Date of Award

January 2014

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Becca Levy


Objectives: This study prospectively followed a cohort of 349 individuals recovering from an acute myocardial infarction (AMI) to investigate the relationship between their perceived stress and their adherence to medical discharge instructions.

Background: Experiencing a heart attack is stressful, and stress post-MI leads to poor outcomes. Worse adherence to discharge instructions can be a pathway, but no prior research has investigated the impact of perceived stress on AMI patients' ability to comply with discharge instructions.

Methods: We assessed adherence to hospital discharge instructions over 12 months among 349 individuals who were hospitalized with AMIs. Linear mixed-effects regression model was used with adjustment for demographic and clinical factors.

Results: Patients with higher perceived stress had significantly lower adherence to discharge instructions (β= -1.957, p<0.001) after adjusting for sociodemographic factors, clinical presentation, and health status. This relationship did not vary over time, but was stronger for females and participants with lower education level.

Conclusions: These findings suggest that clinicians could adopt perceived stress as a tool to identify and target potentially noncompliant patients who are at risk of poor health outcomes after AMI.


This is an Open Access Thesis.