CLINICAL RESEARCH: MYOCARDIAL INFARCTION AND DEPRESSION
Course of Depressive Symptoms and Medication Adherence After Acute Coronary Syndromes
An Electronic Medication Monitoring Study
Nina Rieckmann, PhD*,
William Gerin, PhD ,
Ian M. Kronish, MD ,
Matthew M. Burg, PhD,
William F. Chaplin, PhD||,
Grace Kong, MA||,
François Lespérance, MD and
Karina W. Davidson, PhD,¶,*
* Department of Psychiatry, Mount Sinai School of Medicine, New York, New York
Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
Division of General Internal Medicine, Mount Sinai School of Medicine, New York, New York
Department of Psychiatry, Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
|| Department of Psychology, St. Johns University, Queens, New York
¶ Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York.
Manuscript received May 9, 2006;
revised manuscript received July 17, 2006,
accepted July 23, 2006.
* Reprint requests and correspondence: Dr. Karina W. Davidson, Department of Medicine, Columbia University College of Physicians and Surgeons, 622 West 168th Street, PH9 Center, Room 948, New York, New York 10032. (Email: kd2124{at}columbia.edu).
OBJECTIVES: We tested whether improvements in depressive symptoms precede improved adherence to aspirin in patients with acute coronary syndromes (ACS).
BACKGROUND: Depression is associated with medication nonadherence in patients with ACS, but it is unclear whether changes in depression impact on adherence.
METHODS: Electronic medication monitoring was used to measure adherence to aspirin during a 3-month period in a consecutive cohort of 172 patients (25 to 85 years) recruited within 1 week of hospitalization for ACS. Depressive symptom severity was assessed using the Beck Depression Inventory (BDI) during hospitalization and at 1 and 3 months after hospitalization. Adherence was defined as the percentage of days aspirin was taken as prescribed.
RESULTS: Depression severity in hospital was associated with nonadherence in a gradient fashion: 15% of non-depressed patients (BDI score 0 to 4), 29% of mildly depressed patients (BDI score 10 to 16), and 37% of patients with moderately-to-severely depressive symptoms (BDI score >16) took aspirin less than 80% of the time (p = 0.03). A cross-lagged path analytic model revealed that improvements in depressive symptoms in the first month after the ACS were associated with improvements in adherence rates in the subsequent 2 months (standardized direct effect –0.32, p = 0.016).
CONCLUSIONS: Diagnosis and treatment of depressive symptoms may improve medication adherence in patients after ACS.
|
Abbreviations and Acronyms
| | ACS = acute coronary syndromes | | BDI = Beck Depression Inventory |
|
Related Article
-
Just a Spoonful of Sugar
- Roy C. Ziegelstein and Sara D. Miller
J. Am. Coll. Cardiol. 2006 48: 2223-2224.
[Full Text]
[PDF]
This article has been cited by other articles:
|
|
|
|
 
G. J. Molloy, G. Randall, A. Wikman, L. Perkins-Porras, N. Messerli-Burgy, and A. Steptoe
Type D Personality, Self-Efficacy, and Medication Adherence Following an Acute Coronary Syndrome
Psychosom Med,
January 1, 2012;
74(1):
100 - 106.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Vaccarino, L. Badimon, R. Corti, C. de Wit, M. Dorobantu, A. Hall, A. Koller, M. Marzilli, A. Pries, R. Bugiardini, et al.
Ischaemic heart disease in women: are there sex differences in pathophysiology and risk factors?: Position Paper from the Working Group on Coronary Pathophysiology and Microcirculation of the European Society of Cardiology
Cardiovasc Res,
April 1, 2011;
90(1):
9 - 17.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. C. Huffman, C. A. Mastromauro, G. Sowden, G. L. Fricchione, B. C. Healy, and J. L. Januzzi
Impact of a Depression Care Management Program for Hospitalized Cardiac Patients
Circ Cardiovasc Qual Outcomes,
March 1, 2011;
4(2):
198 - 205.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
U. Laufs, V. Rettig-Ewen, and M. Bohm
Strategies to improve drug adherence
Eur. Heart J.,
February 1, 2011;
32(3):
264 - 268.
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. Connerney and P. A. Shapiro
Assessment of Depression in Heart Failure Patients: What Is the Role for Cardiology?
J. Am. Coll. Cardiol.,
January 25, 2011;
57(4):
424 - 426.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. M. Burg, E. J. Martens, D. Collins, and R. Soufer
Depression Predicts Elevated Endothelin-1 in Patients With Coronary Artery Disease
Psychosom Med,
January 1, 2011;
73(1):
2 - 6.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Kendel, G. Gelbrich, M. Wirtz, E. Lehmkuhl, N. Knoll, R. Hetzer, and V. Regitz-Zagrosek
Predictive Relationship Between Depression and Physical Functioning After Coronary Surgery
Arch Intern Med,
October 25, 2010;
170(19):
1717 - 1721.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. T. BIGGER and A. H. GLASSMAN
The American Heart Association science advisory on depression and coronary heart disease: An exploration of the issues raised
Cleveland Clinic Journal of Medicine,
July 1, 2010;
77(Suppl_3):
S12 - S19.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. W. DAVIDSON and M. R. KORIN
Depression and cardiovascular disease: Selected findings, controversies, and clinical implications from 2009
Cleveland Clinic Journal of Medicine,
July 1, 2010;
77(Suppl_3):
S20 - S26.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A. Hambridge, A. Turner, and A. L. Baker
BraveHeart Begins: Pilot Results of Group Cognitive Behaviour Therapy for Depression and Anxiety in Cardiac Patients
Australian and New Zealand Journal of Psychiatry,
December 1, 2009;
43(12):
1171 - 1177.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. H. Glassman, J. T. Bigger Jr, and M. Gaffney
Psychiatric Characteristics Associated With Long-term Mortality Among 361 Patients Having an Acute Coronary Syndrome and Major Depression: Seven-Year Follow-up of SADHART Participants
Arch Gen Psychiatry,
September 1, 2009;
66(9):
1022 - 1029.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. M. Ho, C. L. Bryson, and J. S. Rumsfeld
Medication Adherence: Its Importance in Cardiovascular Outcomes
Circulation,
June 16, 2009;
119(23):
3028 - 3035.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. M. Carney, K. E. Freedland, and A. S. Jaffe
Depression Screening in Patients With Heart Disease
JAMA,
April 1, 2009;
301(13):
1337 - 1337.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. M. Narayan and M. B. Stein
Do Depression or Antidepressants Increase Cardiovascular Mortality?: The Absence of Proof Might Be More Important Than the Proof of Absence
J. Am. Coll. Cardiol.,
March 17, 2009;
53(11):
959 - 961.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. POZUELO, G. TESAR, J. ZHANG, M. PENN, K. FRANCO, and W. JIANG
Depression and heart disease: What do we know, and where are we headed?
Cleveland Clinic Journal of Medicine,
January 1, 2009;
76(1):
59 - 70.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. H. Lichtman, J. T. Bigger Jr, J. A. Blumenthal, N. Frasure-Smith, P. G. Kaufmann, F. Lesperance, D. B. Mark, D. S. Sheps, C. B. Taylor, and E. S. Froelicher
Depression and Coronary Heart Disease: Recommendations for Screening, Referral, and Treatment: A Science Advisory From the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: Endorsed by the American Psychiatric Association
Circulation,
October 21, 2008;
118(17):
1768 - 1775.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. A. Thomas, D. W. Chapa, E. Friedmann, C. Durden, A. Ross, M. C. Y. Lee, and H.-J. Lee
Depression in Patients With Heart Failure: Prevalence, Pathophysiological Mechanisms, and Treatment
Crit. Care Nurse,
April 1, 2008;
28(2):
40 - 55.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C.-K. Wong, E.W. Tang, P. Herbison, B. Birmingham, L. Barclay, and S.Y.F. Fu
Pre-existent depression in the 2 weeks before an acute coronary syndrome can be associated with delayed presentation of the heart attack
QJM,
February 1, 2008;
101(2):
137 - 144.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A Steptoe and G J Molloy
Personality and heart disease
Heart,
July 1, 2007;
93(7):
783 - 784.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. C. Ziegelstein and S. D. Miller
Just a Spoonful of Sugar
J. Am. Coll. Cardiol.,
December 5, 2006;
48(11):
2223 - 2224.
[Full Text]
[PDF]
|
|
|
|
