Self-Reported Low Lithium Adherence Among Chinese Patients with Bipolar Disorder in Shenzhen: A Cross-Sectional Study

Yifeng Chen,* Jian Zhang,* Fengsu Hou, Yuanhan Bai Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yuanhan Bai, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, No. 77 Zhenbi Road, Pingshan District, Shenzhen City, 518118, People’s Republic of China, Email baiyuanhan@163.comBackground: Lithium has been widely used to treat bipolar disorder (BD), although its adherence is rarely reported in China. This study aimed to explore the rate of lithium adherence and its associated factors in patients with BD, which has rarely been reported in China.Methods: We conducted a cross-sectional study among patients in Shenzhen Mental Health Center (Shenzhen Kangning Hospital), who were aged 12 years or above, were diagnosed with BD based on the International Classification of Diseases, tenth edition (ICD-10), and had been on lithium for at least 1 month. We collected information on sociodemographic and clinical characteristics and on knowledge about and attitudes toward lithium. We also investigated patients’ concerns while taking lithium and where they can and wish to obtain information on lithium.Results: Of the 244 enrolled patients and 221 patients aged 18 years or older, 52% and 50% disclosed low adherence to lithium, respectively. Factors associated with poor lithium adherence were a younger age (odds ratio (OR): 0.962, 95% confidence interval (CI): 0.933– 0.992), female sex (OR: 2.171, 95% CI: 1.146– 4.112), and no hospitalization history (OR: 0.389, 95% CI: 0.217– 0.689) for the full sample, and more years of education (OR: 4.086, 95% CI: 1.397– 11.946) and fewer hospitalizations (OR: 0.615, 95% CI: 0.467– 0.809) for patients aged 18 years or older. Less knowledge of periodic tests conducted during lithium treatment played a critical role in low lithium adherence (regression analysis of the full sample: OR: 0.642, 95% CI: 0.532– 0.775, regression analysis of subgroups: OR: 0.609, 95% CI: 0.500– 0.742). The treatment duration was a major concern among patients on lithium, and patients preferred obtaining lithium-associated information through health services and WeChat.Conclusion: The rate of lithium adherence was low in this study. Psychoeducation to increase lithium compliance should mainly focus on patients who are young and provide thorough background information on lithium. Health services should actively provide lithium-associated information. A greater need for medication information based on WeChat was observed, implying its potential role in adherence-related psychoeducation.Keywords: bipolar disorder, lithium, adherence, China