Patients with depression are less likely to follow recommendations to reduce cardiac risk during recovery from a myocardial infarction

Background: Patients with depression are at greater risk of cardiac death i n the first feu months alter a myocardial infarction (MI), This study was p erformed to determine whether depression affects adherence to recommendatio ns intended to reduce the risk of cardiac events after an MI. Methods: All consenting patients admitted to a university-affiliated teachi ng hospital during an 18-month period were interviewed 3 to 5 days followin g an acute MI using the Beck Depression Inventory to assess symptoms of dep ression 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-r eported adherence to recommendations to modify cardiac risk. Results: Patients who were found in the hospital to have symptoms of at lea st mild to moderate depression (Beck Depression Inventory score greater tha n or equal to 10, n=35 [17.2%]) or to have major depression and/or dysthymi a (n=31 [15.2%]) reported lower adherence to a low-fat diet, regular exerci se, reducing stress, and increasing social support 4 months later. Those wi th major depression and/or dysthymia also reported laking medications as pr escribed less often than those without major depression and/or dysthymia. D iabetic patients with major depression and/or dysthymia were less likely to follow a diet for patients with diabetes than diabetic patients without de pression. 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 depr ession in the hospital is related to long-term prognosis in patients recove ring from an MI.