Pathways to medication adherence: a configurational analysis of psychiatric symptoms and medication attitude in patients with schizophrenia spectrum disorder receiving long-acting injectable antipsychotics.
6 affiliations
- 1Department of Nursing, Haining Fourth People's Hospital, Jiaxing, Zhejiang, 314499, China.
- 2School of nursing, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin City, Heilongjiang Province, 150081, China. [email protected].
- 3School of nursing, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin City, Heilongjiang Province, 150081, China.
- 4School of Medicine and Nursing, Huzhou Normal University, No.759, Erhuandong Road, Huzhou City, Zhejiang Province, 313000, China.
- 5Department of Psychiatry, Daqing Third People's Hospital, Daqing, Heilongjiang, 166499, China.
- 6School of Medicine and Nursing, Huzhou Normal University, No.759, Erhuandong Road, Huzhou City, Zhejiang Province, 313000, China. [email protected].
Abstract
Background
Medication non-adherence affects nearly half of patients with schizophrenia spectrum disorder and is associated with relapse and hospitalization. Long-acting injectable (LAI) antipsychotics may improve adherence, but their effectiveness likely depends on interactions between specific psychiatric symptom patterns and medication attitudes. This study, a secondary analysis of published data from the Dryad repository, examined how configurations of psychiatric symptoms factors influence adherence via medication attitude among patients receiving LAI.Methods
This secondary analysis included 304 patients with schizophrenia spectrum disorder (mean age 45.64 years; 63.16% male) receiving LAI from Italy. We employed complex mediation qualitative comparative analysis (cmQCA) to examine symptom-adherence pathways. Psychiatric symptoms were assessed using the Brief Psychiatric Rating Scale-18 items (BPRS-18) across five dimensions: affect, positive symptoms, negative symptoms, resistance, and activation. Medication attitudes were evaluated with the Drug Attitude Inventory (DAI-10), and adherence was measured using Kemp's 7-point scale. Regression models examined direct and mediated relationships, controlling for demographic variables, substance abuse history, LAI generation, and injection interval.Results
Qualitative comparative analysis (QCA) identified six configurations: three promoting positive medication attitudes (46% solution coverage, 82% consistency) and three leading to poor medication attitudes (39.5% coverage, 79.4% consistency) characterized by high Resistance. The absence of Positive Symptoms and Resistance emerged as core conditions for positive medication attitudes. Regression analyses confirmed partial mediation through medication attitudes.Conclusions
Multiple pathways link psychiatric symptom configurations to medication adherence through medication attitude in patients receiving LAI treatment. Clinicians should consider specific symptom patterns for adherence interventions. Targeted approaches addressing both symptom configurations and medication attitudes may optimize outcomes for schizophrenia spectrum disorder.Clinical trial number
Not applicable.
Related
- Total cost of care for long-acting injectable antipsychotics for schizophrenia: Pharmacy vs medical benefit
- Perceptions of psychiatrists toward long-acting injectable antipsychotics: A cross-sectional survey from Fujian, China
- The Effect of Psychiatric Medication Use on 1- to 3-Level Elective Lumbar Fusion Outcomes
- When You Hear Hoofbeats, It May Still Be the Medication: A Case of Aripiprazole-Induced Hypersexuality Masquerading as Psychiatric Decompensation.
- Medication adherence in patients with psychotic disorders: an observational survey involving patients before they switch to long-acting injectable risperidone
BibTeX
@article{zhang2026pathways,
title = {{Pathways to medication adherence: a configurational analysis of psychiatric symptoms and medication attitude in patients with schizophrenia spectrum disorder receiving long-acting injectable antipsychotics.}},
author = {Linghui Zhang and Yubin Chen and Hong Yu and Yujing Sun and Qi Li and Shuxin Zhang and Wenlong Jiang and Fangping Luo and Yuqiu Zhou},
journal = {BMC psychiatry},
year = {2026},
month = aug,
doi = {10.1186/s12888-026-08475-2},
url = {https://europepmc.org/article/MED/42958153},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Pathways to medication adherence: a configurational analysis of psychiatric symptoms and medication attitude in patients with schizophrenia spectrum disorder receiving long-acting injectable antipsychotics.
AU - Linghui Zhang
AU - Yubin Chen
AU - Hong Yu
AU - Yujing Sun
AU - Qi Li
AU - Shuxin Zhang
AU - Wenlong Jiang
AU - Fangping Luo
AU - Yuqiu Zhou
PY - 2026
DA - 2026/08/01
JO - BMC psychiatry
DO - 10.1186/s12888-026-08475-2
UR - https://europepmc.org/article/MED/42958153
AB - Background Medication non-adherence affects nearly half of patients with schizophrenia spectrum disorder and is associated with relapse and hospitalization. Long-acting injectable (LAI) antipsychotics may improve adherence, but their effectiveness likely depends on interactions between specific psychiatric symptom patterns and medication attitudes. This study, a secondary analysis of published data from the Dryad repository, examined how configurations of psychiatric symptoms factors influence adherence via medication attitude among patients receiving LAI.Methods This secondary analysis included 304 patients with schizophrenia spectrum disorder (mean age 45.64 years; 63.16% male) receiving LAI from Italy. We employed complex mediation qualitative comparative analysis (cmQCA) to examine symptom-adherence pathways. Psychiatric symptoms were assessed using the Brief Psychiatric Rating Scale-18 items (BPRS-18) across five dimensions: affect, positive symptoms, negative symptoms, resistance, and activation. Medication attitudes were evaluated with the Drug Attitude Inventory (DAI-10), and adherence was measured using Kemp's 7-point scale. Regression models examined direct and mediated relationships, controlling for demographic variables, substance abuse history, LAI generation, and injection interval.Results Qualitative comparative analysis (QCA) identified six configurations: three promoting positive medication attitudes (46% solution coverage, 82% consistency) and three leading to poor medication attitudes (39.5% coverage, 79.4% consistency) characterized by high Resistance. The absence of Positive Symptoms and Resistance emerged as core conditions for positive medication attitudes. Regression analyses confirmed partial mediation through medication attitudes.Conclusions Multiple pathways link psychiatric symptom configurations to medication adherence through medication attitude in patients receiving LAI treatment. Clinicians should consider specific symptom patterns for adherence interventions. Targeted approaches addressing both symptom configurations and medication attitudes may optimize outcomes for schizophrenia spectrum disorder.Clinical trial number Not applicable.
SN - 1471-244X
ER -