Self-Efficacy Mediates the Relationship Between Depressive Symptoms and Medication Adherence Among Hypertensive African Americans
Abstract
Many studies have documented the negative effects of depression on adherence to recommended treatment; however, little is known about the mechanism underlying this relationship. Using the Kenny and Baron analytic framework of mediation, the authors assessed whether self-efficacy mediated the relationship between depression and medication adherence in 167 hypertensive African Americans followed in a primary care practice. Depressive symptoms are associated with poor medication adherence (β = .013, p = .036) and low self-efficacy (β = —.008, p = .023). Self-efficacy is negatively associated with medication adherence at follow-up (β = —.612, p < .001). The relationship between depressive symptoms and medication adherence becomes nonsignificant when controlling for self-efficacy (β = .010, p = .087). Implications for further examination into the mediating role of self-efficacy and the deleterious effect of depression on medication adherence are discussed.
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Greater self-efficacy may protect against depression, which is a common side effect of interferon-based therapy.
“Moreover, higher levels of self-efficacy can buffer against the effects of depression, which is a major adverse side effect of interferon-based therapies (13;14;34).”
From Reliability and validity of a self‐efficacy instrument for hepatitis C antiviral treatment regimens (2012) · cites this paper as [34]
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“19,20 We have limited understanding of self-efficacy when nonadherence of medication is separated into intentional and unintentional.”
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“that have explored racial differences with regards to medication adherence have been inconsistent, with some findings suggesting that the independent effect of depression on adherence may be higher in whites than in other ethnic groups,(46) and other studies indicating no racial differences on the impact of depression…”
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“Empirical evidence supports this assertion in other populations where self-efficacy has been found to mediate the relationship between social support and depression with adherence in adults with diabetes (Sacco et al., 2005) and hypertension (Schoenthaler et al., 2009).”
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“…Health Questionnaire (PHQ-8; Kroenke et al., 2009) as a covariate because depression has been associated with negative assessments of individual capabilities and self-efficacy in patients with diabetes (Schoenthaler et al., 2009), as well as with treatment nonadherence (Gonzalez et al., 2008).”
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ResultAntidepressant medication can improve hypertension in elderly patients with depression
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“(9) In our previous work, we have also shown that Black hypertensive patients with depressive symptoms were less likely to adhere to their medications because of low selfefficacy.(10) Accordingly, path b depicts the direct negative effect of depressive symptoms on medication adherence, whereas path c represents the in…”
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“Consistent with this study results, a study conducted on African Americans revealed that lower educational attainment was an independent predictor of medication non-adherence among patients with hypertension.(33) Another study reported that educational level significantly affected medication adherence in African Ameri…”
ResultRelationships between determinants of adjuvant endocrine therapy adherence in breast cancer
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“Depression is also known as a mediator for medication adherence in diabetic and hypertensive patients (25, 26).”
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“For example, in a study of adherence to antihypertensive medication in African Americans, depressive symptoms were associated with poor medication adherence and low self-efficacy (Schoenthaler et al., 2007) but this relationship became non-significant when controlling for self-efficacy.”
Self-efficacy for managing hypertension and comorbid conditions
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- Authors
- Schoenthaler, A., Ogedegbe, G., & Allegrante, J. P.
- Affiliations
- Columbia University (US)
- Venue
- Health Education & Behavior
- Publisher
- SAGE Publications
- Published
- 2006-11-27
- Volume
- 36
- Issue
- 1
- Pages
- 127-137
- ISSN
- 1090-1981 (ISSN-L)
- 1552-6127
- OpenAlex
- W1995969486
- Cited by
- 139
- References
- 39
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 13 · 2023: 3 · 2022: 6 · 2021: 4 · 2020: 10 · 2019: 5 · 2018: 8 · 2017: 7 · 2016: 11 · 2015: 12 · 2014: 16 · 2013: 6 · 2012: 10
- FWCI
- 0.89
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health Education & Behavior (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Public Health Service (F31 081926-01)
- National Heart, Lung, and Blood Institute (R24HL076857, R01HL069408)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- self-efficacy, depressive symptoms, medication adherence, hypertension, African Americans, mediation, primary care
- MeSH terms
- Analysis of Variance, Antihypertensive Agents, Black or African American, Depression, Female, Humans, Hypertension, Male, Middle Aged, Comorbidity, Self Efficacy, Medication Adherence
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