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BACKGROUND: Poor medication adherence is common among bipolar patients. METHOD: We examined prospective data from 2 cohorts of individuals from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study (1999-2005) with bipolar disorder. Clinical and sociodemographic features associated with missing at least 25% of doses of at least 1 medication were assessed using logistic regression, and a risk stratification model was developed and validated. RESULTS: Of 3,640 subjects with 48,287 follow-up visits, 871 (24%) reported nonadherence on 20% or more study visits. Clinical features significantly associated (P < .05) with poor adherence included rapid cycling, suicide attempts, earlier onset of illness, and current anxiety or alcohol use disorder. Nonadherence during the first 3 months of follow-up was associated with less improvement in functioning at 12-month follow-up (P < .03). A risk stratification model using clinical predictors accurately classified 80.6% of visits in an independent validation cohort. CONCLUSION: Risk for poor medication adherence can be estimated and may be useful in targeting interventions.

Original publication




Journal article


J Clin Psychiatry

Publication Date





296 - 303


Adolescent, Adult, Age of Onset, Alcoholism, Antimanic Agents, Bipolar Disorder, Comorbidity, Diagnostic and Statistical Manual of Mental Disorders, Female, Humans, Logistic Models, Longitudinal Studies, Male, Medication Adherence, Prospective Studies, Psychiatric Status Rating Scales, Psychotropic Drugs, Risk Factors, Self Concept, Severity of Illness Index, Suicide, Attempted, Surveys and Questionnaires, Treatment Outcome