Adverse Childhood Experiences, Depression, Patient Activation, and Medication Adherence Among Patients With Uncontrolled Hypertension

Carmen Alvarez; Nancy Perrin; Kathryn A Carson; Jill A Marsteller; Lisa A Cooper; RICH LIFE Project Investigators

doi:10.1093/ajh/hpac123

Adverse Childhood Experiences, Depression, Patient Activation, and Medication Adherence Among Patients With Uncontrolled Hypertension

Am J Hypertens. 2023 Mar 15;36(4):209-216. doi: 10.1093/ajh/hpac123.

Authors

Carmen Alvarez^{1

2}, Nancy Perrin³, Kathryn A Carson^{2

4

5}, Jill A Marsteller^{2

6}, Lisa A Cooper^{1

2

3

5

6

7}; RICH LIFE Project Investigators

Affiliations

¹ Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.
² Johns Hopkins Center for Health Equity, Baltimore, Maryland, USA.
³ Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.
⁴ Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, USA.
⁵ Johns Hopkins University School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, Maryland, USA.
⁶ Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, Maryland, USA.
⁷ Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, Maryland, USA.

Abstract

Background: Identifying potential pathways through which adverse childhood experiences (ACEs) impact health and health behavior remains important, given ACE survivors' increased risk for cardiovascular disease and poor cardiovascular health behaviors. This study examines whether modifiable variables-depression and patient activation-explain the relationship between ACEs and medication adherence.

Methods: Using baseline data from a pragmatic trial designed to decrease disparities in hypertension control, we conducted regression analyses to examine whether depression and patient activation mediated the association between ACEs and medication adherence. Data were collected between August 2017 and October 2019 (n = 1,818).

Results: Participants were predominantly female (59.4%) and Black or African American (57%) with uncontrolled blood pressure (mean-152.3/85.5 mm Hg). Most participants reported experiencing at least 1 ACE (71%) and approximately 50% reported being adherent to their blood pressure medication. A significant indirect effect between ACEs and medication adherence was found for depression symptoms (Sobel's test z = -5.46, P < 0.001). Patient activation was not a mediator in these relationships.

Conclusions: Experiencing more depression symptoms significantly accounted for the association between ACEs and medication adherence in a diverse sample of adults with uncontrolled blood pressure. Addressing depression symptoms, which may result from experiences with ACEs and other current stressors, could translate to better medication adherence and, potentially, better blood pressure control among this high-risk group. Given the serious lifetime health implications of ACEs, continued efforts are needed for primary prevention of childhood adversities.

Trial registration: ClinicalTrials.gov NCT02674464.

Keywords: adverse childhood experiences; blood pressure; depression; hypertension; patient activation.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Adverse Childhood Experiences*
Black or African American
Blood Pressure
Depression / diagnosis
Depression / epidemiology
Female
Humans
Hypertension* / diagnosis
Hypertension* / drug therapy
Hypertension* / epidemiology
Male

Associated data

ClinicalTrials.gov/NCT02674464

Grants and funding

K23 MD014176/MD/NIMHD NIH HHS/United States