, Ethiopia.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCOR (95% CI)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAOR (95% CI)\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.690(0.447–1.065)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.703(0.398–1.242)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumeric\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.975(0.659–1.910)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.958(0.589–1.827)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.971(1.209–3.212)**\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.841( 1.136–2.984)*\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducational Status\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIlliterate\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.684(0.395–1.184)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.867(0.443–1.701)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.610(0.317–1.173)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.598(0.265–1.347)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.650(0.346–1.220)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.770(0.341–1.735)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEmployment status\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.649(1.631–4.303)**\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.593(1.446–4.649)*\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSubstance use\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.858(1.191–2.898)**\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.088(1.222–3.569)**\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eComorbidity\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.419(0.204–0.861)*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.782(0.334–1.831)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003ePsychiatric Diagnosis\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSchizophrenia\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBipolar\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.531(0.304–0.929)*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.369(0.186–0.733)*\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMood Disorder\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.332(0.176–0.628)***\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.378(0.181–0.791)***\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMDD\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.569(0.287–1.131)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.501(0.227–1.105)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers(epilepsy, addiction)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.443(0.045–4.356)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.437(0.029–6.632)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePerceived causation\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBiological/Psychological\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpiritual\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.010(1.274–3.171)**\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.743(1.026–2.959)*\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eLevel of support\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedium\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.35(1.756–6.390)**\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.987(2.330-10.677)**\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.68(1.335–5.380)***\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.277(1.432–7.496)**\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNumber of Drug\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMonotherapy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePolytherapy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.461(0.883–2.419)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.231(0.653–2.32)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDuration of treatment\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.905(0.839–0.997)*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.924(0.847–1.007)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e“***” significant at p-value \u0026lt; 0.001 “**” significant at p-value 0.01 “*” significant at p-value 0.05\u003c/p\u003e \u003cp\u003eHosmer and Lemeshow Goodness of fit test p-value = 0.928, X\u003csup\u003e2\u003c/sup\u003e = 3.102\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e: Bivariable and multivariable binary logistic regression for psychiatric medication non-adherence with predictor variables among mental illness patients at Amanuel specialized psychiatry hospital, Addis Ababa, Ethiopia.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study has attempted to assess the Non-adherence to medications amongst mental illness outpatients in Amanuel comprehensive specialized psychiatric hospital and assess factors associated with poor medication adherence.\u003c/p\u003e \u003cp\u003eThe study revealed that 32.6% of the study participants had poor medication adherence. This was comparable with study in France (30%)[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], Ethiopia, Jimma (39.3%)[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] and Nigeria (39.6%)[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Comparing the prevalence rate between the different studies showed that, the current prevalence were lower than most of the previous studies such as South Africa (37%) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], India (38%)[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], Nigeria (48% and 39.6%.) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], and Jordan 64.2% [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Whereas it was higher than studies from France (30%) and Ethiopia, Mekelle (26.5%). This result was also lower than previous studies in Bahir Dar, Ethiopia (55.2% ) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Another study at Two Hospitals in Eastern Ethiopia found 61.2% were non adherent to psychotic drugs [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Previous study done in Amanuel mental health Hospital among schizophrenic patients showed that the magnitude of medication non-adherence was found to be 48.4% [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe finding in this study is relatively lower than other literatures. This may be due to the reason that most studies were done selecting a single disease conditions among mental illnesses. Another reason may be the study design used as in the case of study in Nigeria [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] which used cohort study design, affect the magnitude of the prevalence whereas this study uses cross sectional study design.\u003c/p\u003e \u003cp\u003eFurthermore measuring medication adherence in patients with mental illness is difficult and lacks a gold standard. Consequently, a great number of different methods and instruments proposed, and this may be responsible for the difference in the rate of non-adherence. Furthermore, the difference in prevalence may be due to the inclusion of all mental illnesses in this study, which may affect the level of adherence to medication as those with mild disease status and good orientation could have good adherence while those with sever disease may have poor adherence. So, the total adherence level, which is the average of all the disease conditions in mental illness, found to be lower than the findings in specific mental disease.\u003c/p\u003e \u003cp\u003eFinally there may be also, time gap between the researches, sociodemographic changes and difference, level of support and advancements in mental health, and health system progress that may alter the non-adherence level.\u003c/p\u003e \u003cp\u003eAccording to the finding of this study, male patients were 1.841 times (AOR\u0026thinsp;=\u0026thinsp;1.841) more likely to be non-adherent than female patients. Similar findings were found in a study conducted in Ethiopia-Tigray by Demoz et al., which found that female patients had 2.34 higher odds of having better adherence than male patients [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The higher adherence rate discovered in females could be attributed to the patriarchal nature of the study setting in which females are socially and culturally expected to be compliant. This may have a favorable impact on their adherence in the therapeutic alliance. However, it was against to a study done in Germany [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] which reports being female as negative determinant for better medication adherence. Whereas against to our finding the Chinese study didn\u0026rsquo;t discover a statistical significant association between medication adherence and sex of the participant [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePatients who have history of substance use (including the present) had 2.088 times (AOR\u0026thinsp;=\u0026thinsp;2.088) higher odds of having poor medication adherence than patients who have no history of substance use. This was supported by the finding from systematic review which was done by P.M. Ljungdalh in Denmark [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] and Ethiopia, Tigray[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Possible reasons for this might include substance use can have negative impacts on persons internal condition, causing increased cognitive problems, unpleasant withdrawal symptoms, increased risk of social withdrawal and eventually lack of social of social support.\u003c/p\u003e \u003cp\u003eAccording to the present study, patients who are currently unemployed had 2.593 times (AOR\u0026thinsp;=\u0026thinsp;2.593) higher odds of having poor medication compared to those who are currently employed. This finding was in agreement with a Chinese [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] and Germanize [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] study. However it oppose with the study done in Nigeria that discovers currently employed participants have higher odds of poor medication adherence than currently unemployed participants [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Contrary to all above studies the South African study discovers that there was no statistical significant association between non adherence and employment status [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The possible explanation for the higher odds of non-adherence among unemployed could be due to the fact that employed patients have money to buy medication and they are less stigmatized than with those of unemployed patients. Also, employed patients were likely to be free of stress which comes due to unemployment and may reinforced to take their medication as they feel better.\u003c/p\u003e \u003cp\u003eThe current study revealed, patients who believe in spiritual causes as their cause for their illness had 1.743 times (AOR\u0026thinsp;=\u0026thinsp;1.743) higher odds of having poor medication adherence than those patients who believes in biological or psychological causes as their cause for their illness. This was concurrent with adewuya et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] that states patients who perceive spiritual causation had 3.74 higher odds of poor medication adherence than patients who believe in biological causation [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This might be driven on by our community's strong religious roots and insufficient patient communication regarding the status of their illnesses. Additionally, a belief in spiritual causation may lead patients and their loved ones to think that a spiritual cure is preferable to medication for treating their mental health issues.\u003c/p\u003e \u003cp\u003ePatients who received poor and intermediate levels of support from their loved ones had, respectively, 3.277 and 4.987 times higher odds of poor medication adherence than patients who received good support from their loved ones. This was in agreement with studies done in German [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], India [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] Nigeria [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], Jimma, Ethiopia [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] and Bahir Dar [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Having social or family support encourage patients to take their medication on time, reducing fear associated to medication side effects, and educating them about the risks of medication non-adherence may all contribute to this. It also due to the fact that family members supervised the medicine intake at home and brought the patients for regular follow-ups.\u003c/p\u003e \u003cp\u003eMental illness patients who had diagnosed with schizophrenia were more at risk for poor drug adherence than patients with bipolar or mood disorder. Patients with schizophrenia had 36.9% and 37.8% higher risk of having poor medication adherence than bipolar (AOR\u0026thinsp;=\u0026thinsp;0.369) and mood disorder (AOR\u0026thinsp;=\u0026thinsp;0.378), respectively. This was supported by the Pakistani study [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] which reports the non-adherence rate among schizophrenia patients were 41.2% which was higher than bipolar patients (26.1%). Similarly an Indian study states, patients with schizophrenia (50.32%) were more likely to be non-adherent than patients with bipolar (33.3%) and MDD (16.33%) [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The probable explanation for the higher prevalence rate among schizophrenic patients could be due to the multiple and complex or combination of medications prescribed for psychosis patients\u003c/p\u003e \u003cp\u003eHowever there was no statistically significant association between poor medication adherence with age, and educational status. This finding was in line with study conducted in Nigeria [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However it was against to the study done in Germany [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], china [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], India [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], South Africa [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] and Ethiopia, Tigray [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] which reports age and educational status as a significant predictor of medication adherence. Furthermore, some of the treatment related factors like comorbidity, duration of treatment, type of drug and presence of side effect were not significant predictors of poor medication adherence in this study. Which was totally in contrary to what is found in previous studies [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003eStrength and limitation\u003c/h2\u003e \u003cp\u003eThe study used a standard method (8-item Morisky adherence scale) to assess medication adherence. The study also tries to include all the outpatients considering the different psychiatric diagnosis and type of medication. The hospital based cross-sectional nature of this study design might not establish cause and effect relationship as well as the temporality effect on medication adherence might not be shown. Therefore, its application to the general population should be done with caution.\u003c/p\u003e \u003c/div\u003e "},{"header":"Conclusion and Recommendation","content":"\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe magnitude of medication non-adherence was found to be 32.6%. Although the finding is lower than the findings reviewed, this is not to mean the adherence level is good, because antipsychotic drugs and mental illness requires full adherence and attention to bring the desired medical outcome. This research also revealed that sex, employment status, substance use, psychiatric diagnosis type, perceived causation, and level of support were significantly associated with poor medication adherence among patients with mental illness. Being male, unemployed, schizophrenic, having poor or intermediate level of social support and believe in spiritual causation were the significant predicators for poor medication adherence among patients with mental illness.\u003c/p\u003e \u003cp\u003eThe study finding will give an insight to any concerned bodies about the level of major psychiatric patients\u0026rsquo; medication non-adherence and associated factors. This implies the need for more, health education, adherence promotion and strategies, mental health policies.\u003c/p\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eRecommendation\u003c/h2\u003e \u003cp\u003eHealth care providers should promote family and social support which is necessary for minimizing medication non-adherence among psychiatric patients. It is also recommended to provide health care and community based health education about medication adherence for all patients. We suggest researchers should undertake further longitudinal studies in different settings using analytical study design to establish causal relationships of psychiatric medication non-adherence and associated factors.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cb\u003eAOR\u003c/b\u003e; Adjusted Odds Ratio, \u003cb\u003eBPR\u003c/b\u003e; Brief Psychiatric Rating Scale, \u003cb\u003eCOR;\u003c/b\u003e Crude Odds Ratio, \u003cb\u003eMDD\u003c/b\u003e; Major Depressive disorder, \u003cb\u003eMMAS;\u003c/b\u003e Morisky Medication Adherence Scale, \u003cb\u003eOPD\u003c/b\u003e; Outpatient Department \u003cb\u003eWHO\u003c/b\u003e; World Health Organization.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical consideration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study proposal was reviewed and approved by the\u0026nbsp;Department of Research and Ethical Review Committee of, Addis city health bureau.\u0026nbsp;The college provided an ethical clearance letter for conducting the research project (Ref. \u0026nbsp; A/A /2907/227). Permission for collecting data from patients and accessing medical records was requested from St. Amanuel specialized psychiatric hospital. Informed written consent\u0026nbsp;was obtained from the patients to be involved in the research. Patients with severe agitation and difficult to communicate including under age 18 were excluded from the study. For some stable patients with minor disability parents /guardians were requested to sign.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;A code number was given for each questionnaire to ensure the confidentiality of the participant\u0026rsquo;s information.\u0026nbsp;The information collected from each study participant was kept confidential and used solely for research purposes. Only the principal investigator and data collectors have access to the patient\u0026apos;s medical file during data collection.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData and materials availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe described all the relevant information in the manuscript but the refined dataset can be obtained from the corresponding author upon reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll Authors declared that have no conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn conducting this research, there was no funding obtained from any organization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions of Authors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAA:\u003c/strong\u003e Conceptualization, methodology, software, validation, formal analysis, investigation, resources,\u0026nbsp;data curation,\u0026nbsp;writing - original manuscript draft,\u0026nbsp;writing - review \u0026amp; editing,\u0026nbsp;visualization, supervision, project administration.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDZ:\u0026nbsp;\u003c/strong\u003eTook part in methodology, software, validation, formal analysis, investigation,\u0026nbsp;writing - review \u0026amp; editing,\u0026nbsp;visualization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAW:\u003c/strong\u003e Methodology, software, validation, formal analysis, investigation,\u0026nbsp;writing - review \u0026amp; editing,\u0026nbsp;visualization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSM:\u003c/strong\u003e Methodology, software, validation, formal analysis, investigation,\u0026nbsp;writing - review \u0026amp; editing,\u0026nbsp;visualization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSM:\u003c/strong\u003e Took part in methodology, software, validation,\u0026nbsp;resources,\u0026nbsp;data curation,\u0026nbsp;writing - original manuscript draft, formal analysis, investigation, writing - review \u0026amp; editing, visualization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to acknowledge Addis Ababa Medical and Business College, we would also like to thank to our colleagues who provide their positive and constructive ideas during the write up. Finally, we express our gratitude to the data collectors and staff members of the outpatient department of St Amanuel specialized psychiatric hospital. \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDemoz, Z., et al., Medication adherence and its determinants among psychiatric patients in an Ethiopian referral hospital. Patient preference and adherence, 2014. \u003cstrong\u003e8\u003c/strong\u003e: p. 1329.\u003c/li\u003e\n\u003cli\u003eDou, L., et al., Factors Associated with Medication Adherence Among Patients with Severe Mental Disorders in China: A Propensity Score Matching Study. Patient preference and adherence, 2020. \u003cstrong\u003e14\u003c/strong\u003e: p. 1329-1339.\u003c/li\u003e\n\u003cli\u003eLjungdalh, P., Non-adherence to pharmacological treatment in schizophrenia and schizophrenia spectrum disorders\u0026ndash;An updated systematic literature review. 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The Journal of clinical psychiatry, 2009. \u003cstrong\u003e70\u003c/strong\u003e(suppl 4): p. 455.\u003c/li\u003e\n\u003cli\u003eAdewuya, A.O., et al., Prevalence and correlates of poor medication adherence amongst psychiatric outpatients in southwestern Nigeria. Gen Hosp Psychiatry, 2009. \u003cstrong\u003e31\u003c/strong\u003e(2): p. 167-74.\u003c/li\u003e\n\u003cli\u003eColdham, E., J. Addington, and D. Addington, Medication adherence of individuals with a first episode of psychosis. Acta Psychiatrica Scandinavica, 2002. \u003cstrong\u003e106\u003c/strong\u003e(4): p. 286-290.\u003c/li\u003e\n\u003cli\u003eKassis, I.T., et al., Treatment non-compliance of psychiatric patients and associated factors: are patients satisfied from their psychiatrist? British Journal of Medicine and Medical Research, 2014. \u003cstrong\u003e4\u003c/strong\u003e(2): p. 785.\u003c/li\u003e\n\u003cli\u003eIbrahim, A.W., et al., Prevalence and predictors of sub-optimal medication adherence among patients with severe mental illnesses in a tertiary psychiatric facility in Maiduguri, North-eastern Nigeria. Pan African Medical Journal, 2015. \u003cstrong\u003e21\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003eTareke, M., et al., Antipsychotic medication non-adherence among schizophrenia patients in Central Ethiopia. The South African Journal of Psychiatry : SAJP : the Journal of the Society of Psychiatrists of South Africa, 2018. \u003cstrong\u003e24\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eDe Geest, S., et al., ESPACOMP Medication Adherence Reporting Guideline (EMERGE). Ann Intern Med, 2018. \u003cstrong\u003e169\u003c/strong\u003e(1): p. 30-35.\u003c/li\u003e\n\u003cli\u003eNega, M., et al., Psychotropic Medication Non-Adherence among Psychiatric Patients at Two Hospitals in Eastern Ethiopia. East African Journal of Health and Biomedical Sciences, 2018. \u003cstrong\u003e2\u003c/strong\u003e(2): p. 45-54.\u003c/li\u003e\n\u003cli\u003eDe Las Cuevas, C. and W. Pe\u0026ntilde;ate, Psychometric properties of the eight-item Morisky Medication Adherence Scale (MMAS-8) in a psychiatric outpatient setting. International journal of clinical and health psychology : IJCHP, 2015. \u003cstrong\u003e15\u003c/strong\u003e(2): p. 121-129.\u003c/li\u003e\n\u003cli\u003eDassa, D., et al., Factors associated with medication non-adherence in patients suffering from schizophrenia: a cross-sectional study in a universal coverage health-care system. Aust N Z J Psychiatry, 2010. \u003cstrong\u003e44\u003c/strong\u003e(10): p. 921-8.\u003c/li\u003e\n\u003cli\u003eSharma, S., et al., Prevalence and factors associated with medication compliance in Indian patients suffering from mental disorders. Trop Doct, 2012. \u003cstrong\u003e42\u003c/strong\u003e(1): p. 28-31.\u003c/li\u003e\n\u003cli\u003eMukattash, T.L., et al., Prevalence of non-adherence among psychiatric patients in Jordan, a cross sectional study. Int J Pharm Pract, 2016. \u003cstrong\u003e24\u003c/strong\u003e(3): p. 217-21.\u003c/li\u003e\n\u003cli\u003eGirma, S., E. Abdisa, and T. Fikadu, Prevalence of Antipsychotic Drug Non Adherence and Associated Factors Among Patients with Schizophrenia Attending at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia: Institutional Based Cross Sectional Study. Health Science Journal, 2017. \u003cstrong\u003e11\u003c/strong\u003e(4).\u003c/li\u003e\n\u003cli\u003eStentzel, U., et al., Predictors of medication adherence among patients with severe psychiatric disorders: findings from the baseline assessment of a randomized controlled trial (Tecla). BMC Psychiatry, 2018. \u003cstrong\u003e18\u003c/strong\u003e(1): p. 155.\u003c/li\u003e\n\u003cli\u003eEticha, T., et al., Factors Associated with Medication Adherence among Patients with Schizophrenia in Mekelle, Northern Ethiopia. PLOS ONE, 2015. \u003cstrong\u003e10\u003c/strong\u003e(3): p. e0120560.\u003c/li\u003e\n\u003cli\u003eTesfay, K., et al., Medication non-adherence among adult psychiatric out-patients in Jimma University specialized hospital, Southwest Ethiopia. Ethiopian journal of health sciences, 2013. \u003cstrong\u003e23\u003c/strong\u003e(3): p. 227-236.\u003c/li\u003e\n\u003cli\u003eTaj, F., et al., Factors associated with non-adherence among psychiatric patients at a tertiary care hospital, Karachi, Pakistan: a questionnaire based cross-sectional study. Journal of the Pakistan Medical Association, 2008. \u003cstrong\u003e58\u003c/strong\u003e(8): p. 432.\u003c/li\u003e\n\u003cli\u003eEl-Mallakh, R.S., Medication adherence and the use of long-acting antipsychotics in bipolar disorder. Journal of Psychiatric Practice\u0026reg;, 2007. \u003cstrong\u003e13\u003c/strong\u003e(2): p. 79-85.\u003c/li\u003e\n\u003cli\u003eValenstein, M., et al., Poor antipsychotic adherence among patients with schizophrenia: medication and patient factors. Schizophrenia bulletin, 2004. \u003cstrong\u003e30\u003c/strong\u003e(2): p. 255-264.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Adherence, Mental illness, Morisky medication adherence scale, Psychotropic drug","lastPublishedDoi":"10.21203/rs.3.rs-3909394/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3909394/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eAdherence is the degree to which patients follow health professionals\u0026rsquo; recommendations regarding prescribed medication and maintain the indicated treatment. Medication non-adherence is a global problem worldwide. Medication non-adherence is a significant clinical concern in patients with mental illnesses than other chronic illness patients.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eTo assess medication non-adherence and associated factor among patients with mental illness who visited St. Amanuel Specialized Psychiatric Hospital, Addis Ababa.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eInstitution-based cross-sectional study design was employed at St. Amanuel Specialized Psychiatric Hospital, Ethiopia from August 20, 2022 to September 30, 2022. The data was collected by interviewer administered structured questionnaire and document review. Medication non-adherence was assessed by using standardized Morisky medication adherence scale. The collected data was entered into EPI data version 4.5 and exported to SPSS version 26 for statistical analysis. After descriptive data was presented; Binary logistic regression was used to assess association. The significance level was set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 and Odds ratio was used to assess the strength of association.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003eA total of 374 patients were included, of this 32.6% were found to have poor adherence. The predictors of poor adherence were male sex [AOR\u0026thinsp;=\u0026thinsp;1.841, 95% CI; 1.136\u0026ndash;2.984, p\u0026thinsp;=\u0026thinsp;0.013], substance use [AOR\u0026thinsp;=\u0026thinsp;2.088, 95% CI; 1.222\u0026ndash;3.569, p\u0026thinsp;=\u0026thinsp;0.008], unemployment [AOR\u0026thinsp;=\u0026thinsp;2.593, 95% CI; 1.446\u0026ndash;4.649, p\u0026thinsp;=\u0026thinsp;0.021], perceived spiritual causation [AOR\u0026thinsp;=\u0026thinsp;1.743, 95% CI; 1.026\u0026ndash;2.959 p\u0026thinsp;=\u0026thinsp;040], poor level of support [AOR\u0026thinsp;=\u0026thinsp;3.277, 95% CI; 1.432\u0026ndash;7.496, p\u0026thinsp;=\u0026thinsp;0.005].\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe magnitude of medication non-adherence was found to be high. Male sex, unemployment, substance use, perceived, and poor level of support were significant predictors of medication non-adherence among patients with mental illness.\u003c/p\u003e","manuscriptTitle":"Medication Non-adherence and Associated Factors Among Patients with Mental Illness at St. Amanuel Specialized Psychiatric Hospital, Addis Ababa, Ethiopia; A Cross Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-05 15:50:24","doi":"10.21203/rs.3.rs-3909394/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6119769b-2f0f-4aef-94fc-600691d95875","owner":[],"postedDate":"March 5th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-03-05T15:50:26+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-05 15:50:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3909394","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3909394","identity":"rs-3909394","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}