Medication Adherence,
Substance Use and
Psychiatric Symptom Severity
among Mental Health Jail
Diversion Program Clients
Elizabeth N. Burris, Evan M. Lowder,
and Sarah L. Desmarais
North Carolina State University
Forensic Psychology in the Public Interest Lab
Background
• Mental health diversion programs
– Designed to improve mental health outcomes
– Connect justice-involved adults with mental
illnesses to treatment
• Previous research
– Diversion increases positive mental health
outcomes (Broner et al., 2004; Shafer et al., 2004)
• Few studies examining predictors of mental
health outcomes in this population
Forensic Psychology in the Public Interest Lab
Background
• Adults with mental illnesses:
– Co-occurrence of substance use (Hunt, Bergen, &
Bashir, 2002; Wilk et al. 2006)
– Problem of medication adherence (Janssen et al.,
2006)
• Both factors associated with psychiatric
symptom severity (Margolese et al., 2006; Drake 1989;
Dixon et al. 1991; Bartko et al., 2007)
• Both hinder treatment progress (Owen et al.,
1996; Fischer et al. 1996)
Forensic Psychology in the Public Interest Lab
The Present Study
• Examine whether differences in psychiatric
symptom severity between:
– Adults with and without substance use
– Adults who are and are not medication adherent
• Examine associations of substance use and
medication adherence with changes in
psychiatric symptom severity
– Baseline to 3-month follow-up
– 3-month to 6-month follow-up
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Sample
• 95 adults with mental illnesses (81.1% male)
in a jail diversion program
• 30.5% co-morbid substance use diagnosis
• Substantial criminal histories
– M = 6.69 (SD = 5.42) bookings in the past three
years
– M = 16.07 (SD = 14.99) lifetime jail bookings
• M age = 36.05 (SD = 12.46) years
• 44.2% African American
• 54.7% Hispanic/Latino
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Measures
• Predictor: Medication adherence
– “In the past 3 months, how often did you take the
medication for mental health, alcohol or drug
problems prescribed by the doctor?”
– Missed <2 times = Adherent
– Missed >2 times = Non-adherent
• Predictor: Substance use
– Current substance use diagnosis
– Addiction Severity Index (ASI; McLellan et al., 1992)
• Outcome: Psychiatric symptom severity
– Brief Psychiatric Rating Scale (BPRS; Ventura et al.
1993)
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Procedures
• Semi-structured interviews conducted by
trained research assistants
– Baseline, 3-month follow-up, and 6-month follow-up
– All variables were measured by self-report
• Analytic strategy
– Differences between groups at baseline and 3month:
• T-tests
– Predictive associations from baseline to 3-month
and 3-month to 6-month:
• Mixed-design ANOVAs
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Results
• Descriptive
– Medication Adherence
• Baseline: 81.1% Adherent; 18.9% Non- Adherent
• 3- Month: 80% Medication Adherent; 20% Non- Adherent
– Substance Use
• Baseline: 53.8% Substance Use; 46.2% No Use
• 3- Month: 51.5% Substance Use; 48.5% No Use
• Between-Group Differences in Symptom Severity
– Medication Adherence
• Baseline: t(88) = 2.00, p = .048
• 3- Month: t(63) = 2.51, p = .015
– Substance Use
• Baseline: t(91) = 2.53, p = .013
• 3- Month: t(64) = 0.44, p = .661
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Results: Predicting Changes in Symptom Severity
Psychiatric Symptom Severity
Changes in Symptom Severity by Medication Adherence
from Baseline to 3- Month
60
58
56
54
52
50
48
46
44
42
40
F (1,59) = 1.01, p = .314, n2 = .02
Medication
Adherence
at Baseline
Yes
No
Baseline
3 Month
Time
Forensic Psychology in the Public Interest Lab
Results: Predicting Changes in Symptom Severity
Psychiatric Symptom Severity
Changes in Symptom Severity by Medication
Adherence from 3-Month to 6-Month
60
58
56
54
52
50
48
46
44
42
40
F(1,36) = 0.06, p = .644, n2 = .018
Medication
Adherence at
Baseline
Yes
No
3 Month
6 Month
Time
Forensic Psychology in the Public Interest Lab
Results: Predicting Changes in Symptom Severity
Psychiatric Symptom Severity
Changes in Symptom Severity by Substance Use
from Baseline to 3-Month
60
58
56
54
52
50
48
46
44
42
40
F(1,62) = 3.01, p = .088,
n2
= .05
Substance Use
at Baseline
Yes
No
Baseline
3 Month
Time
Forensic Psychology in the Public Interest Lab
Results: Predicting Changes in Symptom Severity
Psychiatric Symptom Severity
Changes in Symptom Severity by Substance Use
from 3-Month to 6-Month
60
58
56
54
52
50
48
46
44
42
40
F(1,37) = 0.72, p = .400, n2 = .02
Substance Use
at Baseline
Yes
No
3 Month
6 Month
Time
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Summary of Findings
• Substance use and medication adherence:
– Related to psychiatric symptom severity
– However, may not predict changes in symptom
severity in this population
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Limitations
• Findings are limited by:
–
–
–
–
Self-report nature of the data
High rates of medication adherence
Sample homogeneity
Short follow-up period
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Future Directions
• Further explore relationships between
medication adherence, substance use, and
psychiatric symptom severity
– In other justice-involved samples
– Across longer follow-up periods
– In context of other treatment provision
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Acknowledgments
• This project is funded by the Bristol-Myers
Squibb Foundation. We thank the 11th
Judicial District Criminal Mental Health
Project (CMHP) for its cooperation and
support.
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Thank you!
• Contact information:
Elizabeth N Burris
Email: [email protected]
Lab Website: ncsuforensicpsychology.com
Lab Facebook: facebook.com/fopsypi
Forensic Psychology in the Public Interest Lab