Impact of depression and social support on nonadherence to antipsychotic drugs in persons with schizophrenia in Thailand

Sirijit Suttajit, Sutrak PilakantaDepartment of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, ThailandBackground: Little is known about the effect of social support on nonadherence in persons with schizophrenia, especially in developing Asian countries where social support is considered to be imperative. Additionally, the role of depression as a mediator in the association between social support deficits and nonadherence has not been evaluated.Methods: This was a cross-sectional study conducted in 75 participants at a university hospital in Thailand. Logistic regression was used to determine whether depression and a deficit in social support were associated with nonadherence, and whether depression mediated this association.Results: There were strong relationships between nonadherence and major depressive episodes (odds ratio [OR] 9.5, confidence interval [CI] 2.3–38.9), living alone (OR 21.8, CI 3.5–143.0), and dissatisfaction with support from family (OR 10.0, CI 1.9–53.1). The OR of the association between social support deficits and nonadherence decreased by nearly one half after adjusting for depression.Discussion: Depression and social support deficits were significantly associated with nonadherence in persons with schizophrenia. Depression is important in mediating the association between social support deficits and nonadherence. Enhancing social support, as well as early detection and effective intervention for depression should be emphasized in interventions to improve adherence in persons with schizophrenia.Keywords: nonadherence, schizophrenia, depression, social support, antipsychotic drug

Development and implementation of guidelines for the management of depression: a systematic review

Objective: To evaluate the development and implementation of clinical practice guidelines for the management of depression globally. Methods: We conducted a systematic review of existing guidelines for the management of depression in adults with major depressive or bipolar disorder. For each identified guideline, we assessed compliance with measures of guideline development quality (such as transparency in guideline development processes and funding, multidisciplinary author group composition, systematic review of comparative efficacy research) and implementation (such as quality indicators). We compared guidelines from low- and middle-income countries with those from high-income countries. Findings: We identified 82 national and 13 international clinical practice guidelines from 83 countries in 27 languages. Guideline development processes and funding sources were explicitly specified in a smaller proportion of guidelines from low- and middle-income countries (8/29; 28%) relative to high-income countries (35/58; 60%). Fewer guidelines (2/29; 7%) from low- and middle-income countries, relative to high-income countries (22/58; 38%), were authored by a multidisciplinary development group. A systematic review of comparative effectiveness was conducted in 31% (9/29) of low- and middle-income country guidelines versus 71% (41/58) of high-income country guidelines. Only 10% (3/29) of low- and middle-income country and 19% (11/58) of high-income country guidelines described plans to assess quality indicators or recommendation adherence. Conclusion: Globally, guideline implementation is inadequately planned, reported and measured. Narrowing disparities in the development and implementation of guidelines in low- and middle-income countries is a priority. Future guidelines should present strategies to implement recommendations and measure feasibility, cost-effectiveness and impact on health outcomes

Adjunctive Cariprazine in Major depressive disorder: a Systematic review and Meta-analysis (a Pre-Registration Protocol).

A systematic review and meta-analysis of adjunctive cariprazine in major depressive disorder

Prevalence of and factors associated with depression in patients with schizophrenia in Thailand: a post-hoc analysis

Abstract Objectives This study was aimed to assess the prevalence of depression and identify factors associated with depression in patients with schizophrenia in a university hospital. Methods This was a post-hoc analysis of a cross-sectional study conducted in 75 patients with schizophrenia. Major depressive episodes were diagnosed according to DSM-IV-TR. The six social support defi cits (SSDs) scale was used to identify social support defi cits. Chisquare and logistic regression were used to determine factors associated with depression. Results The prevalence of depression was 16.0%, with only 25.0% of them previously being recognized and treated with antidepressants. Age, sex, marital status, income, duration of illness, type of antipsychotic drugs and number of side effects were not signifi cantly associated with depression. Three out of six social support defi cits were associated signifi cantly with depression, including living alone, reciprocity in the family, and dissatisfaction with family support, with odds ratios of 10.0, 4.9 and 8.6, respectively. Those with at least one social support defi cit were 9.3 times more likely to be depressed than those without one (p=0.002). Conclusion This study suggested that depression in patients with schizophrenia was still under recognized by Thai psychiatrists. The fi ndings do not support the hypothesis that depression is more common in patients receiving typical antipsychotic drugs. Psychosocial factors such as social support defi cits were found to have a higher impact on depression than biological ones in Thai patients with schizophrenia. Chiang Mai Medical Journal 2011;50(4):115-121