title: Course of depressive symptoms and medication adherence after acute coronary syndromes: an electronic medication monitoring study.
abstract: OBJECTIVE
  We tested whether improvements in depressive symptoms precede improved adherence to aspirin in patients with acute coronary syndromes (ACS).
  
  
  BACKGROUND
  Depression is associated with medication nonadherence in patients with ACS, but it is unclear whether changes in depression impact on adherence.
  
  
  METHODS
  Electronic medication monitoring was used to measure adherence to aspirin during a 3-month period in a consecutive cohort of 172 patients (25 to 85 years) recruited within 1 week of hospitalization for ACS. Depressive symptom severity was assessed using the Beck Depression Inventory (BDI) during hospitalization and at 1 and 3 months after hospitalization. Adherence was defined as the percentage of days aspirin was taken as prescribed.
  
  
  RESULTS
  Depression severity in hospital was associated with nonadherence in a gradient fashion: 15% of non-depressed patients (BDI score 0 to 4), 29% of mildly depressed patients (BDI score 10 to 16), and 37% of patients with moderately-to-severely depressive symptoms (BDI score >16) took aspirin less than 80% of the time (p = 0.03). A cross-lagged path analytic model revealed that improvements in depressive symptoms in the first month after the ACS were associated with improvements in adherence rates in the subsequent 2 months (standardized direct effect -0.32, p = 0.016).
  
  
  CONCLUSIONS
  Diagnosis and treatment of depressive symptoms may improve medication adherence in patients after ACS.
authors.affiliation: Department of Psychiatry, Mount Sinai School of Medicine, New York, New York, USA.
authors.forename: Nina
authors.initials: N
authors.lastname: Rieckmann
authors.forename: William
authors.initials: W
authors.lastname: Gerin
authors.forename: Ian M
authors.initials: IM
authors.lastname: Kronish
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Burg
authors.forename: William F
authors.initials: WF
authors.lastname: Chaplin
authors.forename: Grace
authors.initials: G
authors.lastname: Kong
authors.forename: François
authors.initials: F
authors.lastname: Lespérance
authors.forename: Karina W
authors.initials: KW
authors.lastname: Davidson
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D015331:Cohort Studies; D003327:Coronary Disease / Q000188:drug therapy* / Q000523:psychology*; D003863:Depression / Q000209:etiology* / Q000523:psychology*; D016903:Drug Monitoring; D004581:Electronics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D010349:Patient Compliance; D012720:Severity of Illness Index; D013577:Syndrome; D013997:Time Factors
chemical_list: D000925:Anticoagulants; D001241:Aspirin