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.
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Abbreviations and Acronyms
| | ACS = acute coronary syndromes | | BDI = Beck Depression Inventory |
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