Treatment-Related Factors for Medication Non-Adherence Among Patients with Major Depressive Disorder: An Explanatory Sequential Mixed-Methods Study

Purpose: This study aimed to examine treatment-related factors influencing antidepressant non-adherence among patients with Major depressive disorder in Pakistan. Methods: An explanatory sequential mixed-methods cross-sectional design was employed. The study first conducted questionnaire-based quantitative research to assess non-adherence and its treatment-related predictors. This was followed by semi-structured interviews with a purposively selected subset of participants who were poorly adherent to explore their contextual experiences. Quantitative and qualitative findings were integrated using narrative synthesis and joint displays. Results: A total of 2,513 participants with recurrent major depressive disorder (MDD) were surveyed. Among them, 812 (32.3%) were classified as poorly adherent, 719 (28.6%) as moderately adherent, and 982 (39.1%) as highly adherent, based on the UMGLS-4. High ADR burden, low DAI-10 scores, unemployment, low income, and age above 55 years were significantly associated with non-adherence (p