Context Factors Associated with Medication Adherence Among Thai Adolescents with Major Depressive Disorder
Bibliographic record
Abstract
Suchanart Inwanna,1 Alicia K Matthews,2 Cynthia Taylor Handrup,3 Alana D Steffen,3 Masatha Thongpan,4 Sarah Abboud5 1Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2School of Nursing, Columbia University, New York, NY, USA; 3Department of Population Health Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA; 4Department of Psychiatry, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 5Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USACorrespondence: Suchanart Inwanna, Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Phayathai, Ratchathewi, Bangkok, 10400, Thailand, Email suchanart.inn@mahidol.ac.thPurpose: 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.Keywords: context factors, adolescents, legal guardians, family, medication adherence, major depressive disorder
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".