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The sample comprised 357 (65.4%) patients with depression\/anxiety, 126 (23.1%) with schizophrenia, and 63 (11.5%) with bipolar disorder. Moderate-to-high adherence (MMAS-8 score\u2009\u2265\u20096) was observed in 73.1% of patients. Medication adherence showed significant overall associations with education level (\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200922.577,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.007), marital status (\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20095.399,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.032), disease duration (\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2\u2009<\/jats:sup>\n                      =\u20095.273,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.037), and the relationship with the caregiver (\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20097.311,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.011). After Bonferroni correction, only education level and disease duration remained statistically significant. Five core qualitative themes were extracted: lack of illness insight, side effects, family support, doctor-patient trust, and stigma.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Education level and disease duration are the most robust independent predictors of medication adherence in this population. Qualitative findings complement this by revealing that family support quality, stigma, and therapeutic alliance\u2014though not captured as independent factors in the conservative statistical model\u2014constitute essential process-level determinants that static variables fail to capture. Interventions should combine targeted health education for low-education and early-stage patients with family-based psychosocial support, stigma reduction campaigns, and shared decision-making to address both structural and relational barriers to adherence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1038\/s41598-026-66255-0","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:04:55Z","timestamp":1787162695000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Analysis of medication adherence and its influencing factors in outpatients with mental disorders: a mixed study in eastern of China"],"prefix":"10.1038","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6516-2647","authenticated-orcid":false,"given":"Ruoying","family":"Cheng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zijuan","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yufang","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"66255_CR1","unstructured":"United Nations. 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