Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA.
Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA.
J Gen Intern Med. 2019 Jul;34(7):1123-1130. doi: 10.1007/s11606-018-4767-1. Epub 2018 Dec 18.
Identifying potential mechanisms that link depressed mood with worse health behaviors is important given the prevalence of depressed mood in patients with coronary heart disease (CHD) and its relationship with subsequent mortality. Perceived health competence is an individual's confidence in his/her ability to successfully engineer solutions to achieve health goals and may explain how depressed mood affects multiple health behaviors.
Examine whether or not perceived health competence mediates the relationship between depressed mood and worse health behaviors.
A cross-sectional study conducted by the Patient-Centered Outcomes Research Institute-funded Mid-South Clinical Data Research Network between August 2014 and September 2015. Bootstrapped mediation was used.
Patients with coronary heart disease (n = 2334).
Two items assessing perceived health competence, a single item assessing depressed mood, and a Health Behaviors Index including: the International Physical Activity Questionnaire (IPAQ); select items from the National Adult Tobacco Survey and the Alcohol Use Disorder Inventory Test; and single items assessing diet and medication adherence.
Depressed mood was associated with lower perceived health competence (a = - 0.21, p < .001) and lower perceived health competence was associated with worse performance on a Health Behaviors Index(b = 0.18, p < .001). Perceived health competence mediated the influence of depressed mood on health behaviors (ab = - 0.04, 95% CI = - 0.05 to - 0.03). The ratio of the indirect effect to the total effect was used as a measure of effect size (P = 0.26, 95% CI: 0.18 to 0.39).
Depressed mood is associated with worse health behaviors directly and indirectly via lower perceived health competence. Interventions to increase perceived health competence may lessen the deleterious impact of depressed mood on health behaviors and cardiovascular outcomes.
鉴于冠心病（CHD）患者中抑郁情绪的普遍性及其与随后死亡率的关系，确定将抑郁情绪与更差的健康行为联系起来的潜在机制非常重要。感知健康能力是个体对自己成功设计解决方案以实现健康目标的能力的信心，并且可以解释抑郁情绪如何影响多种健康行为。
检验感知健康能力是否在抑郁情绪与更差的健康行为之间起中介作用。
这是一项由患者为中心的成果研究机构资助的中南部临床数据研究网络于 2014 年 8 月至 2015 年 9 月之间进行的横断面研究。采用了 bootstrap 中介分析。
冠心病患者（n=2334）。
两项评估感知健康能力的项目，一项评估抑郁情绪的项目，以及一项健康行为指数，包括：国际体力活动问卷（IPAQ）；国家成人烟草调查和酒精使用障碍测试的精选项目；以及评估饮食和药物依从性的单项项目。
抑郁情绪与较低的感知健康能力相关（a=−0.21，p<0.001），而较低的感知健康能力与健康行为指数的表现更差相关（b=0.18，p<0.001）。感知健康能力在抑郁情绪对健康行为的影响中起中介作用（ab=−0.04，95%置信区间=−0.05 至−0.03）。间接效应与总效应的比值用作效应量的度量（P=0.26，95%置信区间：0.18 至 0.39）。
抑郁情绪与更差的健康行为直接相关，通过感知健康能力的降低间接相关。增加感知健康能力的干预措施可能会减轻抑郁情绪对健康行为和心血管结局的不利影响。
