Dropout is a common problem in the treatment of psychiatric illnesses including bipolar disorders (BD). The aim of the present study is to investigate illness perceptions of dropout patients with BD. A cross sectional study was done on the participants who attended the Mood Disorder Outpatient Clinic at least 3 times from January 2003 through June 2008, and then failed to attend clinic till to the last one year, 2009, determined as dropout. Thirty-nine dropout patients and 39 attendent patients with BD were recruited for this study. A sociodemographic form and brief illness perception questionnaire were used to capture data. The main reasons of patients with BD for dropout were difficulties of transport (31%), to visit another doctor (26%), giving up drugs (13%) and low education level (59%) is significant for dropout patients. The dropout patients reported that their illness did not critically influence their lives, their treatment had failed to control their illnesses, they had no symptoms, and that their illness did not emotionally affect them. In conclusion, the nonattendance of patients with serious mental illness can result in non-compliance of therapeutic drug regimens, and a recurrence of the appearance symptoms. The perception of illness in dropout patients with BD may be important for understanding and preventing nonattendance.
Bipolar Disorder (BD) is one of the most common, severe and persistent mental diseases and characterized by chronic conditions with an episodic and recurrent nature. The lifetime prevalence of bipolar disorder is 1–3% (Judd and Akiskal, 2003 and Regeer et al., 2004). Effective management of bipolar disorders includes early detection and long-term prophylaxis of bipolar episodes (Swann, 2004). Dropout, defined as termination of treatment by patients against the doctor's recommendation is a common problem in the treatment of chronic illnesses including bipolar disorders (Gaudiano and Miller, 2006 and Moon et al., 2012). Dropouts in psychiatric outpatient clinics have been a topic of considerable interest. Moreover, in outpatient clinics of mental health care, 15–46% of patients may inappropriately leave follow-up in the first year of their treatment (Edlund et al., 2002, Killaspy et al., 2000, Lerner and Levinson, 2012, Olfson et al., 2009, Percudani et al., 2002, Rossi et al., 2002 and Wells et al., 2013). The insufficient duration of treatment resulting from dropouts can increase the risk of recurrence/relapse, rehospitalization, functional impairment, and suicide (Gaudiano and Miller, 2006 and Moon et al., 2012).
The Self-Regulation Model (SRM) developed by Howard Leventhal introduces a causal relationship between illness beliefs and health outcomes (Leventhal and Scherer, 1987). According to this model, illness-related coping responses are strongly determined by a patient's subjective representations of the illness. In SRM, illness perceptions include five main dimensions: (1) causal-beliefs about the cause(s) of the illness; (2) identity-beliefs concerning the illness’ label and symptoms; (3) timeline-perceptions about the time course of an illness, characterized along the acute–chronic dimension where individuals may perceive their illness as chronic or acute, or cyclical in nature (where the condition appears under a particular set of circumstances, such as after stressful life events); (4) cure–control-beliefs about how the condition is treated and effectiveness of available treatment and (5) consequences—the perceived effect(s) of the illness on an individual's life. Together, these beliefs form an illness scheme that determines how a patient copes (e.g., adherence to medical advice, attendance to treatment) (Diefenbach and Leventhal, 1996).
Many studies have investigated patients’ beliefs or perceptions regarding their illness using Leventhal's Self-regulatory Model in somatic diseases. Additionally, the SRM has often been used in research within the last decade to explore illness perceptions in mental health. SRM has been used in various researches (Baines and Wittkowski, 2013 and Brown et al., 2001). However, the influence of these beliefs on nonattendance in BD patients has not yet been fully understood. The aim of our study is to investigate illness perceptions of dropout patients with BD.
