Depressive symptoms and self-reported adherence to medical recommendations to prevent cardiovascular disease: NHANES 2005-2010

This study's aim was to examine the relationships between depressive symptom severity and adherence to medication and lifestyle recommendations intended to prevent cardiovascular disease (CVD) in a large, diverse sample of men and women representative of the U.S. population. Participants were adults from the National Health and Nutrition Examination Survey (NHANES) 2005-2010 with a self-reported history of hypertension and/or hypercholesterolemia, but no CVD. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms, and the Blood Pressure and Cholesterol interview was used to assess self-reported adherence to five medical recommendations: take antihypertensive medication (n = 3313), eat fewer high fat/cholesterol foods (n = 2924), control/lose weight (n = 2177), increase physical activity (n = 2540), and take cholesterol medication (n = 2266). Logistic regression models (adjusted for demographics, diabetes, body mass index, smoking, and alcohol intake) revealed that a 1-SD increase in PHQ-9 score was associated with a 14% lower odds of adherence to the control/lose weight recommendation (OR = 0.86, 95% CI: 0.75-0.98, p = .02) and a 25% lower odds of adherence to the increase physical activity recommendation (OR = 0.75, 95% CI: 0.65-0.86, p < .001). PHQ-9 score, however, was not related to the odds of adherence to the take antihypertensive medication (p = .21), eat fewer high fat/cholesterol foods (p = .40), or take cholesterol medication (p = .90) recommendations. Our findings suggest that poor adherence to provider recommendations to control/lose weight and to increase physical activity may partially explain the excess risk of CVD among depressed persons.