Negative affect and self agency’s association with medication adherence in adult organ transplant recipients: A meta-analytic study

Objective: In organ transplant, prevalence estimates of negative affect (e.g., depressive symptoms) are higher than in the general population and self-agency is required for successful medication regimen self-management. Nonetheless, the roles of these psychological factors for immunosuppressant adherence in the organ transplant population remain unclear. Methods: Meta-analytic techniques were used to determine the associations between negative affect and self-agency with immunosuppressant adherence and to identify theoretically derived and methodological moderators of these associational effect sizes (ES). Results: Across 50 studies and 46,106 adult organ recipients, the findings demonstrate that there is a small negative association between negative affect and adherence [mean weighted effect size: r= -.14, p= .00; 95% CI= -.175, -.096] and a small positive association between self-agency and adherence [ES: r= .17, p= .00; 95% CI= .094, .251]. Studies conducted outside of Europe and North America, assessing illness-specific negative affect and utilizing questionnaire adherence measures, and studies of better quality were associated with a larger effect size for the association between negative affect and adherence, and together they explained 54% of the heterogeneity in the effect sizes. For the association between self-agency and adherence, a higher percentage of females and medication-specific self-agency were associated with a larger effect size, explaining 34% of the heterogeneity in the effect sizes. Conclusions: By elucidating overlooked trends in the existing literature for the associations between negative affect and self-agency with immunosuppressant adherence, the current meta-analyses clarify previously contradicting findings in organ transplant and demonstrate that higher negative affect and lower self-agency are each associated with poorer adherence to immunosuppressants in organ transplant. The findings also shed light on six factors contributing to the existing variability in effects and highlight the importance of careful consideration of study methodology in studies of adherence to immunosuppressants post organ transplant.