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.

Open Access

This Article is Open Access