Factors contributing to treatment non-compliance in a large sample of psychiatric patients in Turkey

Objective: This study aims to investigate the determinants of treatment non-compliance among psychiatric patients by exploring related factors. Methods: This is a cross-sectional study including patients hospitalized for psychiatric disorders and aged between 25 and 70 years in Istanbul, Turkey. 1648 patients were approached and 1310 (79.5 %) agreed to participate. A set of sociodemographic and clinical variables were collected as well as the Turkish Version of the 9-item Patient-Doctor Relationship Questionnaire (PDRQ-9) was administered. Statistical analyses included t-tests, chi-square tests, factor analysis, Confirmatory Factor Analysis, and computation of the Lorenz curve and Gini index. Results: Of 1310 patients, 761 (58.1 %) were compliant with treatments while 549 (41.9 %) were considered as non-compliant. Patients aged above 60 years were significantly less represented in the compliant group of patients (p = 0.008). Non-compliant patients were more like to be obese (p = 0.046), cigarette smokers (p = 0.019), nargileh-hookah users (p = 0.037), and perform less physical exercise (p = 0.044). Patients diagnosed with schizophrenia (p = 0.034), bipolar disorder (p = 0.016), depression (p = 0.008), obsessive-compulsive disorder (p = 0.015) and dementia/Alzheimer's disease (p = 0.003) were more likely to be compliant with treatments whereas patients affected by stress or post-traumatic stress disorder were significantly less complaint (p = 0.015 and p = 0.006, respectively). The main factors contributing to non-compliance included lack of social supervision and family support (p < 0.001), not regular attendance of the mental health services (p = 0.016), lack of insight towards treatments (p = 0.0124), lack of satisfaction with the doctor (p = 0.021), lack of education regarding medications side effects (p < 0.001), and poor perceived improvement with treatment (p = 0.005). Concurrently, the exploratory and confirmatory factor analyses confirmed validity and psychometric characteristics of the Turkish version of the 9-item Patient-Doctor Relationship Questionnaire (PDRQ-9). Conclusion: This study reported a high prevalence rate of non-compliance among psychiatric patients. An empathetic patient-doctor approach, shared decision making as well as socially supportive and psychoeducational interventions are potentially useful for improving patients' attitudes toward treatments and their compliance.