title: Patients with depression are less likely to follow recommendations to reduce cardiac risk during recovery from a myocardial infarction.
abstract: BACKGROUND
  Patients with depression are at greater risk of cardiac death in the first few months after a myocardial infarction (MI). This study was performed to determine whether depression affects adherence to recommendations intended to reduce the risk of cardiac events after an MI.
  
  
  METHODS
  All consenting patients admitted to a university-affiliated teaching hospital during an 18-month period were interviewed 3 to 5 days following an acute MI using the Beck Depression Inventory to assess symptoms of depression and using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, to determine the presence of major depression and/or dysthymia. Accessible survivors (n=204; 116 men and 88 women) were interviewed by telephone 4 months later using the Medical Outcomes Study Specific Adherence Scale to measure self-reported adherence to recommendations to modify cardiac risk.
  
  
  RESULTS
  Patients who were found in the hospital to have symptoms of at least mild to moderate depression (Beck Depression Inventory score > or =10, n=35 [17.2%]) or to have major depression and/or dysthymia (n=31 [15.2%]) reported lower adherence to a low-fat diet, regular exercise, reducing stress, and increasing social support 4 months later. Those with major depression and/or dysthymia also reported taking medications as prescribed less often than those without major depression and/or dysthymia. Diabetic patients with major depression and/or dysthymia were less likely to follow a diet for patients with diabetes than diabetic patients without depression.
  
  
  CONCLUSIONS
  Patients with depression following an acute MI are less likely to adhere to recommended behavior and lifestyle changes intended to reduce the risk of subsequent cardiac events. This finding could explain why depression in the hospital is related to long-term prognosis in patients recovering from an MI.
authors.affiliation: Department of Medicine, The Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224-2780, USA. rziegel@jhmi.edu
authors.forename: R C
authors.initials: RC
authors.lastname: Ziegelstein
authors.forename: J A
authors.initials: JA
authors.lastname: Fauerbach
authors.forename: S S
authors.initials: SS
authors.lastname: Stevens
authors.forename: J
authors.initials: J
authors.lastname: Romanelli
authors.forename: D P
authors.initials: DP
authors.lastname: Richter
authors.forename: D E
authors.initials: DE
authors.lastname: Bush
mesh_terms: D000368:Aged; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D003863:Depression / Q000150:complications*; D019263:Dysthymic Disorder / Q000150:complications*; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control* / Q000523:psychology*; D011237:Predictive Value of Tests; D015995:Prevalence; D012306:Risk; D012307:Risk Factors; D011795:Surveys and Questionnaires