Adherence to risk factor management instructions after acute myocardial infarction: The role of emotional support and depressive symptoms

Abstract

Background Emotional support and depression may influence adherence to risk factor management instructions after acute myocardial infarction (AMI), but their role requires further investigation. Purpose To examine the longitudinal association between perceived emotional support and risk factor management adherence and assess depressive symptoms as a moderator of this association. Methods Among 2,202 AMI patients, we assessed adherence to risk factor management instructions over the first recovery year. Modified Poisson mixed-effects regression evaluated associations, with adjustment for demographic and clinical factors. Results Patients with low baseline support had greater risk of poor adherence over the first year than patients with high baseline support (relative risk [RR]=1.20, 95% confidence interval [CI]=1.02-1.43). In stratified analyses, low support remained a significant predictor of poor adherence for non-depressed (RR=1.41, 95% CI=1.23-1.61) but not depressed (RR=1.01, 95% CI=0.78-1.30) patients (p for interaction<0.001). Conclusions Low emotional support is associated with poor risk factor management adherence after AMI. This relationship is moderated by depression, with a significant relationship observed only among non-depressed patients. © The Society of Behavioral Medicine 2011.