Journal of Behavioral Medicine

, Volume 39, Issue 3, pp 441–452 | Cite as

Effects of stress, health competence, and social support on depressive symptoms after cardiac hospitalization

  • Gabriela León-Pérez
  • Kenneth A. Wallston
  • Kathryn M. Goggins
  • Heidi M. Poppendeck
  • Sunil Kripalani
  • For the Vanderbilt Inpatient Cohort Study (VICS)


Little is known about the role of stress on the psychological well-being of patients after cardiac hospitalization or about factors that protect against or exacerbate the effects of stress. We use prospective data from 1542 patients to investigate the relationship between post-discharge stress and changes in depressive symptoms, and whether the level of prior depressive symptoms, health competence, and perceived social support moderate this relationship. Net of depressive symptoms in the 2 weeks prior to hospitalization, higher levels of post-discharge stress significantly increase depressive symptoms 30 days after discharge. The level of prior depressive symptoms moderates the effect of stress. On the other hand, perceived health competence and social support buffer the negative effects of post-discharge stress. Knowing which patients are particularly vulnerable to experiencing stress and a subsequent increase in depressive symptoms can help trigger interventions prior to discharge and possibly ameliorate the prevalence of depression.


Depressive symptoms Stress Health competence Social support Heart disease 



The authors acknowledge the following additional members of the Vanderbilt Inpatient Cohort Study research team who contributed to design or conduct the study: Susan P. Bell, MD, MSCI; Courtney Cawthon, MPH, NP; Catherine Couey; Katharine M. Donato, PhD; Olivia Dozier; Catherine Evans; Vanessa Fuentes; Frank E. Harrell, PhD; Blake Hendrickson; Cardella Leak, MPH; Daniel Lewis; Abby G. Meyers, MD; Samuel Nwosu, MS; Monika Rizk; Hannah Rosenberg; Russell L. Rothman, MD, MPP; Amanda S. Mixon, MD, MS, MSPH; Jonathan S. Schildcrout, PhD; John F. Schnelle, PhD; Eduard E. Vasilevskis, MD, MPH.


This study was funded by the National Heart, Lung, and Blood Institute (R01 HL109388) and in part by the National Center for Advancing Translational Sciences (2 UL1 TR000445-6). The content is solely the responsibility of the authors and does not necessarily represent official views of the National Institutes of Health.

Compliance with ethical standards

Conflict of interest

Gabriela León-Pérez, Kenneth A. Wallston, Kathryn M. Goggins, Heidi M. Poppendeck, and Sunil Kripalani declare that they have no conflict of interest.

Human and animal rights and informed consent

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all patients for being included in the study.


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Gabriela León-Pérez
    • 1
  • Kenneth A. Wallston
    • 2
  • Kathryn M. Goggins
    • 3
  • Heidi M. Poppendeck
    • 3
  • Sunil Kripalani
    • 4
  • For the Vanderbilt Inpatient Cohort Study (VICS)
  1. 1.Department of SociologyVanderbilt UniversityNashvilleUSA
  2. 2.School of NursingVanderbilt UniversityNashvilleUSA
  3. 3.Center for Health Services ResearchVanderbilt University Medical CenterNashvilleUSA
  4. 4.Department of Medicine, Center for Clinical Quality and Implementation ResearchVanderbilt University Medical CenterNashvilleUSA

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