Adverse Childhood Experiences, Depression, Patient Activation, and Medication Adherence Among Patients With Uncontrolled Hypertension

Abstract

Background: Identifying potential pathways through which adverse childhood experiences (ACEs) impact health and health behavior remains important, given ACE survivors’ increased risk for cardiovascular disease and poor cardiovascular health behaviors. This study examines whether modifiable variables—depression and patient activation—explain the relationship between ACEs and medication adherence. Methods: Using baseline data from a pragmatic trial designed to decrease disparities in hypertension control, we conducted regression analyses to examine whether depression and patient activation mediated the association between ACEs and medication adherence. Data were collected between August 2017 and October 2019 (n = 1,818). Results: Participants were predominantly female (59.4%) and Black or African American (57%) with uncontrolled blood pressure (mean—152.3/85.5 mm Hg). Most participants reported experiencing at least 1 ACE (71%) and approximately 50% reported being adherent to their blood pressure medication. A significant indirect effect between ACEs and medication adherence was found for depression symptoms (Sobel’s test z = −5.46, P < 0.001). Patient activation was not a mediator in these relationships. Conclusions: Experiencing more depression symptoms significantly accounted for the association between ACEs and medication adherence in a diverse sample of adults with uncontrolled blood pressure. Addressing depression symptoms, which may result from experiences with ACEs and other current stressors, could translate to better medication adherence and, potentially, better blood pressure control among this high-risk group. Given the serious lifetime health implications of ACEs, continued efforts are needed for primary prevention of childhood adversities.