This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (154)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Treatment Adherence  • Psychiatry  • Depression  • Cardiovascular Disease/ Myocardial Infarction  • Adherence  • Alert me on articles by topic

Roy C. Ziegelstein, MD; James A. Fauerbach, PhD; Sandra S. Stevens, BA; Jeanine Romanelli, MD; Daniel P. Richter, BA; David E. Bush, MD

Arch Intern Med. 2000;160:1818-1823.

Background  Patients with depression are at greater risk of cardiac death in the first few months after a myocardial infarction (MI). This study was performed to determine whether depression affects adherence to recommendations intended to reduce the risk of cardiac events after an MI.

Methods  All consenting patients admitted to a university-affiliated teaching hospital during an 18-month period were interviewed 3 to 5 days following an acute MI using the Beck Depression Inventory to assess symptoms of depression and using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, to determine the presence of major depression and/or dysthymia. Accessible survivors (n=204; 116 men and 88 women) were interviewed by telephone 4 months later using the Medical Outcomes Study Specific Adherence Scale to measure self-reported adherence to recommendations to modify cardiac risk.

Results  Patients who were found in the hospital to have symptoms of at least mild to moderate depression (Beck Depression Inventory score 10, n=35 [17.2%]) or to have major depression and/or dysthymia (n=31 [15.2%]) reported lower adherence to a low-fat diet, regular exercise, reducing stress, and increasing social support 4 months later. Those with major depression and/or dysthymia also reported taking medications as prescribed less often than those without major depression and/or dysthymia. Diabetic patients with major depression and/or dysthymia were less likely to follow a diet for patients with diabetes than diabetic patients without depression.

Conclusions  Patients with depression following an acute MI are less likely to adhere to recommended behavior and lifestyle changes intended to reduce the risk of subsequent cardiac events. This finding could explain why depression in the hospital is related to long-term prognosis in patients recovering from an MI.

From the Division of Cardiology, Department of Medicine (Drs Ziegelstein, Romanelli, and Bush), and the Department of Psychiatry (Dr Fauerbach, Ms Stevens, and Mr Richter), The Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Md.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Depressive Symptoms, Health Behaviors, and Risk of Cardiovascular Events in Patients With Coronary Heart Disease
Whooley et al.
JAMA 2008;300:2379-2388.
ABSTRACT | FULL TEXT  

Depression Screening and Patient Outcomes in Cardiovascular Care: A Systematic Review
Thombs et al.
JAMA 2008;300:2161-2171.
ABSTRACT | FULL TEXT  

Depression and Coronary Heart Disease: Recommendations for Screening, Referral, and Treatment: A Science Advisory From the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: Endorsed by the American Psychiatric Association
Lichtman et al.
Circulation 2008;118:1768-1775.
ABSTRACT | FULL TEXT  

Type-D Personality and Cortisol in Survivors of Acute Coronary Syndrome
Molloy et al.
Psychosom. Med. 2008;70:863-868.
ABSTRACT | FULL TEXT  

Pre-Existing Major Depression Predicts In-Hospital Cardiac Complications After Acute Myocardial Infarction
Huffman et al.
Psychosomatics 2008;49:309-316.
ABSTRACT | FULL TEXT  

Case 14-2008 -- A 78-Year-Old Man with Anergia and Anhedonia Associated with Cardiovascular Surgery
Huffman et al.
NEJM 2008;358:2051-2059.
FULL TEXT  

Depressive Symptoms and the Risk of Atherosclerotic Progression Among Patients With Coronary Artery Bypass Grafts
Wellenius et al.
Circulation 2008;117:2313-2319.
ABSTRACT | FULL TEXT  

Pre-existent depression in the 2 weeks before an acute coronary syndrome can be associated with delayed presentation of the heart attack
Wong et al.
QJM 2008;101:137-144.
ABSTRACT | FULL TEXT  

Depressive Symptoms and Smoking Cessation After Hospitalization for Cardiovascular Disease
Thorndike et al.
Arch Intern Med 2008;168:186-191.
ABSTRACT | FULL TEXT  

Failure to consult for symptoms of heart failure in patients with a type-D personality
Schiffer et al.
Heart 2007;93:814-818.
ABSTRACT | FULL TEXT  

2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary]
Lau et al.
CMAJ 2007;176:S1-S13.
FULL TEXT  

Lignes directrices canadiennes de 2006 sur la prise en charge et la prevention de l'obesite chez les adultes et les enfants [sommaire]
Lau et al.
CMAJ 2007;176:SF1-SF14.
FULL TEXT  

Just a Spoonful of Sugar
Ziegelstein and Miller
J Am Coll Cardiol 2006;48:2223-2224.
FULL TEXT  

Course of Depressive Symptoms and Medication Adherence After Acute Coronary Syndromes: An Electronic Medication Monitoring Study
Rieckmann et al.
J Am Coll Cardiol 2006;48:2218-2222.
ABSTRACT | FULL TEXT  

Vascular Nutritional Correlates of Late-Life Depression
Payne et al.
AJGP 2006;14:787-795.
ABSTRACT | FULL TEXT  

Depression and cardiovascular disease: healing the broken-hearted.
Whooley
JAMA 2006;295:2874-2881.
ABSTRACT | FULL TEXT  

The heart, the brain, and the Kounis syndrome: reply
Ziegelstein and Thombs
Eur Heart J 2006;27:757-758.
FULL TEXT  

The brain and the heart: the twain meet
Ziegelstein and Thombs
Eur Heart J 2005;26:2607-2608.
FULL TEXT  

Impact of Antidepressant Drug Adherence on Comorbid Medication Use and Resource Utilization
Katon et al.
Arch Intern Med 2005;165:2497-2503.
ABSTRACT | FULL TEXT  

Depression and Medication Adherence in Outpatients With Coronary Heart Disease: Findings From the Heart and Soul Study
Gehi et al.
Arch Intern Med 2005;165:2508-2513.
ABSTRACT | FULL TEXT  

Cardiovascular Risk Factors May Moderate Pharmacological Treatment Effects in Major Depressive Disorder
Iosifescu et al.
Psychosom. Med. 2005;67:703-706.
ABSTRACT | FULL TEXT  

Depression Following Acute Myocardial Infarction: A Prospective Relationship With Ongoing Health and Function
Fauerbach et al.
Psychosomatics 2005;46:355-361.
ABSTRACT | FULL TEXT  

Integrating Complementary Medicine Into Cardiovascular Medicine: A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents (Writing Committee to Develop an Expert Consensus Document on Complementary and Integrative Medicine)
Vogel et al.
J Am Coll Cardiol 2005;46:184-221.
FULL TEXT  

Mental Disorders and Revascularization Procedures in a Commercially Insured Sample
Jones and Carney
Psychosom. Med. 2005;67:568-576.
ABSTRACT | FULL TEXT  

Can Doctors and Nurses Recognize Depression in Patients Hospitalized With an Acute Myocardial Infarction in the Absence of Formal Screening?
Ziegelstein et al.
Psychosom. Med. 2005;67:393-397.
ABSTRACT | FULL TEXT  

Integrating Psychologic Approaches Into the Behavioral Management of Cardiac Patients
Rozanski
Psychosom. Med. 2005;67:S67-S73.
ABSTRACT | FULL TEXT  

Depression-Related Hyperglycemia in Type 1 Diabetes: A Mediational Approach
Lustman et al.
Psychosom. Med. 2005;67:195-199.
ABSTRACT | FULL TEXT  

Longitudinal Course of Depressive Symptomatology After a Cardiac Event: Effects of Gender and Cardiac Rehabilitation
Grace et al.
Psychosom. Med. 2005;67:52-58.
ABSTRACT | FULL TEXT  

Depression as a Risk Factor for Mortality in Patients With Coronary Heart Disease: A Meta-analysis
Barth et al.
Psychosom. Med. 2004;66:802-813.
ABSTRACT | FULL TEXT  

Anxiety and Depression in Patients With Pulmonary Hypertension
Lowe et al.
Psychosom. Med. 2004;66:831-836.
ABSTRACT | FULL TEXT  

Predictors of Depression Three Months After Cardiac Hospitalization
Schrader et al.
Psychosom. Med. 2004;66:514-520.
ABSTRACT | FULL TEXT  

Posttraumatic Stress, Nonadherence, and Adverse Outcome in Survivors of a Myocardial Infarction
Shemesh et al.
Psychosom. Med. 2004;66:521-526.
ABSTRACT | FULL TEXT  

Engaging patients in managing their cardiovascular health
Newman
Heart 2004;90:iv9-iv13.
ABSTRACT | FULL TEXT  

Depression as a Risk Factor for Coronary Artery Disease: Evidence, Mechanisms, and Treatment
Lett et al.
Psychosom. Med. 2004;66:305-315.
ABSTRACT | FULL TEXT  

Inflammation, coagulation, and depressive symptomatology in cardiovascular disease-free people; the ATTICA study
Panagiotakos et al.
Eur Heart J 2004;25:492-499.
ABSTRACT | FULL TEXT  

Prevalence and Correlates of Successful Transfer From Pediatric to Adult Health Care Among a Cohort of Young Adults With Complex Congenital Heart Defects
Reid et al.
Pediatrics 2004;113:e197-205.
ABSTRACT | FULL TEXT  

The Association Between Major Depression and Levels of Soluble Intercellular Adhesion Molecule 1, Interleukin-6, and C-Reactive Protein in Patients With Recent Acute Coronary Syndromes
Lesperance et al.
Am. J. Psychiatry 2004;161:271-277.
ABSTRACT | FULL TEXT  

Coronary artery disease and depression
Zellweger et al.
Eur Heart J 2004;25:3-9.
ABSTRACT | FULL TEXT  

The Content of a Low-income, Uninsured Primary Care Population: Including the Patient Agenda
Mauksch et al.
J Am Board Fam Med 2003;16:278-289.
ABSTRACT | FULL TEXT  

Utility of Routine Psychological Screening in the Childhood Cancer Survivor Clinic
Recklitis et al.
JCO 2003;21:787-792.
ABSTRACT | FULL TEXT  

Prevalence of Depression in Hospitalized Patients With Congestive Heart Failure
Freedland et al.
Psychosom. Med. 2003;65:119-128.
ABSTRACT | FULL TEXT  

Effect of Depressive Symptoms on Survival After Heart Transplantation
Zipfel et al.
Psychosom. Med. 2002;64:740-747.
ABSTRACT | FULL TEXT  

Sertraline Treatment of Major Depression in Patients With Acute MI or Unstable Angina
Glassman et al.
JAMA 2002;288:701-709.
ABSTRACT | FULL TEXT  

Depressive Symptoms as a Predictor of 6-Month Outcomes and Services Utilization in Elderly Medical Inpatients
Bula et al.
Arch Intern Med 2001;161:2609-2615.
ABSTRACT | FULL TEXT  

Depression in Patients Recovering From a Myocardial Infarction
Ziegelstein
JAMA 2001;286:1621-1627.
ABSTRACT | FULL TEXT  

Depressive symptoms and risk of functional decline and death in patients with heart failure
Vaccarino et al.
J Am Coll Cardiol 2001;38:199-205.
ABSTRACT | FULL TEXT