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Effect of depression onset on adherence to medication among hypertensive patients: a longitudinal modelling study

Sjösten, Nooraa; Nabi, Hermannb; Westerlund, Hugoc; Salo, Paulaa; Oksanen, Tuulaa,d; Pentti, Jaanaa; Virtanen, Mariannae; Kivimäki, Mikae,f; Vahtera, Jussia,g

doi: 10.1097/HJH.0b013e32836098d1
ORIGINAL PAPERS: Therapeutic aspects

Objectives: Although a link between depression and poor adherence to antihypertensive medication (AHM) has been found, it is not known whether depression actually leads to poorer adherence or whether poor adherence only is a marker of depression. In this study we aimed to determine the time order between hypertension, depression and changes in adherence to AHM.

Methods: The analyses were based on data gathered from a longitudinal cohort of Finnish employees (The Finnish Public Sector Study). A total of 852 chronically hypertensive men and women at baseline with a recorded onset of depression during the 9-year observation window and 2359 hypertensive control participants matched for age, sex, socio-economic status, time of study entry, employer and geographic area were included in the study. Individuals with any sign of depression during 4 years before the beginning of the study were excluded. To describe long-term trajectories (4 years before and 4 years after the recorded depression) of AHM adherence in relation to the onset of depression, annual data on reimbursed AHM prescriptions were gathered from the national Drug Prescription Register. Annual nonadherence rates (i.e. number of ‘days-not-treated’) were based on filled prescriptions.

Results: Among male cases, the rate of ‘days-not-treated’ was 1.52 times higher (95% confidence interval 1.08–2.14) in the years after the onset of depression compared to preonset levels. In women and in male controls, no change in adherence to AHM was observed between these time periods.

Conclusion: In hypertensive men, the onset of recorded depression increases the risk of nonadherence to AHM.

aFinnish Institute of Occupational Health, Turku, Finland

bINSERM U1018 Epidemiology of Occupational and Social Determinants of Health-Centre for Research in Epidemiology and Population Health, Villejuif, France

cStress Research Institute, Stockholm University, Stockholm, Sweden

dDepartment of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts, USA

eFinnish Institute of Occupational Health, Helsinki, Finland

fDepartment of Epidemiology and Public Health, University College London, UK

gDepartment of Public Health, University of Turku, and Turku University Hospital, Turku, Finland

Correspondence to Noora Sjösten, Finnish Institute of Occupational Health, Lemminkäisenkatu 14-18b, 20520 Turku, Finland. Tel: +358 30 4741; fax: +358 30 474 7556; e-mail:

Abbreviations: AHM, adherence to antihypertensive medication; ATC, Anatomical Therapeutic Chemical; CI, confidence interval; DDD, defined daily dose; GEE, generalized estimating equation; ICD, International Classification of Diseases; SES, socio-economic status; SII, Social Insurance Institution

Received 13 August, 2012

Revised 7 January, 2013

Accepted 25 February, 2013

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins