title: History of major depression as a barrier to health behavior changes after a chronic disease diagnosis.
abstract: To examine whether changes in smoking, drinking, and physical activity after a chronic disease diagnosis differ between middle-aged and older adults with and without a history of major depression.
  
  
  
  Individual-level data came from 1996 to 2010 waves of the U.S. Health and Retirement Study. Chronic disease diagnosis was ascertained from self-reports of physician diagnosed diseases. Major depression was assessed by the short-form Composite International Diagnostic Interview. Mixed-effects logistic regressions were performed to estimate the potential moderating effect of a history of major depression.
  
  
  
  Baseline major depression was associated with a more than 3-fold increase (OR=4.48, 95% CI=2.27-8.86) in the odds of smoking and 37% decrease (OR=0.63, 95% CI=0.52-0.75) in the odds of staying physically active, but not with odds of excessive drinking. After a chronic disease diagnosis, the odds of smoking was reduced by 75% (OR=0.25, 95% CI=0.20-0.32), the odds of excessive drinking was reduced by 47% (OR=0.53, 95% CI=0.47-0.61), and the odds of staying physically active was reduced by 30% (OR=0.70, 95% CI=0.63-0.78). There was a significant interaction effect for smoking such that the decline in the odds of smoking was smaller among adults with a history of major depression.
  
  
  
  Chronic disease diagnosis may be an important teachable moment for health behavior change, but the behavior changing effect may be smaller for those with a history of major depression especially when it comes to smoking.
authors.affiliation: Center for Education in Health Sciences, Feinberg School of Medicine, Northwestern University, 633 North St. Clair, 20th floor, Chicago, IL 60611, United States. Electronic address: xiaoling.xiang@northwestern.edu.
authors.forename: Xiaoling
authors.initials: X
authors.lastname: Xiang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000523:psychology*; D016022:Case-Control Studies; D002908:Chronic Disease / Q000523:psychology*; D003865:Major Depressive Disorder / Q000523:psychology*; D015444:Exercise / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D057566:Self Report; D012907:Smoking / Q000523:psychology*
keywords: Health and retirement study; Health behavior; Major depression; Older adults; Teachable moment