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Depressive symptoms moderate the relationship between medication regimen complexity and objectively measured medication adherence in adults with heart failure

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Abstract

Patients with heart failure (HF) take many medications to manage their HF and comorbidities, and 20–50% experience depression. Depressed individuals with more complex medication regimens may be at greater risk for poor adherence. The aim of this study was to assess depressive symptoms as a moderator of the relationship between medication regimen complexity and medication adherence in an observational study of patients with HF. In hierarchical linear regression with the final sample of 299, the interaction of medication regimen complexity and depressive symptoms predicted medication adherence, p < .05. For individuals with higher levels of depressive symptoms [1 standard deviation (SD) above the mean], more regimen complexity was associated with lower adherence. For individuals with low (1 SD below the mean) or average levels of depressive symptoms, regimen complexity was unrelated to medication adherence. Care management strategies, including pillboxes and caregiver involvement, may be valuable in HF patients with depression.

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Acknowledgements

This research was funded by generous grant support from the National Heart, Lung, and Blood Institute at the National Institute of Health (R01 HL096710-01A1 and T32 5T32HL076134-10). The authors wish to acknowledge all of the participants and study staff that contributed to the present work being possible.

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Authors and Affiliations

  1. Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, 196 Richmond Street, Providence, RI, 02903, USA

    Carly M. Goldstein & Emily C. Gathright

  2. The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, 02903, USA

    Carly M. Goldstein

  3. Department of Psychological Sciences, Kent State University, Kent, OH, 44242, USA

    Emily C. Gathright, John Gunstad & Joel W. Hughes

  4. School of Nursing, Case Western Reserve University, Cleveland, OH, 44106, USA

    Mary A. Dolansky & Shirley M. Moore

  5. Summa Cardiovascular Institute, Akron City Hospital, Summa Health System, Akron, OH, 44307, USA

    Joseph D. Redle & Joel W. Hughes

  6. School of Medicine, Case Western Reserve University, Cleveland, OH, 44106, USA

    Richard Josephson

  7. Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, 44106, USA

    Richard Josephson

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  1. Carly M. Goldstein
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Correspondence to Carly M. Goldstein.

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Carly M. Goldstein, Emily C. Gathright, John Gunstad, Mary A. Dolansky, Joseph D. Redle, Richard Josephson, Shirley M. Moore, and Joel W. Hughes declare that they have no conflict of interest.

Human and animal rights and Informed consent

All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

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Goldstein, C.M., Gathright, E.C., Gunstad, J. et al. Depressive symptoms moderate the relationship between medication regimen complexity and objectively measured medication adherence in adults with heart failure. J Behav Med 40, 602–611 (2017). https://doi.org/10.1007/s10865-017-9829-z

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