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Depression and self-reported physical health in patients with coronary disease: mediating and moderating factors
M D Sullivan1, A Z LaCroix, J E Russo
1Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle 98195, USA. sullimar@u.washington.edu
Insights
Depression significantly impacts physical health in coronary disease patients. This effect is mediated by physical symptoms, psychological traits like positive affect, and spousal support, highlighting multifaceted influences on perceived health.
Area of Science:
- Cardiology
- Psychology
- Health Services Research
Background:
- Depression is a known comorbidity in patients with coronary heart disease (CHD).
- The interplay between depression and self-reported physical health in CHD patients is complex and influenced by various factors.
Purpose of the Study:
- To investigate how patient-centered factors modify the relationship between depression and self-reported physical health in individuals with coronary disease.
- To identify specific mediators influencing perceived physical health in this population.
Main Methods:
- Prospective cohort study involving 111 patients with angiographically confirmed coronary disease.
- Utilized multiple hierarchical regression models to analyze data collected over 5 years.
- Examined the influence of physical symptoms, psychological states/traits, and spousal support on the depression-physical health relationship.
Main Results:
- Depression remained a significant predictor of physical health across all models.
- Physical symptoms (angina, fatigue), psychological factors (positive affect, novelty seeking), and spousal support substantially mediated the effect of depression.
- The overall model, including these factors, explained 65% of the variance in physical health.
Conclusions:
- Physical symptoms, personality traits, and social support significantly mediate the impact of depression on self-reported physical health in coronary disease patients.
- Positive affect and novelty seeking demonstrated a more pronounced effect on physical health when depression levels were higher.
- Perceived physical health in CHD patients is influenced by a wide array of factors beyond the disease's objective severity.
Objectives:
The purpose of this study was to define how the relation between depression and self-reported physical health in patients with coronary disease is modified by other patient-centered factors.
Methods:
We conducted a prospective cohort study of 111 patients (members of a health maintenance organization) with angiographically documented coronary disease, examining factors (physical symptoms, psychological states and traits, and spousal support) modifying the relation between depression and patient-reported physical health 5 years later using multiple hierarchical regression models.
Results:
Five regression models (all including demographic and disease severity covariates) were constructed to predict physical health from depression only (R2 = 0.22); depression plus angina and fatigue (R2 = 0.53); depression plus positive affect and novelty seeking and their interaction (R2 = 0.48); depression plus spousal support (R2 = 0.27); and depression, angina, fatigue, positive affect, and novelty seeking (overall model) (R2 = 0.65). Depression remained significant in each model, but the proportion of variance it predicted was diminished in the presence of the other variables (bivariate r = 0.39, partial r = 0.37-0.13).
Conclusions:
The effect of depression on self-reported physical health is significantly mediated by physical symptoms (angina and fatigue), personality states and traits (positive affect and novelty seeking), and spousal support. Positive affect and novelty seeking had more marked effects on physical health in the presence of more depression. Thus, a broad range of factors beyond the severity of coronary disease itself affect the perceived physical health of patients with coronary heart disease.