# Association Between Depression and Medication Adherence Among Post-myocardial Infarction Patients in a South Asian Clinical Setting

## TL;DR

This study finds a weak positive link between depression and medication adherence in heart attack patients in Pakistan, suggesting cultural and treatment factors influence recovery.

## Contribution

The study reports a novel positive correlation between depressive symptoms and medication adherence in post-MI patients in a South Asian context.

## Key findings

- Depression scores were weakly but significantly positively correlated with medication adherence scores.
- Patients with moderate medication burdens showed the highest adherence rates.
- Angioplasty patients had better adherence and lower psychological distress compared to other treatment types.

## Abstract

Background: Medication adherence is vital for successful recovery after a myocardial infarction (MI). Unfortunately, many patients experience depression following an MI, which can negatively affect their ability to stick to prescribed medication plans. It is important to explore how depression influences medication adherence, especially in South Asian clinical environments where cultural factors can significantly impact health outcomes.

Methods: A cross-sectional study was carried out among 385 post-MI patients who attended outpatient clinics in Islamabad, Pakistan. The Patient Health Questionnaire-9 (PHQ-9) was used to measure depression, and the Morisky Medication Adherence Scale (MMAS-8) was used to quantify medication adherence. Statistical tests involved descriptive statistics, normality tests using Shapiro-Wilk, Spearman correlation, Kruskal-Wallis, chi-square, and linear regression. Data were collected between January and May 2025.

Results: There was also a weak, statistically significant positive relation between the PHQ-9 and the MMAS-8 scores (r = 0.124, p < 0.05). In a linear regression model, PHQ-9 scores were significantly predictive of MMAS-8 scores (B = 0.064, p = 0.002), which means that the higher the depressive symptoms, the more likely medication adherence was. Depression scores worsened over time since MI and heavier medication burden, whereas adherence was highest among patients taking moderate numbers of medications (three to five/day). The rates of adherence and psychological distress also differed significantly depending on the treatment type, with the best rates being in angioplasty patients.

Conclusion: This study, unlike the majority of the previous findings, reported a minor positive correlation between self-reported medication adherence and depressive symptoms in post-MI patients. The findings indicate that, in particular, in the cultural backdrop, depressive symptoms can be present alongside more health conscientiousness or planned-out care use. Comorbidities and complexities of treatment should be assessed, and mental health screening and adherence support to medications should be a component of post-MI care strategies.