title: The psychosocial context impacts medication adherence after acute coronary syndrome.
abstract: BACKGROUND
  Depression is associated with poor adherence to medications and worse prognosis in patients with acute coronary syndrome (ACS).
  
  
  OBJECTIVE
  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.
authors.affiliation: Center for Behavioral Cardiovascular Health, Columbia University Medical Center, PH9-311, 622 W168th Street, New York, NY, 10032, USA, ik2293@columbia.edu.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Kronish
authors.forename: Nina
authors.initials: N
authors.lastname: Rieckmann
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Burg
authors.forename: Carmela
authors.initials: C
authors.lastname: Alcántara
authors.forename: Karina W
authors.initials: KW
authors.lastname: Davidson
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D000223:Adaptation, Psychological; D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D003863:Depression / Q000150:complications* / Q000523:psychology; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012720:Severity of Illness Index
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin