title: Perceived discrimination and medication adherence in black hypertensive patients: the role of stress and depression.
abstract: OBJECTIVE
  To examine the relationship between perceived discrimination and medication adherence among black people with hypertension and the role of stress and depressive symptoms in this relationship. Perceived racial discrimination has been associated with poor health outcomes in blacks; its relationship to medication adherence among hypertensive patients remains untested.
  
  
  METHODS
  We measured perceived racial discrimination at baseline, stress and depressive symptoms at 6 months, and medication adherence at 12 months among patients enrolled in a 30-site cluster-randomized controlled trial testing a patient and physician-targeted intervention to improve blood pressure. A mediational method with bootstrapping (stratified by site) confidence intervals was used to estimate the indirect association between perceived discrimination and medication adherence through stress and depression.
  
  
  RESULTS
  Of 1056 patients from 30 sites enrolled in the trial, 463 had complete data on all four measures at 6 and 12 months and were included in the analyses. Adjusting for clustering, perceived discrimination was associated with poor medication adherence (B = 0.138, p = .011) at 12 months, and with stress (B = 2.24, p = .001) and depression (B = 1.47, p = .001) at 6 months. When stress and depression were included in the model, there was a 65% reduction in the total association of perceived discrimination with medication adherence, and the relationship was no longer significant (B = 0.049, p = .35).
  
  
  CONCLUSIONS
  Perceived discrimination is associated with poor medication adherence among hypertensive blacks, and stress and depressive symptoms may account for this relationship.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00233220.
authors.affiliation: From the Department of Population Health (J.F., A.S., G.O., J.R.), NYU School of Medicine, New York, New York; and Department of Psychology (W.F.C.), St John's University, Queens, New York.
authors.forename: Jessica
authors.initials: J
authors.lastname: Forsyth
authors.forename: Antoinette
authors.initials: A
authors.lastname: Schoenthaler
authors.forename: William F
authors.initials: WF
authors.lastname: Chaplin
authors.forename: Gbenga
authors.initials: G
authors.lastname: Ogedegbe
authors.forename: Joseph
authors.initials: J
authors.lastname: Ravenell
mesh_terms: D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D016000:Cluster Analysis; D003376:Counseling; D003863:Depression / Q000208:ethnology*; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000208:ethnology*; D008297:Male; D055118:Medication Adherence / Q000208:ethnology* / Q000523:psychology; D008875:Middle Aged; D008960:Models, Psychological; D015999:Multivariate Analysis; D010353:Patient Education as Topic / Q000379:methods; D063505:Racism / Q000523:psychology / Q000706:statistics & numerical data*; D057566:Self Report; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000208:ethnology*; D014481:United States / Q000453:epidemiology; D016903:Drug Monitoring
chemical_list: D000959:Antihypertensive Agents