Background: Estimates indicate 20-70% of renal transplant recipients (RTR) are medication non-adherent, significantly increasing the risk of organ rejection. Medication adherence decreases in relation to everyday problem solving (EPS), and associations between depressive symptoms, self-efficacy (SE), and adherence are reported in RTR. Nonetheless, to date, these individual associations have not been examined concurrently and comprehensively. To increase our understanding of adherence in RTR, we computed an omnibus model examining relationships among neurocognitive abilities, depressive symptoms, SE, and medication adherence. Methods: RTR (N= 211) underwent transplant at least 6-months prior to participation. Adherence was measured via self-report, medication possession ratio, and immunosuppressant blood-level. Traditionally-measured neurocognitive and everyday problem-solving abilities were assessed. Depressed and positive affect, somatic, and interpersonal symptoms of depression were measured via self-report, as were general and medication adherence related SE. Structural equation modeling was used to assess the fit of the model to available data. Results: For our final model, the fit indices examined indicated a good fit between the model and the data (CFI =.97; SRMR =.072; RMSEA =.031). EPS and SE had direct positive effects on adherence. Depressive symptoms were negatively associated with SE. Traditionally-measured neurocognitive abilities were positively associated with SE, and negatively associated with depressive symptoms. Conclusions: This study presents a comprehensive investigation of relationships between neurocognitive and psychosocial factors and adherence in RTR. Findings confirm the importance of EPS and SE in predicting adherence within a causal model, and suggest that influences of depressive symptoms and neurocognitive abilities are indirect. Findings have important implications for future development of interventions to improve medication adherence in RTR
