Medication compliance in mood disorders: relevance of the Health Belief Model and other determinants

This paper examines research on predictors of medication noncompliance in patients with unipolar depression and bipolar disorder, Specifically, the utility of the Health Belief Model (HBM), the most widely studied model of compliance, is examined. Also methodological issues that contribute to the difficulty in identifying consistent and reliable determinants of compliance with prescribed medication are reviewed. A Medline and PsychLit search from 1985 to the present was conducted to identify articles with the key word "compliance" paired with "depression, bipolar disorder, health belief model, attitudes, beliefs and/or doctor-patient relationship". Key review articles were searched for their references. All pertinent studies and review papers were obtained and critically reviewed. The search revealed relatively few studies looking at determinants of medication compliance in patients with major depression and bipolar disorder. Based on the Literature that does exist, it appears that overall the HEM is only modestly useful in predicting compliant/noncompliant individuals. However, other descriptive research has identified determinants of medication compliance that are not subsumed under the HEM. Factors such as treatment alliance and important social influences have a positive impact on improving treatment adherence. A broader theoretical model that incorporates constructs within the HEM as well as additional factors is necessary. Issues relating to methodology need to be addressed. Directions for future research are suggested. Primary Care Psychiatry 2000; 6:101-110, Copyright (C) 2000 LibraPharm Limited.