Interrupting the Cycle of Parental Stress and Child/Youth Nonadherence to Psychotropic Medication

Objectives
Efficacy of psychotropic medication depends in large part on successful adherence to prescribed regimens. The current study investigated whether negative family dynamics and lack of informal support were associated with medication nonadherence in children/youth with complex needs.

Method
The participants were 10225 children and youth who were prescribed psychotropic medication and receiving services from 50 Ontario mental health agencies, assessed with the interRAI Child and Youth Mental Health (ChYMH) and ChYMH-Developmental Disability (ChYMH-DD) tools. Specific responses were examined in the following areas related to family interpersonal dynamics to investigate the presence of any correlated variables in predicting medication nonadherence: parental distress, family feeling overwhelmed by child/youth’s condition, family persistently hostile/critical of child/youth, and family access to informal support from extended family and friends.

Results
Preliminary analysis indicated age differences in nonadherence, so children (4-11 years) and youth (12-18 years) were considered separately. Multiple logistic regression analyses showed elevations in parental distress was a significant predictor of medication nonadherence for children/youth. Family overwhelmed and persistently hostile of the participant also predicted nonadherence in youth, but not younger children. Whether or not families had informal support did not predict nonadherence. Post-hoc analysis indicated more nonadherent children/youth with parents with high stress tended to have worsening psychiatric symptoms in the recent month than those with low stress parents.

Conclusions
Findings suggest a cycle of parental stress and child/youth medication nonadherence possibly perpetuated by worsening mental health symptoms. Informal supports do not appear to moderate this cycle. While the present data cannot speak to the causes of medication nonadherence in children/youth or where the cycle begins, the results are consistent with the extant literature calling for attention to parental wellbeing to support children/youth for optimal therapeutic benefits. Understanding home dynamics related to nonadherence can assist care planning that engages the family for children/youth to achieve best possible outcomes.