Adolescents' Commitment to Continuing Psychotropic Medication: Their Experiences and Important Considerations

Background and Purpose: Many psychiatric conditions for which adolescents are treated with psychotropic medication are regarded as chronic conditions that may require long-term, possibly life-long treatment. Consequently, we hope/expect that youth prescribed medication will assume greater responsibility for this treatment as they emerge into adulthood. At the same time, because youth are often not full participants in treatment decision-making, and typically have mixed reactions or attitudes toward medication, and poor adherence rates overall—a question arises about the extent to which youth prescribed psychotropic medication are committed to this treatment and what explains more/less commitment. ‘Commitment', in this context, is defined as youths' reported inclination to continue taking medication even if there were no external influence or pressure.

This study addresses three questions: (1) To what extent do adolescents prescribed medication for various psychiatric disorders report a commitment to psychotropic medication (as defined above)? (2) What are adolescents' subjective experiences with psychotropic medication and how do these experiences correspond with their medication commitment? and (3) To what extent do factors such as social and family support, social affiliation with peers/friends who are also mental health consumers, and clinical and demographic characteristics predict youths' reported medication commitment?

Methods: Fifty adolescents receiving mental health wraparound services were engaged in face-to-face, semi-structured and mixed method interviews that included detailed open-ended questions about subjective experiences with/perceptions of medication and problem perceptions. Participant were prescribed an average of two psychotropic medications (SD=.98) for one or more diagnosed mental disorders (78% affective disorders and 72% disruptive behavior disorders). A majority of participants were Caucasian (56%), male (58%), from a low income household (56% Medicaid), with an average age of 14.8 (SD=1.6).

Content analysis (with inter-rater reliability checks) was applied to data pertaining to medication commitment and general medication experiences. Based on content analysis, youth were classified as “less committed” and “more committed” to medication treatment (binary variable). Cross tabulation was used to illuminate associations between medication commitment and other coded medication perceptions/experiences. Student's t-test/Chi-square analyses were used to analyze relationships between adolescents' medication commitment and demographic, clinical/treatment, and social/family characteristics. Factors significant at p<.05 were analyzed as predictors of medication commitment using logistic regression analysis.

Results: Most adolescents (62%) were classified as ‘less committed" (would discontinue treatment if there were no external pressure). These “less committed” participants were more likely to report various negative medication perceptions and experiences in open-ended questions relative to “more committed” youth (lack of need, mistrust of clinicians, medication as bothersome, liking self ‘as is', and so forth). Multivariate analysis found that medication commitment was associated with adolescents' perceived treatment coerciveness vs. choice, medication type, perceptions of one's mental health problems, family support, and parent's level of education.

Conclusions and Implications: The findings demonstrate the tenuous relationship many youth have with their psychopharmacologic treatment and factors that potentially contribute to medication commitment. Overall, these results reinforce the importance of eliciting and addressing youths' concerns about medication, understanding youths' conceptions of their emotional/behavior challenges, and maximizing youths' participation in treatment decision-making.