{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T11:52:10Z","timestamp":1788349930086,"version":"build-2803163510"},"reference-count":64,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T00:00:00Z","timestamp":1745798400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>In Pakistan, Major depressive disorder (MDD) contributes significantly to the mental health burden. It is crucial to understand patients\u2019 medication adherence status for developing a strategy for improving adherence and treatment outcomes. Therefore, a valid and reliable tool in the local Urdu language is required. The Morisky, Greene, and Levine Medication Adherence Scale (MGLS-4) is a reliable, valid and straightforward instrument to assess medication-taking behavior. The valid and reliable Urdu translation of MGLS-4 can fill this gap within the local context. Therefore, the present study aims to validate the Urdu Morisky, Green and Levine Adherence Scale (UMGLS-4) for MDD patients. This was a quantitative, cross-sectional validation study for Pakistani MDD patients. Reliability was measured using Cronbach\u2019s \u03b1 and for test-retest reliability intraclass correlation coefficient (ICC) was calculated. Validity was assessed through face validity, content validity, construct validity, and convergent validity with the Drug Attitude Inventory (DAI-10). Descriptive and inferential statistical analyses were carried out to demonstrate adherence level and statistical significance, respectively. Linear regression was applied to find the association between the UGMLS-4 score and demographic characteristics. The UMGLS-4 demonstrated high reliability (Cronbach\u2019s <jats:italic>\u03b1<\/jats:italic>\u2009=\u20090.829) and a significant strong ICC (x\u2009=\u20090.601, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01) was detected. Exploratory factor analysis (EFA) revealed a single-factor structure explaining 66.084% of the variance. Confirmatory factor analysis (CFA) confirmed good model fit (GFI\u2009=\u20090.950, AGFI\u2009=\u20090.920, NFI\u2009=\u20090.930, RMSEA\u2009=\u20090.050, SRMSR\u2009=\u20090.055). Medication adherence was observed to be high in 39.1% of patients, moderate in 28.6%, and poor in 32.3%. Significant associations were found between adherence scores and gender, educational attainment, and occupational status (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.005) with education predicting adherence (B\u2009=\u20090.301, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.000), indicating the scale\u2019s robustness in detecting adherence variations among Urdu-speaking MDD patients. The UMGLS-4 is a reliable and valid tool for assessing medication adherence in Pakistani MDD patients, effectively capturing adherence variations across demographic variables.<\/jats:p>","DOI":"10.1371\/journal.pone.0320258","type":"journal-article","created":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T17:25:42Z","timestamp":1745861142000},"page":"e0320258","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Cross-cultural adaptation and psychometric evaluation of the urdu version of the morisky, greene, and levine medication adherence scale (MGLS-4) for major depressive disorder patients"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4188-5162","authenticated-orcid":true,"given":"Sohail","family":"Riaz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6847-1744","authenticated-orcid":true,"given":"Fazli","family":"Khuda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia Shamshad","family":"Malik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitasha","family":"Gohar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayesha","family":"Rashid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abuzar","family":"Khan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdur","family":"Rahman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sajid","family":"Ali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asif","family":"Jan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aqeel","family":"Nasim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,4,28]]},"reference":[{"key":"pone.0320258.ref001","volume-title":"Depression and other common mental disorders: global health estimates","author":"World Health Organization.","year":"2017"},{"issue":"4","key":"pone.0320258.ref002","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1001\/jamapsychiatry.2017.4602","article-title":"Epidemiology of Adult DSM-5 major depressive disorder and its specifiers in the United States","volume":"75","author":"DS Hasin","year":"2018","journal-title":"JAMA Psychiatry"},{"issue":"6","key":"pone.0320258.ref003","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1590\/1516-4446-2020-0650","article-title":"Prevalence and correlates of major depressive disorder: a systematic review","volume":"42","author":"L Guti\u00e9rrez-Rojas","year":"2020","journal-title":"Braz J Psychiatry"},{"issue":"7","key":"pone.0320258.ref004","first-page":"e5094","article-title":"Perceptions pertaining to clinical depression in Karachi, Pakistan","volume":"11","author":"M Nisar","year":"2019","journal-title":"Cureus"},{"issue":"2","key":"pone.0320258.ref005","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/S2215-0366(21)00395-3","article-title":"Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"9","author":"Collaborators GBD 2019 Mental Disorders","year":"2022","journal-title":"Lancet Psychiatry"},{"key":"pone.0320258.ref006","volume-title":"Global Burden of Disease Study 2019 (GBD 2019) Results. 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