title: Effect of smoking and sedentary behavior on the association between depressive symptoms and mortality from coronary heart disease.
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.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Durham, North Carolina 27710, USA. brummett@duke.edu
authors.forename: Beverly H
authors.initials: BH
authors.lastname: Brummett
authors.forename: Michael A
authors.initials: MA
authors.lastname: Babyak
authors.forename: Ilene C
authors.initials: IC
authors.lastname: Siegler
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Mark
authors.forename: Redford B
authors.initials: RB
authors.lastname: Williams
authors.forename: John C
authors.initials: JC
authors.lastname: Barefoot
mesh_terms: D017677:Age Distribution; D000367:Age Factors; D003327:Coronary Disease / Q000209:etiology* / Q000401:mortality* / Q000517:prevention & control; D003863:Depression / Q000145:classification / Q000150:complications* / Q000175:diagnosis / Q000517:prevention & control; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects*; D011795:Surveys and Questionnaires; D016019:Survival Analysis