title: Baseline Depressive Symptoms, Completion of Study Assessments, and Behavior Change in a Long-Term Dietary Intervention Among Breast Cancer Survivors.
abstract: BACKGROUND
  Depressive symptoms can lower adherence and change in dietary studies. Behavioral activation may reduce these effects.
  
  
  OBJECTIVE
  This study aims to assess relationships among depressive symptoms on adherence and dietary change in the Women's Healthy Eating and Living (WHEL) Study
  
  
  METHODS
  Secondary analyses from the WHEL Study, which achieved major dietary change in breast cancer survivors (N = 2817), were conducted. Logistic regressions were undertaken of baseline depressive symptoms (six-item Center for Epidemiologic Studies Depression Scale (CES-D)) with (1) completion of 1- and 4-year study assessments and (2) validated change in dietary behavior in the intervention group.
  
  
  RESULTS
  In the comparison group (vs. intervention), depressive symptoms lowered completion of dietary recalls and clinic visits [4 years: odds ratio (OR) = 2.0; 95 % confidence interval (CI) = 1.4-3.0]. The behaviorally oriented intervention achieved major change in those furthest from study targets, although changes were lower in those with depressive symptoms: fruit/vegetable (+37.2 %), fiber (+49.0 %), and fat (-22.4 %).
  
  
  CONCLUSIONS
  Behavioral activation in dietary change interventions can overcome the impact of depressive symptoms.
authors.affiliation: University of California, San Diego, 530 Parnassus Avenue, Library Room 366, San Francisco, CA,, 94143, USA.
authors.forename: Julie B
authors.initials: JB
authors.lastname: Wang
authors.affiliation: University of California, San Diego, Family Medicine and Public Health, 9500 Gilman Drive, MC 0901, La Jolla, 92093-0901, CA, USA. jppierce@ucsd.edu.|University of California, San Diego, Moores Cancer Center 3855 Health Sciences Drive, MC 0901, La Jolla, CA,, 92093-0901, USA. jppierce@ucsd.edu.
authors.forename: John P
authors.initials: JP
authors.lastname: Pierce
authors.affiliation: San Diego State University, Graduate School of Public Health, 5500 Campanile, MC 4124, San Diego, CA, 92182-4124, USA.|San Diego State University, Institute for Behavioral And Community Health, 9245 Sky Park Court, Ste. 221, San Diego, CA 92123-4311, USA.
authors.forename: Guadalupe X
authors.initials: GX
authors.lastname: Ayala
authors.affiliation: University of Wisconsin - Madison, Department of Kinesiology, 2000 Observatory Drive, Madison, WI, 53706, USA.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Cadmus-Bertram
authors.affiliation: University of California, San Diego, Moores Cancer Center 3855 Health Sciences Drive, MC 0901, La Jolla, CA,, 92093-0901, USA.
authors.forename: Shirley W
authors.initials: SW
authors.lastname: Flatt
authors.affiliation: San Diego State University, Institute for Behavioral And Community Health, 9245 Sky Park Court, Ste. 221, San Diego, CA 92123-4311, USA.|San Diego State University, Graduate School of Public Health, 5500 Campanile MC 4162, San Diego, CA, 92182-4162, USA.
authors.forename: Hala
authors.initials: H
authors.lastname: Madanat
authors.affiliation: University of California, San Diego, Moores Cancer Center 3855 Health Sciences Drive, MC 0901, La Jolla, CA,, 92093-0901, USA.
authors.forename: Vicky A
authors.initials: VA
authors.lastname: Newman
authors.affiliation: San Diego State University, Institute for Behavioral And Community Health, 9500 Gilman Drive, MC 0811, La Jolla, CA, 92093-0811, USA.
authors.forename: Jeanne F
authors.initials: JF
authors.lastname: Nichols
authors.affiliation: University of California, San Diego, Family Medicine and Public Health, 9500 Gilman Drive, MC 0901, La Jolla, 92093-0901, CA, USA.|University of California, San Diego, Moores Cancer Center 3855 Health Sciences Drive, MC 0901, La Jolla, CA,, 92093-0901, USA.
authors.forename: Loki
authors.initials: L
authors.lastname: Natarajan
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D004032:Diet / Q000523:psychology*; D004043:Dietary Fiber; D005247:Feeding Behavior / Q000523:psychology; D005260:Female; D005638:Fruit; D015438:Health Behavior; D006801:Humans; D008875:Middle Aged; D017741:Survivors / Q000523:psychology*; D014675:Vegetables
keywords: Adherence; Behavioral activation; Depressive symptoms; Dietary change