Abstract P265: Sex Differences in the Mediation of Relationship Between Depression and Nonadherence by Self-Efficacy
Purpose: We tested for sex differences in how self-efficacy explains the relationship between incident depressive symptoms and incident low adherence using data from the Cohort Study of Medication Adherence among Older Adults (CoSMO).
Methods: A telephone survey was administered to hypertensive older adults three times at yearly intervals. Depressive symptoms were defined as a score ≥16 on the Center for Epidemiologic Studies Depression Scale. Low adherence was defined as a score <6 on the 8-item Morisky Medication Adherence Scale. Item scores on the 26-item Medication Adherence Self-Efficacy Scale were summed to create a self-efficacy score. Analysis was restricted to those without low adherence or depressive symptoms at baseline (n=1478). Mediation of the relationship between incident depressive symptoms and incident low adherence between baseline and first follow-up by self-efficacy at first follow-up was assessed using Baron & Kenny’s procedures, modified to test for sex differences.
Results: The sample was 58% female and 28% black, with a mean age of 75.2 years. The incidence of depressive symptoms and low adherence were 7.7% and 7.2%, respectively. The indirect effect (IE) – the portion of the effect of incident depressive symptoms on incident low adherence that is explained by self-efficacy - was significant for women (IE=0.029 95% CI 0.005, 0.068), such that 34.1% of the total effect of incident depressive symptoms on incident low adherence was explained by self-efficacy. The IE for women was significantly different from that for men (IE=-0.003 95% CI -0.019, 0.006). The direct effect of incident depressive symptoms on incident low adherence – the portion of the effect that is not explained by self-efficacy – was significantly different for women and men (direct effect (DE)=0.056 95% CI -0.082, 0.155 and DE=0.205 95% CI 0.060, 0.323, respectively).
Conclusions: Self-efficacy explains some of the relationship between incident depressive symptoms and incident low adherence for women, but not for men.
Author Disclosures: E. Peacock: None. L. Williams: None. P. Muntner: None. D. Morisky: None. M. Krousel-Wood: None.
- © 2017 by American Heart Association, Inc.