Persistent depression affects adherence to secondary prevention behaviors after acute coronary syndromes.
BACKGROUND
The persistence of depressive symptoms after hospitalization is a strong risk factor for mortality after acute coronary syndromes (ACS). Poor adherence to secondary prevention behaviors may be a mediator of the relationship between depression and increased mortality.


OBJECTIVE
To determine whether rates of adherence to risk reducing behaviors were affected by depressive status during hospitalization and 3 months later.


METHODS
Prospective observational cohort study.


METHODS
Three university hospitals.


METHODS
Five hundred and sixty patients were enrolled within 7 days after ACS. Of these, 492 (88%) patients completed 3-month follow-up.


METHODS
We used the Beck Depression Inventory (BDI) to assess depressive symptoms in the hospital and 3 months after discharge. We assessed adherence to 5 risk-reducing behaviors by patient self-report at 3 months. We used chi2 analysis to compare differences in adherence among 3 groups: persistently nondepressed (BDI < 10 at hospitalization and 3 months); remittent depressed (BDI > or = 10 at hospitalization; < 10 at 3 months); and persistently depressed patients (BDI > or = 10 at hospitalization and 3 months).


RESULTS
Compared with persistently nondepressed, persistently depressed patients reported lower rates of adherence to quitting smoking (adjusted odds ratio [OR] 0.23, 95% confidence interval [95% CI] 0.05 to 0.97), taking medications (adjusted OR 0.50, 95% CI 0.27 to 0.95), exercising (adjusted OR 0.57, 95% CI 0.34 to 0.95), and attending cardiac rehabilitation (adjusted OR 0.5, 95% CI 0.27 to 0.91). There were no significant differences between remittent depressed and persistently nondepressed patients.


CONCLUSIONS
Persistently depressed patients were less likely to adhere to behaviors that reduce the risk of recurrent ACS. Differences in adherence to these behaviors may explain in part why depression predicts mortality after ACS.
Kronish
Ian M
IM
Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY, USA.
Rieckmann
Nina
N
Halm
Ethan A
EA
Shimbo
Daichi
D
Vorchheimer
David
D
Haas
Donald C
DC
Davidson
Karina W
KW
D000208:Acute Disease; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003327:Coronary Disease / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control* / Q000523:psychology; D003866:Depressive Disorder / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology; D011446:Prospective Studies; D013577:Syndrome