Context Factors Associated with Medication Adherence Among Thai Adolescents with Major Depressive Disorder

Abstract

Purpose: Major depressive disorder (MDD) is a significant mental health issue among adolescents globally. In Thailand, medication adherence among adolescents with MDD is low. While international studies highlight factors such as family support and beliefs about medication, these may not apply to the Thai context, where cultural norms, stigma, and access to care differ. Guided by the Individual and Family Self-management Theory (IFSMT), this study explored context-specific factors influencing medication adherence among Thai adolescents with MDD. Methods: A cross-sectional quantitative study was conducted with 146 adolescent-legal guardian dyads recruited via purposive sampling from two psychiatric outpatient clinics in Thailand. Guided by the IFSMT, the study assessed context factors across three domains: condition-specific, physical and social environment, and individual and family factors. To examine associations between IFSMT context factors and medication adherence, multiple linear regression analysis was performed. Written informed assent and consent were obtained. Results: The adolescents (mean age = 16.16 years, 71.92% female) and legal guardians (mean age = 48.62 years, 77.40% female, 90.41% parents) completed the survey. Approximately 80% of adolescents reported low adherence to the guidelines. Three context factors were significantly associated with adherence: antidepressant side effects, adolescent preference for medication-only treatment, and legal guardian preference for medication-only treatment (p <0.05). Other variables were not significant. Conclusion: Medication adherence among Thai adolescents with MDD was associated with side effects and treatment preferences of both adolescents and their legal guardians. These findings highlight the importance of addressing individual and family preferences during treatment planning. Culturally informed interventions that consider these contextual influences may improve adherence outcomes. Future research should explore these factors further using longitudinal designs.