Coping and medication adherence in bipolar disorder

Background: Effective treatment of bipolar disorder depends on medication adherence, yet few correlates of adherence have been identified. The pleasure experienced during some manic episodes may render some individuals reluctant to adhere to medications that reduce these ‘highs’. Clinical observers identify denial of the severity or existence of illness as common to both bipolar disorder and addiction. The Alcoholics Anonymous model promotes acceptance as a pathway to abstinence adherence. This report hypothesized that acceptance coping would correlate positively and denial coping would correlate inversely with adherence to mood-stabilizing medication among individuals with bipolar disorder. Methods: Thirty-two participants diagnosed with bipolar I disorder were administered scales from the Brief COPE and an adherence self-report measure. Results: Consistent with hypotheses, curvilinear relationships between acceptance and denial with adherence were detected, suggesting that low levels of acceptance and high levels of denial undermine medication adherence. Limitations: Given the cross-sectional, naturalistic design of the study, no causal inferences can be made. Conclusions: The results uncover links between coping styles and adherence in a psychiatric population. The link between acceptance–denial coping, and mature, self-supportive behavior may point the way towards more effective psychosocial interventions.