title: Depression, patient characteristics, and attachment style: correlates and mediators of medication treatment adherence in a racially diverse primary care sample.
abstract: BACKGROUND
  The depth and breadth of problems related to depressive symptomatology and optimal treatment outcomes, including medication treatment adherence, have long been documented in the literature. Missing are clear explanations as to what factors and patient characteristics may account for lack of medication treatment adherence.
  
  
  OBJECTIVE
  The two objectives of the current study were to examine the predictive strength of depression, patient characteristics, and patient attachment style regarding medication treatment adherence and to consider the extent to which attachment styles mediate the relation between depression and medication treatment adherence.
  
  
  METHODS
  Participants in the present study were 237 racially diverse American primary care patients with a diagnosis of hypertension who were participants in a clinical trial. Depression, patient characteristics, attachment style, and medication treatment adherence were assessed.
  
  
  RESULTS
  Partly consistent with our four hypotheses, the following results were found: (a) Black American, younger, never married, and poorer patients had lower medication treatment adherence (b) depression was significantly associated with lower self-reported medication adherence; (c) insecure-dismissing attachment style was related to lower medication adherence; and (d) insecure-dismissing attachment style mediates the relation between depression and medication treatment adherence by exacerbating the negative association.
  
  
  CONCLUSIONS
  Physicians and other primary care providers should consider how depressive symptomatology, patient characteristics, and attachment style may inform the treatment plans they put forward and the extent to which patients may adhere to those treatment plans.
authors.affiliation: 1Department of Counseling and Human Development,University of Louisville,Louisville,Kentucky,USA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Hooper
authors.affiliation: 2Department of Educational Studies in Psychology, Research Methodology & Counseling,The University of Alabama,Tuscaloosa,Alabama,USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Tomek
authors.affiliation: 3Department of Health Behavior and Society,Johns Hopkins Bloomberg School of Public Health,Baltimore,Maryland,USA.
authors.forename: Debra
authors.initials: D
authors.lastname: Roter
authors.affiliation: 4Department of Epidemiology,Johns Hopkins Bloomberg School of Public Health,Baltimore,Maryland,USA.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Carson
authors.affiliation: 2Department of Educational Studies in Psychology, Research Methodology & Counseling,The University of Alabama,Tuscaloosa,Alabama,USA.
authors.forename: George
authors.initials: G
authors.lastname: Mugoya
authors.affiliation: 5Department of Medicine,Johns Hopkins University School of Medicine,Baltimore,Maryland,USA.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Cooper
mesh_terms: D000368:Aged; D003866:Depressive Disorder / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009769:Object Attachment; D011320:Primary Health Care
keywords: attachment styles; attachment theory; depression; primary care; treatment adherence