The Association Between Medication Adherence, Internalized Stigma and Social Support Among Outpatients with Major Depressive Disorder in a Malaysian Hospital: A Cross-Sectional Study.
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引用次数: 0
Abstract
Background: Internalized stigma and medication non-adherence pose significant challenges for treating major depressive disorder (MDD), leading to disability, increased suicide risk, and morbidity. Limited data exists on modifiable factors associated with adherence in lower-resourced settings like Malaysia. This study aimed to investigate poor adherence prevalence and the demographic and clinical factors associated with poor medication adherence among patients with MDD.
Methods: This cross-sectional survey recruited participants using universal sampling from a major hospital in Selangor, Malaysia. Participants answered questionnaires consisting of demographic and clinical information (medical history, duration of anti-depressant treatment for MDD, psychiatric ward admission history, and any medication side effects experienced), the Internalized Stigma of Mental Illness Scale (comprising alienation, stereotype, perceived discrimination, and social withdrawal), the Multidimensional Scale of Perceived Social Support (comprising family, friend, and significant other support), and the Malaysia Medication Adherence Assessment Tool. Simple and multiple logistic regression and mediation analyses were conducted.
Results: Of the 268 participants (69% female), 57.1% were suboptimally or moderately adherent to their medication. Buddhists (adjusted odds ratio [aOR] = 0.280, 95% CI [0.115, 0.679], p = 0.005), higher family support (aOR = 0.753, 95% CI [0.591, 0.960], p = 0.022), a history of ward admissions (aOR = 3.523, 95% CI [1.537, 8.072], p = 0.003), and higher internalized stigma (aOR = 2.828, 95% CI [1.497, 5.344], p = 0.001) were significantly associated with low/moderate medication adherence. The effect of internalized stigma subdomains (alienation, perceived discrimination, and social withdrawal) on medication adherence were partially mediated by family support.
Conclusion: More than half of the participants demonstrated low to moderate medication adherence. Those with higher internalized stigma demonstrated higher odds of low/moderate medication adherence, but this effect was attenuated by family support. Therefore, internalized stigma and family support are important points of consideration when assessing patients with MDD in Malaysia.
背景：内化的耻辱感和药物依从性给治疗重度抑郁症（MDD）带来了重大挑战，导致残疾、自杀风险和发病率增加。在马来西亚等资源匮乏的地区，与依从性相关的可改变因素的数据有限。本研究旨在调查重度抑郁症患者药物依从性差的患病率以及与药物依从性差相关的人口统计学和临床因素。方法：本横断面调查采用普遍抽样从马来西亚雪兰莪州的一家大医院招募参与者。参与者回答的问卷包括人口统计和临床信息（病史、重度抑郁症抗抑郁治疗持续时间、精神科住院史和任何药物副作用）、精神疾病内化污名量表（包括疏离感、刻板印象、感知歧视和社交退缩）、感知社会支持多维度量表（包括家庭、朋友和重要的其他支持）。以及马来西亚药物依从性评估工具。进行了简单、多元逻辑回归和中介分析。结果：在268名参与者（69%为女性）中，57.1%的人对药物的依从性为次优或中等。佛教徒（调整比值比[aOR] = 0.280, 95% CI [0.115, 0.679], p = 0.005）、较高的家庭支持（aOR = 0.753, 95% CI [0.591, 0.960], p = 0.022）、住院史（aOR = 3.523, 95% CI [1.537, 8.072], p = 0.003）、较高的内化污名（aOR = 2.828, 95% CI [1.497, 5.344], p = 0.001）与低/中度药物依从性显著相关。内化污名子域（疏离感、感知歧视和社会退缩）对药物依从性的影响部分由家庭支持介导。结论：超过一半的参与者表现出低到中等程度的药物依从性。内化耻辱感较高的患者表现出较高的低/中度药物依从性，但这种影响在家庭支持下减弱。因此，内化的耻辱感和家庭支持是评估马来西亚重度抑郁症患者时的重要考虑因素。
期刊介绍：
Psychology Research and Behavior Management is an international, peer-reviewed, open access journal focusing on the science of psychology and its application in behavior management to develop improved outcomes in the clinical, educational, sports and business arenas. Specific topics covered in the journal include: -Neuroscience, memory and decision making -Behavior modification and management -Clinical applications -Business and sports performance management -Social and developmental studies -Animal studies The journal welcomes submitted papers covering original research, clinical studies, surveys, reviews and evaluations, guidelines, expert opinion and commentary, case reports and extended reports.
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