Journal of General Internal Medicine

, Volume 26, Issue 10, pp 1175–1182 | Cite as

Depression and Medication Adherence in the Treatment of Chronic Diseases in the United States: A Meta-Analysis

  • Jerry L. GrenardEmail author
  • Brett A. Munjas
  • John L. Adams
  • Marika Suttorp
  • Margaret Maglione
  • Elizabeth A. McGlynn
  • Walid F. Gellad



To conduct a meta-analysis of the association between depression and medication adherence among patients with chronic diseases. Poor medication adherence may result in worse outcomes and higher costs than if patients fully adhere to their medication regimens.

Data Sources

We searched the PubMed and PsycINFO databases, conducted forward searches for articles that cited major review articles, and examined the reference lists of relevant articles.

Study Eligibility Criteria, Participants, and Interventions

We included studies on adults in the United States that reported bivariate relationships between depression and medication adherence. We excluded studies on special populations (e.g., substance abusers) that were not representative of the general adult population with chronic diseases, studies on certain diseases (e.g., HIV) that required special adherence protocols, and studies on interventions for medication adherence.

Study Appraisal and Synthesis Methods

Data abstracted included the study population, the protocol, measures of depression and adherence, and the quantitative association between depression and medication adherence. Synthesis of the data followed established statistical procedures for meta-analysis.


The estimated odds of a depressed patient being non-adherent are 1.76 times the odds of a non-depressed patient, across 31 studies and 18,245 participants. The association was similar across disease types but was not as strong among studies that used pharmacy records compared to self-report and electronic cap measures.


The meta-analysis results are correlations limiting causal inferences, and there is some heterogeneity among the studies in participant characteristics, diseases studied, and methods used.


This analysis provides evidence that depression is associated with poor adherence to medication across a range of chronic diseases, and we find a new potential effect of adherence measurement type on this relationship. Although this study cannot assess causality, it supports the importance that must be placed on depression in studies that assess adherence and attempt to improve it.


depression adherence chronic disease meta-analysis 



This research was supported by the Agency for Healthcare Research and Quality (AHRQ: T32 HS00046-14), a VA HSR&D Career Development Award to Dr. Gellad (CDA 09-207), and by Mehlman Vogel Castagnetti.

Conflicts of Interest

None disclosed.

Supplementary material

11606_2011_1704_MOESM1_ESM.doc (24 kb)
ESM 1 Appendix 1. (DOC 23.5 kb)
11606_2011_1704_MOESM2_ESM.doc (107 kb)
ESM 2 Appendix 2. (DOC 107 kb)


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Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Jerry L. Grenard
    • 1
    Email author
  • Brett A. Munjas
    • 2
  • John L. Adams
    • 2
  • Marika Suttorp
    • 2
  • Margaret Maglione
    • 2
  • Elizabeth A. McGlynn
    • 3
  • Walid F. Gellad
    • 2
    • 4
    • 5
  1. 1.School of Community and Global HealthClaremont Graduate UniversitySan DimasUSA
  2. 2.RAND CorporationSanta MonicaUSA
  3. 3.Kaiser Permanente Center for Effectiveness and Safety ResearchPasadenaUSA
  4. 4.VA Pittsburgh Healthcare System and the Center for Health Equity Research and PromotionPittsburghUSA
  5. 5.University of Pittsburgh School of MedicinePittsburghUSA

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