Personality traits and other factors associated with psychotropic medication non-adherence at two hospitals in Uganda. A cross-sectional study

Background Mental illnesses, like other chronic illnesses, require medications for both immediate, short term and long term treatment. Medication adherence is the first and most important factor for better treatment outcome. Non-adherence to psychotropic medications is associated with relapse, readmission, and early death. The beliefs about medication which influence non-adherence to medications are moderated by specific personality traits. Sociodemographic and clinical factors can also influence non-adherence psychotropic medications. Non-adherence to psychotropic medications is high in Africa but there is paucity of published studies on the level of psychotropic medication non-adherence and associated personality traits in Uganda. Aim To determine the prevalence of psychotropic medication non-adherence and associated personality traits among people with mental illness attending Kampala International University Teaching Hospital (KIU-TH) and Jinja Regional Referral Hospital (JRRH). Methods This study employed a hospital-based cross-sectional design. 396 adult patients suffering from mental illness were collected from KIU-TH and JRRH outpatient clinics. Medication adherence was assessed using Medication Adherence Rating Scale (MARS) while personality traits were assessed by the short form of Big Five Inventory (Ten Items Personality Inventory). We first assessed sociodemographic and clinical factors influencing psychotropic medication non-adherence in our study (confounders). A questionnaire with sociodemographic and clinical information was also used. Logistic regression was used to assess personality traits and other factors associated with psychotropic medication non-adherence. Results The majority of the study participants were males (59.1%), from rural areas (74.2%), with secondary educational level (47.5%) and unemployed (44.9%). The prevalence of psychotropic medication was 46.21%. Poor family support (aOR= 6.915, CI=3.679-12.998, P<0.001), belief in witchcraft/sorcery (aOR=2.959, CI=1.488-5.884, P=0.002), experiencing side effects (aOR=2.257, CI=1.326-3.843, P=0.003), and substance use (aOR=4.174, CI=2.121-8.214, P<0.001) were factors significantly associated with psychotropic medication non-adherence. The personality traits significantly associated with psychotropic medication non-adherence after controlling for the confounders were neuroticism (aOR=7.424, CI=3.890-14.168, P<0.001) and agreeableness (aOR=0.062, CI=0.024-0.160, P<0.001). Conclusion Medication non-adherence was high. Non-adherent patients were more likely to have predominant neuroticism personality traits. Medication non-adherence was shown to be less common in individuals with agreeableness personality traits. Other factors associated with psychotropic medication non-adherence were poor social support, witchcraft beliefs, presence of side effects and substance use. Reinforced psycho-education should be given to patients with high risk of being non-adherent to psychotropic medications. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Approval to carry out the study obtained from Research Ethics committee of Bishop Stuart University (the research number is: BSU-REC-2023-99) and it has been conducted according to the principles expressed in the declaration of Helsinki I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All relevant data are within the manuscript and its Supporting Information files. * JRRH : Jinja Regional Referral Hospital KIU-TH : Kampala International University Teaching hospital MARS : Medication Adherence Rating Scale TIPI : Ten Items Personality Inventory