Qualitative study on adherence to prescribed antipsychotics in individuals with schizophrenia in regional Victoria, Australia

Non-adherence to prescribed antipsychotics contributes to relapse of psychotic symptoms, increasing risks of rehospitalisation, involuntary treatment, and higher health-care costs. Little is known about medication adherence experiences of adults with schizophrenia residing in regional Australia. This qualitative study explored why individuals aged 25–65 years with schizophrenia living in regional Victoria adhere to their prescribed antipsychotic medication.

Eleven purposively selected participants completed one-to-one semi-structured interviews, which were recorded, transcribed, and analysed using Braun and Clarke’s Reflexive Thematic Analysis. Interviews were carried out between 15 April 2024 and 10 February 2025. Three overarching themes were identified: adherence as avoidance of adverse consequences, adherence within relationships of dependency and constrained choice, and medication as a pathway to stability and everyday life.

Participants described adherence as motivated by fear of hospitalisation, worsening psychosocial circumstances, loss of support, limited autonomy in treatment decision-making, perceived benefits of medication, established routines, and the desire to maintain social relationships and everyday functioning. The findings suggest that adherence among adults with schizophrenia in regional Australia is influenced by a complex interaction of perceived benefits, social relationships, support systems, and treatment experiences. Expanding home visits, strengthening telehealth, integrating peer support workers, promoting social prescribing, improving regional mental health research, and enhancing social infrastructure may support sustained adherence.

Multidisciplinary efforts have a key role in addressing these needs. Schizophrenia is defined as a psychotic disorder characterized by disturbances in cognition, emotional responsiveness, and behaviour, distorting the individual’s sense of reality. Typical symptoms reported by individuals with schizophrenia include delusions, hallucinations, disorganized speech, thoughts, and behaviours, as well as negative symptoms such as diminished emotional expression.

The World Health Organisation (WHO) (2022) reported that schizophrenia affects 1 in 300 people globally1. Similarly, people with schizophrenia are approximately two to three times more likely to die prematurely than the general population and may experience a reduction in life expectancy of 12–20 years2,3. In the Australian context, schizophrenia affects between 150,000 and 200,000 individuals, ranking as the third leading cause of disability and costing over AUD 2.6 billion dollars in addition to National Disability Insurance Scheme (NDIS) expenditures4,5.

A combination of antipsychotic medications and psychosocial therapy has been found to be the most effective treatment for managing symptoms and improving well-being6. However, studies have shown that individuals with schizophrenia struggle to adhere to their prescribed medications for various reasons, and only about one-third of patients are found to respond well to these medications7,8. The non-adherence rate to antipsychotics is up to 70% among patients with schizophrenia, compared to 50% among those with bipolar affective disorder and 57% among those with anxiety disorders9.