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The Psychosocial Context Impacts Medication Adherence After Acute Coronary Syndrome

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Depression is associated with poor adherence to medications and worse prognosis in patients with acute coronary syndrome (ACS).

Purpose

To determine whether cognitive, behavioral, and/or psychosocial vulnerabilities for depression explain the association between depression and medication adherence among ACS patients.

Methods

One hundred sixty-nine ACS patients who agreed to have their aspirin adherence measured using an electronic pill bottle for 3 months were enrolled within 1 week of hospitalization. Linear regression was used to determine whether depression vulnerabilities predicted aspirin adherence after adjustment for depressive symptoms, demographics, and comorbidity.

Results

Of the depression vulnerabilities, only role transitions (beta = −3.32; P = 0.02) and interpersonal conflict (beta -3.78; P = 0.03) predicted poor adherence. Depression vulnerabilities did not mediate the association between depressive symptoms and medication adherence.

Conclusions

Key elements of the psychosocial context preceding the ACS including major role transitions and conflict with close contacts place ACS patients at increased risk for poor medication adherence independent of depressive symptoms.

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Conflict of Interest Statement

The authors have no conflicts of interest to disclose.

Sources of Funding

This work was supported by grants HL08817 and HC25197 from the National Institutes of Health (NIH), Bethesda, MD. Dr. Kronish received supported by grant K23-HL098359 from the National Heart, Lung, and Blood Institute (NHLBI) and by a Scientist Development Grant (10SDG2600321) from the American Heart Association. Dr. Alcantara is supported by grant 3R01HL115941-01S1 from NHLBI. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the National Center for Research Resources or the NIH. No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Center for Behavioral Cardiovascular Health, Columbia University Medical Center, PH9-311, 622 W168th Street, New York, NY, 10032, USA

    Ian M. Kronish M.D., M.P.H., Matthew M. Burg Ph.D., Carmela Alcántara Ph.D. & Karina W. Davidson Ph.D.

  2. Berlin School of Public Health, Charité Universitätsmedizin, Berlin, Germany

    Nina Rieckmann Ph.D.

  3. Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA

    Matthew M. Burg Ph.D.

Authors
  1. Ian M. Kronish M.D., M.P.H.
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  2. Nina Rieckmann Ph.D.
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  3. Matthew M. Burg Ph.D.
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  4. Carmela Alcántara Ph.D.
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  5. Karina W. Davidson Ph.D.
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Correspondence to Ian M. Kronish M.D., M.P.H..

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Kronish, I.M., Rieckmann, N., Burg, M.M. et al. The Psychosocial Context Impacts Medication Adherence After Acute Coronary Syndrome. ann. behav. med. 47, 158–164 (2014). https://doi.org/10.1007/s12160-013-9544-0

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