title: Depression and medication adherence in the treatment of chronic diseases in the United States: a meta-analysis.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Claremont Graduate University, San Dimas, CA 91773-3901, USA. jerry.grenard@cgu.edu
authors.forename: Jerry L
authors.initials: JL
authors.lastname: Grenard
authors.forename: Brett A
authors.initials: BA
authors.lastname: Munjas
authors.forename: John L
authors.initials: JL
authors.lastname: Adams
authors.forename: Marika
authors.initials: M
authors.lastname: Suttorp
authors.forename: Margaret
authors.initials: M
authors.lastname: Maglione
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: McGlynn
authors.forename: Walid F
authors.initials: WF
authors.lastname: Gellad
mesh_terms: D002908:Chronic Disease; D003863:Depression / Q000453:epidemiology* / Q000523:psychology*; D006801:Humans; D055118:Medication Adherence / Q000523:psychology*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology