Lifestyle changes are related to reductions in depression in persons with elevated coronary risk factors

Abstract

This observational study investigates whether persons with elevated coronary risk factors (CRFs >3 and/or diabetes) and depression [i.e., ≥16 on the Center for Epidemiological Scale – Depression (CES-D)] can make changes in health behaviours over 3 months and improve depressive symptoms and other CRFs. Analyses were based on data from 310 men and 687 women enrolled in the high-risk arm of the Multisite Cardiac Lifestyle Intervention Program, targeting diet (10% fat), exercise (3 h per week) and stress management (7 h per week). As expected, at study entry, depressed persons had a more adverse medical status, consumed more dietary fat and practiced less stress management than non-depressed persons. To examine 3-month changes, participants were grouped into (1) depressed persons who became non-depressed (CES-D ≤ 16, n = 248; 73%), (2) persons who remained or became depressed (CES-D >16, n = 76) and (3) non-depressed persons who remained non-depressed (n = 597). All persons, regardless of group, met program goals. The greatest improvements (i.e., diet, exercise, perceived stress, hostility and mental health) were observed in Group 1 relative to Groups 2 and 3, which did not differ from each other. Comprehensive lifestyle changes appear to be feasible and beneficial for initially depressed persons with elevated CRFs.

Keywords:

• elevated coronary risk factors
• depressive symptoms
• lifestyle changes

Acknowledgements

Preparation of this article was supported, in part, by a grant from the Department of the Army (US Army Medical Research Acquisition Activity W81XWH-06-1-0565) and does not reflect the position or the policy of the government; the German Academic Exchange Service (DAAD); the Alexander von Humboldt Foundation; Highmark, Inc.; Random House; the Kerzner Foundation; the Resnick Foundation and the Gallin Foundation. Special appreciation is expressed to Ralf Schwarzer, Joanne Frattaroli, Loren Yglecias and Daniel Purnell for their helpful comments. We also thank the patients for their participation in the study, and gratefully acknowledge staff from the following program sites and participating health insurance companies (indicated by asterisks; Highmark, Inc. was also a program site) for their contributions to the MCLIP: Alegent Health, Omaha NE; Allegheny General Hospital, Pittsburgh, PA; Charleston Area Medical Center, Inc., Charleston, WV; Dubois Regional Hospital, Dubois, PA; Good Samaritan Health System, Kearny, NE; Hamot Medical Center, Hamot, PA; *Highmark, Inc., Pittsburgh, PA; Jameson Health System, New Castle, PA; Lehigh Valley Hospital, Lehigh, PA; Monongahela Valley Hospital, Monongahela, PA; *Mountain State Blue Cross Blue Shield, Charleston, WV; Ohio Valley Medical Center, Wheeling, WV; *Public Employee Insurance Agency of West Virginia, Charleston, WV; Princeton Community Hospital Association, Inc., Princeton, WV; St. Joseph's Hospital/Camden Clark Memorial Hospital, Parkersburg, WV; St. Mary's Hospital, Huntington, WV; Swedish American Health System, Rockford, IL; United Hospital Center, Clarksburg, WV; The Wellness Center at City Hospital, Martinsburg, WV; West Virginia University Hospitals, Inc., Morgantown, WV; Westmoreland Regional Hospital, part of Excela Health, Greensburg, PA; Wheeling Hospital, Wheeling, WV and Windber Medical Center, Windber, PA.