Effect of smoking and sedentary behavior on the association between depressive symptoms and mortality from coronary heart disease

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Abstract

It has been suggested that one of the mechanisms linking depression with elevated mortality risk is the association between depressive symptoms and other established coronary artery disease (CAD) risk factors, such as smoking and failure to exercise. The present study examined this hypothesis using repeated assessments of smoking and exercise from patients with CAD in whom depressive symptoms had been shown to predict decreased survival. Initially, associations between depressive symptoms and the risk factors of smoking and sedentary behavior were assessed. Next, patterns of smoking and sedentary behavior were examined as mediators and/or moderators of the association between depressive symptoms and mortality. Depressive symptoms were positively related to smoking (p <0.01) and sedentary behavior (p <0.01). Depressive symptoms, smoking, and sedentary behavior were independent predictors of mortality. Results indicated that smoking and/or sedentary behavior may partially mediate the relation between depressive symptoms and mortality. No evidence for moderation was found.

Section snippets

Patient population

Patients admitted to Duke University Medical Center for diagnostic coronary angiography between October 1974 and February 1980 were asked to participate in a study of the associations between psychosocial constructs and CAD. The study was approved by the institutional review committee at Duke. Those who consented were enrolled if they were medically stable, admitted for their first cardiac catheterization, able to read at least at a sixth grade level, and found to have significant CAD (≥75%

Associations among depressive symptoms, smoking, exercise, and mortality

Survival among those who did and did not have depression data at baseline did not differ after control for illness severity and treatment status. The ordinal logit model showed that higher depressive symptom scores at baseline were associated with increased likelihood of a high-risk pattern of behavior for smoking, with a difference of 2 SDs associated with an odds ratio of 1.42 (p <0.01). Similarly, baseline depressive symptoms were positively associated with a pattern of sedentary behavior

Discussion

Although extensive research has documented the association between depression and mortality in patients with CAD, the mechanisms underlying this association are not well understood.

The present findings suggest that smoking and sedentary behavior may partially account for the relation between depressive symptoms and mortality; however, the extent of this mediation was modest. Moreover, the present findings are strengthened by the fact that they included follow-up assessments of smoking and

References (25)

  • J.C. Barefoot et al.

    Depression and long-term mortality risk in patients with coronary artery disease

    Am J Cardiol

    (1996)
  • J.C. Barefoot et al.

    Type A behavior and survivala follow up study of 1,467 patients with coronary artery disease

    Am J Cardiol

    (1989)
  • G.E. Miller et al.

    Clinical depression and inflammatory risk markers for coronary heart disease

    Am J Cardiol

    (2002)
  • R.F. Anda et al.

    Depression and the dynamics of smoking. A national perspective

    JAMA

    (1990)
  • D. Kritz-Silverstein et al.

    Cross-sectional and prospective study of exercise and depressed mood in the elderlythe Rancho Bernardo study

    Am J Epidemiol

    (2001)
  • K. Wilson et al.

    Effect of smoking cessation on mortality after myocardial infarctionmeta-analysis of cohort studies

    Arch Int Med

    (2000)
  • Oldridge NB, Guyatt GH, Fischer ME, Rimm AA. Cardiac rehabilitation after myocardial infarction. Combined experience of...
  • R.M. Carney et al.

    Depression as a risk factor for cardiac events in established coronary heart diseasea review of possible mechanisms

    Ann Behav Med

    (1995)
  • J.C. Barefoot et al.

    Depressive symptoms and survival of patients with coronary artery disease

    Psychosom Med

    (2000)
  • Barefoot JB, Helms MJ, Mark DB, Siegler IC, Williams RB. Research Participation as a Predictor of Survival in Cardiac...
  • W. Zung

    A self-rating depression scale

    Arch Gen Psychiatry

    (1965)
  • W. Zung

    Zung Self-rating depression scale, and depression status inventory

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    This research was supported in part by Grants P01-HL36587, R01-HL55356, and R01-HL54780 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland.

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