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Findings From the Heart and Soul Study

Anil Gehi, MD; Donald Haas, MD, MPH; Sharon Pipkin, MPH; Mary A. Whooley, MD

Arch Intern Med. 2005;165:2508-2513.

Background  Depression leads to adverse outcomes in patients with coronary heart disease (CHD). Medication nonadherence is a potential mechanism for the increased risk of CHD events associated with depression, but it is not known whether depression is associated with medication nonadherence in outpatients with stable CHD.

Methods  We examined the association between current major depression (assessed using the Diagnostic Interview Schedule) and self-reported medication adherence in a cross-sectional study of 940 outpatients with stable CHD.

Results  A total of 204 participants (22%) had major depression. Twenty-eight (14%) of 204 depressed participants reported not taking their medications as prescribed compared with 40 (5%) of 736 nondepressed participants (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.7-4.7; P<.001). Twice as many depressed participants as nondepressed participants (18% vs 9%) reported forgetting to take their medications (OR, 2.4; 95% CI, 1.6-3.8; P<.001). Nine percent of depressed participants and 4% of nondepressed participants reported deciding to skip their medications (OR, 2.2; 95% CI, 1.2-4.2; P = .01). The relationship between depression and nonadherence persisted after adjustment for potential confounding variables, including age, ethnicity, education, social support, and measures of cardiac disease severity (OR, 2.2; 95% CI, 1.2-3.9; P = .009 for not taking medications as prescribed).

Conclusions  Depression is associated with medication nonadherence in outpatients with CHD. Medication nonadherence may contribute to adverse cardiovascular outcomes in depressed patients.

Author Affiliations: The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY (Drs Gehi and Haas); and San Francisco Department of Public Health (Ms Pipkin), Section of General Internal Medicine, Department of Veterans Affairs Medical Center (Dr Whooley), and Departments of Medicine and Epidemiology and Biostatistics, University of California (Dr Whooley), San Francisco.

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