{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T17:10:07Z","timestamp":1788973807242,"version":"build-2803163510"},"reference-count":46,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T00:00:00Z","timestamp":1762819200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["1R01 MH119487\u201001A1"],"award-info":[{"award-number":["1R01 MH119487\u201001A1"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Bipolar Disorders"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>While suboptimal medication adherence is a widely recognized problem for people with bipolar disorder (BD), it is less clear how individual characteristics are associated with varying levels of adherence and how specific adherence barriers impact behaviors. This interim analysis from an ongoing randomized controlled trial (RCT) examined associations between patient\u2010reported adherence, adherence barriers, and mood symptoms among poorly adherent individuals with BD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>RCT participants were adults age \u2265\u200918\u2009years old with BD Type 1 or 2, difficulties with medication adherence, and actively symptomatic as measured by Brief Psychiatric Rating Scale (BPRS) score\u2009\u2265\u200936, Young Mania Rating Scale (YMRS)\u2009&gt;\u20098, or Montgomery Asberg Depression Rating Scale (MADRS)\u2009&gt;\u20098. Adherence was assessed using the self\u2010reported Tablets Routine Questionnaire (TRQ) and grouped into 3 clinically relevant groups: those with TRQs &lt;\u200920% (good adherence), \u2265\u200920% and &lt;\u200950% (fair adherence), and \u2265\u200950% (poor adherence). Adherence barriers were assessed with the Oxford Bipolar Knowledge Questionnaire (OBQ), Self\u2010Report Habit Index (SRHI), Communication Styles Scale (CSS), and Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES 8A).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Analysis was derived from screening and baseline data on the first 129 randomized participants. Mean age was 42.18 (SD\u2009=\u200913.04) years, with 76.74% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200999) female and 41.09% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200953) non\u2010White. The mean past 7\u2010day percentage of days with missed BD medications using TRQ was 34.34% (SD\u2009=\u200930.32) at screening and 24.82% (SD\u2009=\u200927.70) at baseline. The average time between screening visit and baseline was 18.90 (SD\u2009=\u200912.46) days. Comparing adherence groups, MADRS and BPRS were significantly higher in those with worse adherence both at screening and baseline (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05 for all). With respect to BD adherence barriers, only SRHI was significantly inversely correlated with TRQ at screening (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and both SRHI and SOCRATES 8A (Taking steps sub\u2010scale) were significantly inversely correlated with TRQ at baseline (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001 and\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.022, respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Poorly adherent individuals with BD have significantly more severe global psychopathology and worse depressive severity. Significant adherence barriers include lifestyle routines that do not promote regular medication\u2010taking and engagement in reducing the use of substances. Given the extensive burden of poor adherence in BD, adherence promotion efforts should target specific and actionable barriers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">ClinicalTrials.gov<\/jats:ext-link>\n                      identifier: NCT04622150\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bdi.70067","type":"journal-article","created":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T05:25:09Z","timestamp":1762925109000},"page":"567-577","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association Between Adherence Barriers, Self\u2010Reported Adherence, and Psychiatric Symptoms Among Adults With Bipolar Disorder"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3073-668X","authenticated-orcid":false,"given":"Martha","family":"Sajatovic","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Case Western Reserve University School of Medicine University Hospitals Cleveland Medical Center  Cleveland Ohio USA"},{"name":"Neurological and Behavioral Outcomes Center University Hospitals Cleveland Medical Center  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1214-0636","authenticated-orcid":false,"given":"Jennifer B.","family":"Levin","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Case Western Reserve University School of Medicine University Hospitals Cleveland Medical Center  Cleveland Ohio USA"},{"name":"Neurological and Behavioral Outcomes Center University Hospitals Cleveland Medical Center  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Adeniyi","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Case Western Reserve University School of Medicine University Hospitals Cleveland Medical Center  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Black","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Case Western Reserve University School of Medicine University Hospitals Cleveland Medical Center  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celeste","family":"Weise","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Case Western Reserve University School of Medicine University Hospitals Cleveland Medical Center  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Fiorelli","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Case Western Reserve University School of Medicine University Hospitals Cleveland Medical Center  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Kelley","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Case Western Reserve University School of Medicine University Hospitals Cleveland Medical Center  Cleveland Ohio USA"},{"name":"Department of Obstetrics and Gynecology University Hospitals Cleveland Medical Center  Cleveland Ohio USA"},{"name":"Department of Reproductive Biology Case Western Reserve University  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doug","family":"Einstadter","sequence":"additional","affiliation":[{"name":"Center for Health Care Research and Policy MetroHealth System Cleveland  Cleveland Ohio USA"},{"name":"Department of Medicine and Population and Quantitative Health Sciences Case Western Reserve University School of Medicine  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Bauer","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farren B. 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