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Degree

PhD, University of Cincinnati, Arts and Sciences : Psychology, 2006.

Abstract

Background: Previous literature suggests that African Americans are less likely than White patients to adhere to maintenance pharmacotherapy for bipolar disorder. This study explores two factors that may influence adherence in African Americans: satisfaction with outpatient services and acculturation levels. Method: Eighteen African American and twenty-six White participants with bipolar disorder participated in this study. Demographic variables, symptom severities, medication adherence, and attitudes regarding treatment satisfaction were measured by questionnaire. In addition, the African American Acculturation Scale-33 was administered to African American participants to assess acculturation levels. Results: Over 50% of the participants were determined to be either fully or partially non-adherent with medications. Using logistic regression it was determined that although participants with White ethnicity were more adherent overall, adherence in both ethnic groups was predicted by higher WRAT-III Reading subtest scores. Satisfaction was not predictive of medication adherence with the majority of participants reporting that they were moderately satisfied with treatment regardless of adherence with treatment. In African Americans, adherence was not associated with acculturation. Conclusion: Although in a multivariate model African American ethnicity predicted non-adherence overall, educational achievement moderated this relationship with higher WRAT-III Reading subtest scores predicting adherence in both ethnic groups. It is possible that a certain level of education is needed to understand the complexity of bipolar illness and the need for continued medication prophylaxis once an episode has resolved. Additionally, it is possible that physicians respond differently to patients with higher levels of education, perhaps taking more time to engage more educated patients in active discussions about treatment recommendations. Two explanations for ethnic differences in adherence (decreased satisfaction and acculturation levels) were also explored in the current study, but neither accounted for this ethnic difference. It is possible that the lack of ethnic differences in satisfaction may be associated with the fundamental difficulty with recruiting participants who are dissatisfied with mental health treatment. In addition, acculturation did not predict medication adherence in this sample, however it is likely that this question could not be adequately explored due to the small sample size. Clearly, further research with a larger sample is warranted.

Subject Headings

Psychology, Clinical

Keywords

bipolar disorder; medication adherence; ethnicity; acculturation

Advisor

Dr. Stephen M. Strakowski

Pages

69p.

Document number: ucin1147396351
Permalink: http://rave.ohiolink.edu/etdc/view?acc_num=ucin1147396351

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