Depressed Mood, Perceived Health Competence and Health Behaviors: aCross-Sectional Mediation Study in Outpatients with Coronary Heart Disease

BACKGROUND: 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. OBJECTIVE: Examine whether or not perceived health competence mediates the relationship between depressed mood and worse health behaviors. DESIGN: 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. PARTICIPANTS: Patients with coronary heart disease (n=2334). MAIN MEASURES: 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. KEY RESULTS: 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-M=0.26, 95% CI: 0.18 to 0.39). CONCLUSIONS: 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.