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Direction of Association Between Depressive Symptoms and Lifestyle Behaviors in Patients with Coronary Heart Disease: the Heart and Soul Study

  • Original Article
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Annals of Behavioral Medicine

Abstract

Background

Emerging evidence indicates that the association between depression and subsequent cardiovascular events is largely mediated by health behaviors. However, it is unclear whether depression is the cause or the consequence of poor health behaviors.

Purpose

The purpose of the present study is to examine prospective, bidirectional relationships of depressive symptoms with behavioral and lifestyle factors among patients with coronary heart disease.

Methods

Depressive symptoms and lifestyle behaviors (physical activity, medication adherence, body mass index, waist to hip ratio, sleep quality, and smoking status) were assessed at baseline and 5 years later among a prospective cohort of 667 patients with stable coronary heart disease.

Results

Greater depressive symptoms at baseline predicted poorer lifestyle behaviors 5 years later (less physical activity, lower medication adherence, higher body mass index, higher waist to hip ratio, worse sleep quality, and smoking). After adjustment for demographics, cardiac disease severity, comorbidity, and baseline lifestyle behaviors, depressive symptom severity remained predictive of subsequent worsening of physical activity (beta = −0.08; 95 % confidence interval (CI) = −0.16, −0.01; p = 0.03), medication adherence (beta = −0.16; 95 % CI = −0.24, −0.08; p < 0.001), and sleep quality (beta = −0.19; 95 % CI = −0.27, −0.11; p < 0.001). Baseline lifestyle behaviors also predicted 5-year change in depressive symptoms, although the associations were attenuated after adjustment for baseline depressive symptoms and covariates.

Conclusions

Among patients with coronary heart disease, depressive symptoms were linked to a range of lifestyle risk factors and predicted further declines in physical activity, medication adherence, and sleep quality.

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Funding

Nancy Sin was supported by T32AG000212 and F32AG048698 from the National Institute on Aging. The Heart and Soul Study was funded by the Department of Veteran Affairs (Epidemiology Merit Review Program), WA, DC; grant R01 HL-079235 from the National Heart, Lung, and Blood Institute, Bethesda, MD; the Robert Wood Johnson Foundation (Generalist Physician Faculty Scholars Program), Princeton, NJ; the American Federation for Aging Research (Paul Beeson Faculty Scholars in Aging Research Program), New York, NY; and the Ischemia Research and Education Foundation, South San Francisco, CA.

Author information

Authors and Affiliations

  1. Center for Healthy Aging, The Pennsylvania State University, 422 Biobehavioral Health Building, University Park, PA, 16802, USA

    Nancy L. Sin PhD

  2. Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA

    Nancy L. Sin PhD

  3. Tufts University School of Medicine, Boston, MA, USA

    Anupama D. Kumar BA

  4. Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Anil K. Gehi MD

  5. Department of Medicine, University of California, San Francisco, CA, USA

    Mary A. Whooley MD

  6. Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA

    Mary A. Whooley MD

  7. Veterans Affairs Medical Center, San Francisco, CA, USA

    Mary A. Whooley MD

Authors
  1. Nancy L. Sin PhD
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  2. Anupama D. Kumar BA
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  3. Anil K. Gehi MD
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  4. Mary A. Whooley MD
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Corresponding author

Correspondence to Nancy L. Sin PhD .

Ethics declarations

Authors’ Statement of Conflict of Interest and Adherence to Ethical Standards

Authors Nancy L. Sin, Anupama D. Kumar, Anil K. Gehi, and Mary A. Whooley declare that they have no conflict of interest. All procedures, including the informed consent process, were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Additional files

Below is the link to the electronic supplementary material.

Additional file 1: Table S1

Correlations between participant characteristics and lifestyle behaviors at baseline (N = 667) (DOC 44 kb)

Additional file 2: Table S2

Descriptive statistics for change in depressive symptoms and lifestyle behaviors (N = 667) (DOC 35 kb)

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Sin, N.L., Kumar, A.D., Gehi, A.K. et al. Direction of Association Between Depressive Symptoms and Lifestyle Behaviors in Patients with Coronary Heart Disease: the Heart and Soul Study. ann. behav. med. 50, 523–532 (2016). https://doi.org/10.1007/s12160-016-9777-9

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  • DOI: https://doi.org/10.1007/s12160-016-9777-9

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