ArticlePLOS mental health2025
Socio-demographic and clinical predictors of medication adherence among psychiatric outpatients in Mozambique: A two-year longitudinal survival analysis.
Article in PLOS mental health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Research on medication adherence among patients with psychiatric illness is particularly sparse in low- and middle-income countries (LMICs). This study examined the relationship between psychiatric medication adherence and clinical and sociodemographic factors in outpatient psychiatric settings in central Mozambique. We conducted a longitudinal study among 803 Psychiatric Outpatients (1,811 total follow-up visits) attending eight healthcare facilities in Mozambique from February 2022 to January 2024. Multivariable linear mixed and non-parametric Kaplan-Meier models were employed to analyze the association between medication and clinical/sociodemographic variables over time. Approximately 93% of patients (N = 729) were non-adherent to their medication at a minimum of one follow-up visit, with a median time in treatment prior to non-adherence of 60 days (mean: 52 days; 95% CI: 51, 53). In the Stratified Cox model, patients aged 56+ had a 33% higher hazard of nonadherence compared to those aged 18-35 (aHR: 1.33; 95% CI: 1.14, 1.55). Patients prescribed amitriptyline had a 56% higher hazard of nonadherence compared to those prescribed carbamazepine (aHR: 1.56; 95% CI: 1.23, 1.98). For every 30 days in treatment, disability scores decreased by an average of 0.13 (95% CI: -0.16 to -0.09) while systolic blood pressure decreased by 0.46 mmHg (95% CI: -0.18 to -0.10) and diastolic blood pressure decreased by 0.15 mmHg (95% CI: -0.23 to -0.06). Currently, the median duration of medication adherence for patients initiating essential psychiatric treatment in Mozambique is 60 days. Patients prescribed amitriptyline and older patients are at a higher risk of non-adherence. Consistent engagement in treatment is linked to lower disability scores and blood pressure. There is an urgent need for research into adherence support strategies, especially for these high-risk groups within Mozambique's mental health patient population.
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