How often do patients with psychosis fail to adhere to treatment programmes? A systematic review

Psychol Med. 2003 Oct;33(7):1149-60. doi: 10.1017/s0033291703008328.


Background: Studies that assess the rates of psychotic patients who fail to adhere to treatment programmes have generated heterogeneous results, with estimates ranging from 24 to 90%. This paper presents findings from a systematic review on adherence to treatment by patients with psychosis. Its purpose is to provide an overall estimate of treatment non-adherence in community psychiatric services, and to analyse and study patient characteristics explaining the between-study heterogeneity in rates of non-adherence.

Method: A systematic review of published studies that report rates of non-adherence with medication and scheduled appointments by psychotic patients in community settings has been undertaken.

Results: A total of 103 studies were included in this systematic review. Eighty-six of these studies were suitable for data re-analysis. The overall weighted mean rate of non-adherence, calculated in a sample of 23 796 patients, was 25.78%. A linear regression analysis of non-adherence rates on background characteristics showed that sample size was negatively associated with non-adherence rates, while first-contact cases and low-adherence cases, in comparison with ongoing cases, were associated with higher non-adherence rates. Factors associated with poor compliance included: lack of insight; positive symptoms; younger age; male gender; history of substance abuse; unemployment; and low social functioning.

Conclusions: Approximately one in four patients with psychosis fails to adhere with treatment programmes. Preventive evidence-based clinical interventions should be routinely implemented in community settings to reduce patient non-adherence.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Antipsychotic Agents / adverse effects
  • Antipsychotic Agents / therapeutic use
  • Community Mental Health Services / statistics & numerical data
  • Cross-Sectional Studies
  • Humans
  • Psychotic Disorders / drug therapy
  • Psychotic Disorders / epidemiology*
  • Psychotic Disorders / psychology
  • Regression Analysis
  • Risk Factors
  • Treatment Refusal / statistics & numerical data*


  • Antipsychotic Agents