Associations among subjective cognitive complaints, perceived social support, and medication adherence in patients with psychotic disorders

Abstract

Background Medication adherence is essential for the management of psychotic disorders, yet it remains difficult for many patients to sustain over time. In this study, the focus is on subjective cognitive complaints, defined as patients’ self-perceived everyday cognitive difficulties, rather than cognitive biases or objectively measured cognitive deficits. These complaints may be associated with difficulties in remembering medication schedules, organizing treatment routines, and maintaining consistent follow-up. Perceived social support may also be relevant, as supportive family members, friends, and caregivers can provide practical and emotional assistance that helps patients manage treatment demands. Objective To examine the associations among subjective cognitive complaints, perceived social support, and medication adherence among patients with psychotic disorders, and to assess whether perceived social support statistically accounts for part of the association between subjective cognitive complaints and medication adherence. Methods A cross-sectional study was conducted between July 2024 and January 2025 at the psychiatric outpatient clinic of XX. A total of 202 patients with psychotic disorders were recruited using systematic random sampling. Data were collected using the Self-Assessment Scale of Cognitive Complaints in Schizophrenia, the Brief Medication Adherence Rating Scale, and the Multidimensional Scale of Perceived Social Support. Correlation, regression, mediation, and moderation analyses were conducted to examine the relationships among the study variables. Results Subjective cognitive complaints were negatively correlated with medication adherence, r = –0.193, p = 0.005, and perceived social support, r = –0.217, p = 0.002. Perceived social support was positively correlated with medication adherence, r = 0.244, p < 0.001. Regression analysis showed that executive function complaints, B = –0.667, p = 0.016, and language complaints, B = –0.905, p = 0.038, were significantly associated with lower medication adherence scores. The indirect-effect analysis showed that perceived social support statistically accounted for part of the association between subjective cognitive complaints and medication adherence, indirect effect B = –0.019, bootstrapped 95% CI [–0.035, –0.006]. The direct association between subjective cognitive complaints and medication adherence remained significant, B = –0.061, p = 0.034. Moderation analysis showed that the interaction between subjective cognitive complaints and perceived social support did not reach statistical significance, B = –0.004, p = 0.077. Conclusion Among patients with psychotic disorders, greater subjective cognitive complaints were associated with lower medication adherence and lower perceived social support, while higher perceived social support was associated with better adherence. Perceived social support statistically accounted for part of the association between subjective cognitive complaints and adherence; however, because of the cross-sectional self-report design, these findings should be interpreted as associative rather than causal. Interventions aimed at improving medication adherence may benefit from combining cognitive compensatory strategies with family and social support enhancement.