Role of medication adherence in the relationship between neuroticism and functioning in patients with bipolar disorder

Yıl 2025, Cilt: 50 Sayı: 4, 1123 - 1134, 22.12.2025

Hasan Bakay , Mukaddes Funda Şahin

https://doi.org/10.17826/cumj.1795623

Öz

Purpose: This study examined the relationship between neuroticism, medication adherence, and functioning in Bipolar disorder (BD) patients. Furthermore, the role of medication adherence as a mediator between neuroticism and functioning was investigated.
Materials and Methods: The study included 71 patients with BD and 44 healthy controls. All participants were assessed using the Eysenck Personality Inventory (EPI), Brief Functional Assessment Scale (FAST), and Medication Adherence Rating Scale (MARS). Anxiety and depression levels were assessed using the Hamilton Anxiety (HAM-A) and Depression (HAM-D) Rating Scales.
Results: Patients with bipolar disorder showed higher neuroticism scores compared with healthy controls (mean 2.61 vs. 1.66) and poorer functioning (FAST: 13.70 vs. 7.74). Within the patient group, neuroticism was moderately associated with worse functioning (r = .43) and lower medication adherence (r = –.28). Medication adherence showed a strong association with better functioning (r = –.50). In the mediation analysis, higher neuroticism predicted lower adherence (standardized β = –0.29), and lower adherence predicted poorer functioning (β = –0.35), indicating a significant indirect pathway from neuroticism to functional impairment through medication adherence.
Conclusion: Neuroticism negatively affects the functioning of patients with BD through poor medication adherence. Thus, personality traits should be considered when planning treatments aimed at improving functioning in patients with BD. Interventions aimed at increasing medication adherence in patients with high levels of neuroticism may lead to better functioning-related outcomes.

Anahtar Kelimeler

Bipolar disorder , functionality , medication adherence , neuroticism , personality

Etik Beyan

This study was conducted in accordance with the Declaration of Helsinki for research involving human participants and was approved by the Necmettin Erbakan University Ethics Committee for Non-Drug and Non-Medical Device Research (IRB date and number: 2024/5023).

Teşekkür

None

Bipolar bozuklukta nevrotiklik ve işlevsellik arasındaki ilişkide ilaç uyumunun rolü

Öz

Amaç: Bu çalışmada, Bipolar bozukluk (BB) tanılı bireylerde nevrotiklik, ilaç uyumu ve işlevsellik arasındaki ilişkilerin incelenmesi amaçlanmıştır. Ek olarak, ilaç uyumunun nevrotiklik ile işlevsellik arasındaki ilişkide aracı rolü araştırılmıştır.
Gereç ve Yöntem: Bu çalışmaya 44 sağlıklı kontrol ile birlikte 71 BB hastası dahil edilmiştir. Katılımcılara Eysenck Kişilik Envanteri (EKE), Kısa İşlevsellik Değerlendirme Testi (KİDT) ve İlaç Uyum Derecelendirme Ölçeği (İUDÖ) uygulanmıştır. Anksiyete ve depresyon düzeyleri Hamilton Anksiyete (HAM-A) ve Depresyon (HAM-D) Derecelendirme Ölçekleri ile değerlendirilmiştir.
Bulgular: BB hastaları, sağlıklı kontrollere kıyasla daha yüksek nevrotiklik puanlarına (ort. 2.,61 vs. 1.,66) ve daha kötü işlevselliğe (KİDT: 13.,70 vs. 7.,74) sahipti. Hasta grubunda nevrotiklik, işlevsellik ile orta düzeyde pozitif (r=.,43) ve ilaç uyumu ile negatif yönde ilişkiliydi (r=–.,28). İlaç uyumu, daha iyi işlevsellik ile güçlü bir ilişki gösterdi (r=–.,50). Mediyasyon analizinde yüksek nevrotikliğin daha düşük ilaç uyumunu yordadığı (standart β=–0.,29) ve düşük uyumun daha kötü işlevsellik ile ilişkili olduğu (β=–0.,35) görüldü; bu bulgular, nevrotiklik ile işlevsellik arasındaki ilişkinin ilaç uyumu üzerinden dolaylı olarak gerçekleştiğini gösterdi.
Sonuç: Nevrotiklik, BB’de işlevselliği olumsuz etkilemekte ve bu etki düşük ilaç uyumu aracılığıyla dolaylı olarak ortaya çıkmaktadır. Bulgularımız, BB’de işlevselliği artırmaya yönelik tedavi planlamasında kişilik özelliklerinin dikkate alınması gerektiğini göstermektedir. Yüksek nevrotiklik düzeyine sahip hastalarda ilaç uyumunu artırmaya yönelik müdahalelerin işlevsellikle ilgili sonuçları olumlu etkileyebilir.

Anahtar Kelimeler

Bipolar bozukluk , ilaç uyumu , işlevsellik , kişilik , nevrotiklik

Kaynakça

• Trautmann S, Rehm J, Wittchen H. The economic costs of mental disorders: Do our societies react appropriately to the burden of mental disorders? EMBO Rep. 2016;17:1245-51.
• Serravalle L, Iacono V, Hodgins S, Ellenbogen MA. A comprehensive assessment of personality traits and psychosocial functioning in parents with bipolar disorder and their intimate partners. Int J Bipolar Disord. 2020;8:8.
• Fleischmann E, Dalkner N, Fellendorf FT, Bengesser SA, Lenger M, Birner A et al. The Big Five as predictors of cognitive function in individuals with bipolar disorder. Brain Sci. 2023;13:773.
• Kirchner SK, Lauseker M, Adorjan K, Anderson-Schmidt H, Anghelescu IG, Baune BT et al. Medication adherence in a cross-diagnostic sample of patients from the affective-to-psychotic spectrum: Results from the PsyCourse Study. Front Psychiatry. 2022;12:713060.
• Semahegn A, Torpey K, Manu A, Assefa N, Tesfaye G, Ankomah A. Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis. Syst Rev. 2020;9:17.
• Ibrahim AW, Yahya S, Pindar SK, Wakil MA, Garkuwa A, Sale S. Prevalence and predictors of sub-optimal medication adherence among patients with severe mental illnesses in a tertiary psychiatric facility in Maiduguri, North-eastern Nigeria. Pan Afr Med J. 2015;21:39.
• Okasha TA, Radwan DN, Elkholy H, Hendawy HMFM, Shourab EMME, Teama RRA et al. Psycho-demographic and clinical predictors of medication adherence in patients with bipolar I disorder in a university hospital in Egypt. S Afr J Psychiatry. 2020;26:1437.
• Bagby RM, Ryder AG. Personality and the affective disorders: Past efforts, current models, and future directions. Curr Psychiatry Rep. 2000;2:465-72.
• Loftus ST, Garno JL, Jaeger J, Malhotra AK. Temperament and character dimensions in bipolar I disorder: A comparison to healthy controls. J Psychiatr Res. 2008;42:1131-6.
• Hanke N, Penzel N, Betz LT, Rohde M, Kambeitz-Ilankovic L, Kambeitz J. Personality traits differentiate patients with bipolar disorder and healthy controls: A meta-analytic approach. J Affect Disord. 2022;302:401-11.
• Aydın EF, Koca Laçin T. The association between borderline personality disorder, childhood trauma, neuroticism, and self-rated or clinician-rated functional impairment in euthymic bipolar disorder-1 patients. Front Psychiatry. 2024;15:1444583.
• Wang Q, Sui A, Gong L, Chattun MR, Han R, Cao Q et al. Personality traits influence the effectiveness of hypomania checklist-32 in screening for bipolar disorder. Front Psychiatry. 2022;13:919305.
• Xu Q, Li H, Zhu D. Socioeconomic status, personality, and major mental disorders: A bidirectional Mendelian randomization study. Schizophrenia (Heidelb). 2024;10:49.
• Leen J, Soczynska JK, Gallaugher LA, Woldeyohannes HO, Alsuwaidan MT, Cha DS et al. The effect of personality dimensions on functional outcomes in mood disorders. Adv Ther. 2013;30:671-83.
• Wouters H, Amin DFH, Taxis K, Heerdink ER, Egberts ACG, Gardarsdottir H. Associations between personality traits and adherence to antidepressants assessed through self-report, electronic monitoring, and pharmacy dispensing data. J Clin Psychopharmacol. 2016;36:465-71.
• Johnson MO, Neilands TB. Neuroticism, side effects, and health perceptions among HIV-infected individuals on antiretroviral medications. J Clin Psychol Med Settings. 2007;14:69-78.
• Huang J, Ding S, Xiong S, Liu Z. Medication adherence and associated factors in patients with type 2 diabetes: A structural equation model. Front Public Health. 2021;9:730845.
• Linkievicz NM, Sgnaolin V, Engroff P, Behr Gomes Jardim G, Cataldo A Neto. Association between Big Five personality factors and medication adherence in the elderly. Trends Psychiatry Psychother. 2022;44:e20200143.
• Axelsson M, Cliffordson C, Lundbäck B, Lötvall J. The function of medication beliefs as mediators between personality traits and adherence behavior in people with asthma. Patient Prefer Adherence. 2013;7:1101-8.
• Eysenck SBG, Eysenck HJ, Barrett P. A revised version of the psychoticism scale. Pers Individ Dif. 1985;6:21-9.
• Francis LJ, Brown LB, Philipchalk R. The development of an abbreviated form of the revised Eysenck Personality Questionnaire (EPQR-A). Pers Individ Dif. 1992;13:443-9.
• Karancı AN, Dirik G, Yorulmaz O. Eysenck Kişilik Anketi-Gözden Geçirilmiş Kısaltılmış Formu’nun Türkiye’de geçerlik ve güvenilirlik çalışması. Turk Psikiyatri Derg. 2007;18:254-61.
• Rosa AR, Sánchez-Moreno J, Martínez-Aran A, Salamero M, Torrent C, Reinares M et al. Validity and reliability of the Functioning Assessment Short Test (FAST) in bipolar disorder. Clin Pract Epidemiol Ment Health. 2007;3:5.
• Aydemir Ö, Uykur B. Kısa İşlevsellik Değerlendirme Ölçeği’nin Türkçe sürümünün bipolar bozuklukta güvenilirliği ve geçerliği. Turk Psikiyatri Derg. 2012;23:193-200.
• Thompson K, Kulkarni J, Sergejew AA. Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. Schizophr Res. 2000;42:241-7.
• Koç A. Kronik psikoz hastalarında tedavi uyumunun ve tedavi uyumu ile ilişkili etkenlerin değerlendirilmesi [Yüksek lisans tezi ]. Adana, Çukurova Üniversitesi, 2006.
• Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32:5-50.
• Yazıcı MK, Demir B, Tanrıverdi N, Karaağaoğlu E, Yolaç P . Hamilton Anksiyete Değerlendirme Ölçeği, değerlendiriciler arası güvenirlik ve geçerlik çalışması. Turk Psikiyatri Derg. 1998;9:114-7.
• Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56-62.
• Akdemir A, Özbay H, Dağ İ, Türkçapar MH, İşcan N, Dönbak Örsel S. Hamilton Depresyon Derecelendirme Ölçeği. Psikiyatri Psikoloji Psikofarmakoloji Derg. 1996;4:251-9.
• Young RC, Biggs JT, Ziegler VE, Meyer DA. A rating scale for mania: Reliability, validity and sensitivity. Br J Psychiatry. 1978;133:429-35.
• Karadağ F, Oral ET, Yalçın FA, Erten E. Young Mani Derecelendirme Ölçeği’nin Türkiye’de geçerlik ve güvenilirliği. Turk Psikiyatri Derg. 2002;13:107-14.
• Schwarz R, Miskowiak KW, Kessing LV, Vinberg M. Clinical and personal predictors of functioning in affective disorders: Exploratory results from baseline and 6-month follow-up of a randomised controlled trial. J Psychiatr Res. 2024;175:386-392.
• Ferretti F, Goracci A, Laurenzi PF, Centola R, Crecchi I, De Luca A et al. Neuroticism and conscientiousness moderate the effect of oral medication beliefs on adherence during the pandemic. Brain Sci. 2022;12:1315.
• Fanelli G, Domschke K, Minelli A, Gennarelli M, Martini P, Bortolomasi M et al. A meta-analysis of polygenic risk scores for mood disorders, neuroticism, and schizophrenia in antidepressant response. Eur Neuropsychopharmacol. 2022;55:86-95.
• Senner F, Hiendl L, Bengesser S, Adorjan K, Anghelescu IG, Baune BT et al. Medication adherence and cognitive performance in schizophrenia-spectrum and bipolar disorder: results from the PsyCourse Study. Transl Psychiatry. 2023;13:99.
• Sutin AR, Stephan Y, Luchetti M, Strickhouser JE, Aschwanden D, Terracciano A. The association between five factor model personality traits and verbal and numeric reasoning. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2022;29:297-317.
• Dimou K, Dragioti E, Tsitsas G, Mantzoukas S, Gouva M. Association of personality traits and self-care behaviors in type 2 diabetes mellitus: A systematic review and meta-analysis. Cureus. 2023;15:e50714.
• Matsumoto Y, Suzuki A, Shirata T, Takahashi N, Noto K, Goto K et al. Implication of the DGKH genotype in openness to experience, a premorbid personality trait of bipolar disorder. J Affect Disord. 2018;238:539-541.
• Kohli R. A systematic review to evaluate the association between medication adherence and personality traits. Value Health. 2017;20:9.A686.
• Emilsson M, Berndtsson I, Lötvall J, Millqvist E, Lundgren J, Johansson A et al. The influence of personality traits and beliefs about medicines on adherence to asthma treatment. Prim Care Respir J. 2011;20:141-7.
• Adeniran A, Akinyinka M, Wright KO, Bakare OQ, Goodman OO, Kuyinu Y et al. Personality traits, medication beliefs & adherence to medication among diabetic patients attending the diabetic clinic in a teaching hospital in southwest Nigeria. J Diabetes Mellitus. 2015;5:319-329.
• Axelsson M, Brink E, Lundgren J, Lötvall J. The influence of personality traits on reported adherence to medication in individuals with chronic disease: an epidemiological study in West Sweden. PLoS One. 2011;6:e18241.
• Axelsson M, Lötvall J, Cliffordson C, Lundgren J, Brink E. Self-efficacy and adherence as mediating factors between personality traits and health-related quality of life. Qual Life Res. 2013;22:567-75.
• Jerant A, Chapman B, Duberstein P, Robbins J, Franks P. Personality and medication non-adherence among older adults enrolled in a six-year trial. Br J Health Psychol. 2011;16:151-69.
• Xing Y, Li T, Mao Z, Zhao L, Sun Y, Jiang Q et al. Effects of neuroticism on suicide risk in major depressive disorder and bipolar disorder. Front Psychiatry. 2025;19:16:1527054.