title: Medication beliefs mediate between depressive symptoms and medication adherence in cystic fibrosis.
abstract: OBJECTIVE
  Depression is a known barrier to regimen adherence for chronic conditions. Despite elevated depression rates and complex regimens for people with cystic fibrosis (CF), little is known about associations between depressive symptoms and CF adherence. One possibility is that depressive symptoms distort beliefs about medications, which may influence adherence.
  
  
  METHODS
  Adolescents and adults (N = 128; mean age = 29 ± 11 years, range = 16-63, 93% Caucasian) with CF reported on depressive symptoms and medication beliefs (self-efficacy, motivation, perceived importance, and outcome expectancies related to taking medications). Medication adherence was assessed objectively through pharmacy refill data. Cross-sectional structural equation models evaluated medication beliefs as a mediator between depressive symptoms and medication adherence.
  
  
  RESULTS
  Twenty-three percent of participants exceeded clinical cutoffs for depressive symptoms. Participants took less than half of prescribed pulmonary medications (mean adherence rate = 44.4 ± 26.7%). Depressive symptoms were correlated with adherence (r = -.22, p < .05), and medication beliefs (b = -0.13, 95% CI [-0.24, -0.03]) significantly mediated this relation. Higher depressive symptoms were associated with less positive medication beliefs (b = -0.27, p < .01), which were associated with lower medication adherence (b = 0.49, p < .01).
  
  
  CONCLUSIONS
  Depressive symptoms are related to beliefs about and adherence to CF medications. Monitoring depressive symptoms and medication beliefs in routine CF care may help identify risks for nonadherence and facilitate interventions to reduce depression, adaptive medication beliefs, and ultimately improve adherence and CF management. (PsycINFO Database Record
authors.affiliation: Johns Hopkins University School of Medicine, Johns Hopkins Adherence Research Center, Division of Pulmonary and Critical Care Medicine.
authors.forename: Marisa E
authors.initials: ME
authors.lastname: Hilliard
authors.affiliation: Johns Hopkins University School of Medicine, Johns Hopkins Adherence Research Center, Division of Pulmonary and Critical Care Medicine.
authors.forename: Michelle N
authors.initials: MN
authors.lastname: Eakin
authors.affiliation: Warren Alpert School of Medicine at Brown University.
authors.forename: Belinda
authors.initials: B
authors.lastname: Borrelli
authors.affiliation: Johns Hopkins University School of Medicine, Johns Hopkins Adherence Research Center, Division of Pulmonary and Critical Care Medicine.
authors.forename: Angela
authors.initials: A
authors.lastname: Green
authors.affiliation: Johns Hopkins University School of Medicine, Johns Hopkins Adherence Research Center, Division of Pulmonary and Critical Care Medicine.
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Riekert
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003550:Cystic Fibrosis / Q000188:drug therapy* / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D005100:Expectorants / Q000627:therapeutic use; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D009042:Motivation; D020377:Self Efficacy; D055815:Young Adult
chemical_list: D005100:Expectorants
references.citation: PLoS One. 2013 Dec 02;8(12):e80633
references.pmid: 24312488
references.citation: J Psychosom Res. 2002 Oct;53(4):859-63
references.pmid: 12377294
references.citation: BMC Pulm Med. 2011 Jan 20;11:5
references.pmid: 21251275
references.citation: Res Social Adm Pharm. 2005 Dec;1(4):508-25
references.pmid: 17138493
references.citation: Health Educ Behav. 2009 Feb;36(1):127-37
references.pmid: 18077654
references.citation: Chest. 2007 Jul;132(1):231-7
references.pmid: 17625085
references.citation: Int J Nurs Stud. 2008 Aug;45(8):1175-84
references.pmid: 17949723
references.citation: J Pediatr Psychol. 2009 Sep;34(8):893-902
references.pmid: 19196850
references.citation: Psychosom Med. 2004 Nov-Dec;66(6):802-13
references.pmid: 15564343
references.citation: Health Psychol. 2007 Jan;26(1):40-9
references.pmid: 17209696
references.citation: J Behav Med. 2010 Feb;33(1):81-9
references.pmid: 20128112
references.citation: J Am Diet Assoc. 2008 May;108(5):832-9
references.pmid: 18442507
references.citation: Diabetes Educ. 2011 May-Jun;37(3):392-408
references.pmid: 21478378
references.citation: J Cyst Fibros. 2011 Jul;10(4):258-64
references.pmid: 21458391
references.citation: Br J Health Psychol. 2012 Feb;17(1):202-19
references.pmid: 22107150
references.citation: Clin Infect Dis. 2011 Feb 15;52(4):493-506
references.pmid: 21245156
references.citation: Health Psychol. 2009 Jan;28(1):1-10
references.pmid: 19210012
references.citation: J Health Psychol. 2013 Jan;18(1):139-52
references.pmid: 22322986
references.citation: Chest. 2014 Jul;146(1):142-151
references.pmid: 24480974
references.citation: Diabetes Res Clin Pract. 2010 Jun;88(3):e35-7
references.pmid: 20451278
references.citation: Pediatrics. 2009 Apr;123(4):1223-8
references.pmid: 19336383
references.citation: Arch Phys Med Rehabil. 2000 Apr;81(4):460-4
references.pmid: 10768536
references.citation: J Psychosom Res. 2002 Oct;53(4):917-24
references.pmid: 12377304
references.citation: Health Psychol. 2007 Nov;26(6):693-700
references.pmid: 18020841
references.citation: Health Educ Res. 2012 Oct;27(5):868-85
references.pmid: 22926008
references.citation: J Cyst Fibros. 2013 Dec;12(6):794-6
references.pmid: 23628513
references.citation: J Med Econ. 2013;16(6):801-8
references.pmid: 23506540
references.citation: J Cyst Fibros. 2009 Mar;8(2):91-6
references.pmid: 18952504
references.citation: Lancet. 2007 Apr 28;369(9571):1481-1489
references.pmid: 17467519
references.citation: Med J Aust. 2009 Apr 6;190(S7):S54-60
references.pmid: 19351294
references.citation: J Womens Health (Larchmt). 2004 Jun;13(5):557-68
references.pmid: 15257847
references.citation: Eur Respir J. 2008 Sep;32(3):710-7
references.pmid: 18417510
references.citation: Eur Respir J. 2010 Dec;36(6):1277-83
references.pmid: 20378603
references.citation: Arch Intern Med. 2000 Jul 24;160(14):2101-7
references.pmid: 10904452
references.citation: Pediatrics. 2010 Mar;125(3):566-73
references.pmid: 20176665
references.citation: Paediatr Respir Rev. 2012 Dec;13(4):206-14
references.pmid: 23069117
references.citation: J Gen Intern Med. 2011 Oct;26(10):1175-82
references.pmid: 21533823
references.citation: J Allergy Clin Immunol. 2007 Nov;120(5):1023-30
references.pmid: 17904625
references.citation: Chest. 2010 Oct;138(4):929-36
references.pmid: 20472857
references.citation: Chest. 2011 Aug;140(2):425-432
references.pmid: 21330381