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Association Between Therapeutic Alliance, Care Satisfaction, and Pharmacological Adherence in Bipolar Disorder

Sylvia, Louisa G. PhD*†; Hay, Aleena BA; Ostacher, Michael J. MD, MPH§; Miklowitz, David J. PhD; Nierenberg, Andrew A. MD*†; Thase, Michael E. MD; Sachs, Gary S. MD*†; Deckersbach, Thilo PhD*†; Perlis, Roy H. MD, MSc†#

Journal of Clinical Psychopharmacology: June 2013 - Volume 33 - Issue 3 - p 343–350
doi: 10.1097/JCP.0b013e3182900c6f
Original Contributions

Objectives We sought to understand the association of specific aspects of care satisfaction, such as patients’ perceived relationship with their psychiatrist and access to their psychiatrist and staff, and therapeutic alliance with participants’ likelihood to adhere to their medication regimens among patients with bipolar disorder.

Methods We examined data from the multicenter Systematic Treatment Enhancement Program for Bipolar Disorder, an effectiveness study investigating the course and treatment of bipolar disorder. We expected that participants (n = 3037) with positive perceptions of their relationship with their psychiatrist and quality of psychopharmacologic care, as assessed by the Helping Alliance Questionnaire and Care Satisfaction Questionnaire, would be associated with better medication adherence. We utilized logistic regression models controlling for already established factors associated with poor adherence.

Results Patients’ perceptions of collaboration, empathy, and accessibility were significantly associated with adherence to treatment in individuals with bipolar disorder completing at least 1 assessment. Patients’ perceptions of their psychiatrists’ experience, as well as of their degree of discussing medication risks and benefits, were not associated with medication adherence.

Conclusions Patients’ perceived therapeutic alliance and treatment environment impact their adherence to pharmacotherapy recommendations. This study may enable psychopharmacologists’ practices to be structured to maximize features associated with greater medication adherence.

From the *Bipolar Clinical and Research Program, Massachusetts General Hospital and Harvard Medical School; and †Department of Psychiatry, Harvard Medical School, Boston, MA; and ‡Yale University, Department of Psychology, New Haven, CT; §Stanford University School of Medicine, Department of Psychiatry &; Behavioral Sciences, Stanford, CA; ∥Department of Psychiatry and Behavioral Sciences, UCLA Semel Institute, Los Angeles, CA; ¶University of Pennsylvania School of Medicine, Philadelphia, PA; and #Center for Experimental Drugs and Diagnostics, Massachusetts General Hospital and Harvard Medical School, Boston, MA.

Received June 28, 2010; accepted after revision October 16, 2012.

Reprints: Louisa G. Sylvia, PhD, Bipolar Clinical and Research Program, 50 Staniford St, Suite 580, Boston, MA 02114 (e-mail:

This study was supported in part by the National Institute of Mental Health Contract N01MH80001.

© 2013 Lippincott Williams & Wilkins, Inc.