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. 2018 Oct 1:238:147-155.
doi: 10.1016/j.jad.2018.05.063. Epub 2018 May 29.

Identifying clinical net benefit of psychotropic medication use with latent variable techniques: Evidence from Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)

Natalie Bareis  1 , Juan Lu  2 , Cynthia K Kirkwood  3 , Susan G Kornstein  4 , Elwin Wu  5 , Briana Mezuk  6
Affiliations

Identifying clinical net benefit of psychotropic medication use with latent variable techniques: Evidence from Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)

Natalie Bareis et al. J Affect Disord. .

Abstract

Background: Poor medication adherence is common among individuals with Bipolar Disorder (BD). Understanding the sources of heterogeneity in clinical net benefit (CNB) and how it is related to psychotropic medications can provide new insight into ways to improve adherence.

Methods: Data come from the baseline assessments of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Latent class analysis identified groups of CNB, and validity of this construct was assessed using the SF-36. Adherence was defined as taking 75% or more of medications as prescribed. Associations between CNB and adherence were tested using multiple logistic regression adjusting for sociodemographic characteristics.

Results: Five classes of CNB were identified: High (24%), Moderately high (12%), Moderate (26%), Moderately low (27%) and Low (12%). Adherence to psychotropic medications did not differ across classes (71% to 75%, χ2 = 3.43, p = 0.488). Medication regimens differed by class: 57% of the High CNB were taking ≤2 medications, whereas 49% of the Low CNB were taking ≥4. CNB classes had good concordance with the SF-36.

Limitations: Missing data limited measures used to define CNB. Participants' perceptions of their illness and treatment were not assessed.

Conclusions: This novel operationalization of CNB has construct validity as indicated by the SF-36. Although CNB and polypharmacy regimens are heterogeneous in this sample, adherence is similar across CNB. Studying adherent individuals, despite suboptimal CNB, may provide novel insights into aspects influencing adherence.

Trial registration: ClinicalTrials.gov NCT00012558.

Keywords: Adverse effects; Bipolar Disorder; Medication adherence; Polypharmacy.

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Conflict of interest statement

Conflict of interest

None.

Figures

Fig. 1.
Fig. 1.
Dots represent different hypothetical CNB groups and their relative coordinates of psychiatric symptoms, adverse medication effects, and overall functioning.
Fig. 2.
Fig. 2.
Results of the latent class analysis depicting the five classes of CNB. BHS, YMRS and MADRS are the psychiatric symptoms dimension. Tremor through sex are the adverse effects dimension. QLESQ, LRIFT, GAF and work impairment are the overall functioning dimension.
Fig. 3.
Fig. 3.
Medication regimens by class.
See this image and copyright information in PMC

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