The Association Between Medication Adherence Internalized Stigma and Social Support Among Outpatients with Major Depressive Disorder in a Malaysian Hospital: A Cross-Sectional Study
Document Type
Article
Publication Date
1-1-2025
Abstract
Background: Internalized stigma and medication non-adherence pose significant challenges for treating major depressive disorder (MDD), leading to disability, increased suicide risk, and morbidity. Limited data exists on modifiable factors associated with adherence in lower-resourced settings like Malaysia. This study aimed to investigate poor adherence prevalence and the demographic and clinical factors associated with poor medication adherence among patients with MDD. Methods: This cross-sectional survey recruited participants using universal sampling from a major hospital in Selangor, Malaysia. Participants answered questionnaires consisting of demographic and clinical information (medical history, duration of anti-depressant treatment for MDD, psychiatric ward admission history, and any medication side effects experienced), the Internalized Stigma of Mental Illness Scale (comprising alienation, stereotype, perceived discrimination, and social withdrawal), the Multidimensional Scale of Perceived Social Support (comprising family, friend, and significant other support), and the Malaysia Medication Adherence Assessment Tool. Simple and multiple logistic regression and mediation analyses were conducted. Results: Of the 268 participants (69% female), 57.1% were suboptimally or moderately adherent to their medication. Buddhists (adjusted odds ratio aOR] = 0.280, 95% CI 0.115, 0.679], p = 0.005), higher family support (aOR = 0.753, 95% CI 0.591, 0.960], p = 0.022), a history of ward admissions (aOR = 3.523, 95% CI 1.537, 8.072], p = 0.003), and higher internalized stigma (aOR = 2.828, 95% CI 1.497, 5.344], p = 0.001) were significantly associated with low/moderate medication adherence. The effect of internalized stigma subdomains (alienation, perceived discrimination, and social withdrawal) on medication adherence were partially mediated by family support. Conclusion: More than half of the participants demonstrated low to moderate medication adherence. Those with higher internalized stigma demonstrated higher odds of low/moderate medication adherence, but this effect was attenuated by family support. Therefore, internalized stigma and family support are important points of consideration when assessing patients with MDD in Malaysia.
Keywords
medication adherence, MDD, internalized stigma, social support, Malaysia
Divisions
psychological
Publication Title
Psychology Research and Behavior Management
Volume
18
Publisher
Dove Medical Press
Publisher Location
PO BOX 300-008, ALBANY, AUCKLAND 0752, NEW ZEALAND