Individualized psychological intervention for medication adherence in outpatients with depression

In China’s mental healthcare system, a critical shortage of professionals limits the implementation of guideline-recommended shared decision-making, leading to high rates of antidepressant non-adherence. This study tested whether a brief, theory-based psychological intervention could improve early medication adherence within existing resource constraints. We conducted a parallel-group, assessor-blinded randomized controlled trial at a tertiary hospital in Guangdong. Eighty outpatients with major depressive disorder were randomized to receive either a 12-week personalized intervention or treatment as usual. The personalized intervention, delivered in eight 30-min sessions, integrated a predictive risk algorithm with stage-matched behavioral techniques to target key adherence determinants. The primary outcomes were medication adherence (MMAS-8) and depressive symptoms (SDS). Among the 60 study completers, the intervention group achieved significantly higher medication adherence at 12 weeks than the control group (between-group difference: 1.09 points), representing an 18% relative improvement. Depressive symptoms decreased substantially in both groups, with no between-group difference. The intervention also led to a significant increase in patient autonomy. This theory-guided protocol effectively improved antidepressant adherence without accelerating short-term symptom reduction. This scalable approach shows promise for bridging the treatment gap in routine psychiatric care in China without requiring additional specialist resources.