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Editor's Correspondence
April 13, 1998

Depression, Adherence Behavior, and Coronary Disease Outcomes

Author Affiliations

Copyright 1998 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1998

Arch Intern Med. 1998;158(7):808-809. doi:

The review by McDermott et al1 of studies linking adherence behavior to coronary heart disease outcomes is interesting and provocative. The authors review findings indicating that adherence to placebo is also related to reduced morbidity and mortality and therefore suggest that adherence behavior per se is important in coronary heart disease outcomes. While we agree with the possibility suggested by the authors that "adherence is a marker of some unidentified health care behavior that is itself linked to prognosis," we would like to also propose an alternative explanation that nonadherence is a marker of psychological factors that adversely affect outcome in patients with coronary heart disease, like depression and psychological distress.2,3