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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)
Article

Abstract

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.

Keywords

Depressive symptoms Stress Health competence Social support Heart disease 

Notes

Acknowledgments

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.

Funding

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.

References

  1. Aiken, L. S., & West, S. G. (1991). Multiple regression: Testing and interpreting interactions. Newbury Park, CA: Sage.Google Scholar
  2. Aneshensel, C. S. (1992). Social stress: Theory and research. Annual Review of Sociology, 18, 15–38.CrossRefGoogle Scholar
  3. Arnold, R., Ranchor, A. V., Koëter, G. H., de Jongste, M. J. L., & Sanderman, R. (2005). Consequences of chronic obstructive pulmonary disease and chronic heart failure: The relationship between objective and subjective health. Social Science and Medicine, 61, 2144–2154.CrossRefPubMedGoogle Scholar
  4. Arora, N. K., Johnson, P., Gustafson, D. H., McTavish, F., Hawkins, R. P., & Pingree, S. (2002). Barriers to information access, perceived health competence, and psychosocial health outcomes: Test of a mediation model in a breast cancer sample. Patient Education and Counseling, 47, 37–46.CrossRefPubMedGoogle Scholar
  5. Bane, C., Hughes, C. M., & McElnay, J. C. (2006). The impact of depressive symptoms and psychosocial factors on medication adherence in cardiovascular disease. Patient Education and Counseling, 60, 187–193.CrossRefPubMedGoogle Scholar
  6. Barker, C., Pistrang, N., & Elliott, R. (2002). Research methods in clinical psychology: An introduction for students and practitioners (2nd ed.). Chichester, UK: Wiley.CrossRefGoogle Scholar
  7. Bekke-Hansen, S., Pedersen, C., Thygesen, K., Christensen, S., Waelde, L., & Zachariae, R. (2014). The role of religious faith, spirituality and existential considerations among heart patients in a secular society: Relation to depressive symptoms 6 months past acute coronary syndrome. British Journal of Health Psychology, 19, 740–753.CrossRefGoogle Scholar
  8. Bellizzi, K. M., Rowland, J. H., Arora, N. K., Hamilton, A. S., Miller, M. F., & Aziz, N. M. (2009). Physical activity and quality of life in adult survivors of non-Hodgkin’s lymphoma. Journal of Clinical Oncology, 27, 960–966.CrossRefPubMedPubMedCentralGoogle Scholar
  9. Boyle, M. (2011). Identifying core behavioral and psychosocial data elements for the electronic health record: Executive summary. Retrieved from http://www.sbm.org/UserFiles/file/EHR_Meeting_May_2-3-2011–Executive_Summary.pdf
  10. Bremmer, M. A., Hoogendijk, W. J., Deeg, D. J., Schoevers, R. A., Schalk, B. W., & Beekman, A. T. (2006). Depression in older age is a risk factor for first ischemic cardiac events. American Journal of Geriatric Psychiatry, 14, 523–530.CrossRefPubMedGoogle Scholar
  11. Caspi, A., Sugden, K., Moffitt, T. E., Taylor, A., Craig, I. W., Harrington, H., & Poulton, R. (2003). Influence of life stress on depression: Moderation by a polymorphism in the 5-HTT gene. Science, 301, 386–389.CrossRefPubMedGoogle Scholar
  12. Cassel, J. (1976). The contribution of the social environment to host resistance. American Journal of Epidemiology, 104, 107–123.PubMedGoogle Scholar
  13. Chung, M. L., Moser, D. K., Lennie, T., & Frazier, S. K. (2013). Perceived social support predicted quality of life in patients with heart failure, but the effect is mediated by depressive symptoms. Quality of Life Research, 22, 1555–1563.CrossRefPubMedPubMedCentralGoogle Scholar
  14. Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385–396.CrossRefPubMedGoogle Scholar
  15. Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98, 310–357.CrossRefPubMedGoogle Scholar
  16. Donovan, K. A., Grassi, L., McGinty, H. L., & Jacobsen, P. B. (2014). Validation of the distress thermometer worldwide: State of the science. Psycho-Oncology, 23, 241–250.CrossRefPubMedGoogle Scholar
  17. Folkman, S., Lazarus, R. S., Dunkel-Schetter, C., DeLongis, A., & Gruen, R. J. (1986). Dynamics of stressful encounter: Cognitive appraisal, coping, and encounter outcomes. Journal of Personality and Social Psychology, 50, 992–1003.CrossRefPubMedGoogle Scholar
  18. Frasure-Smith, N., Lesperance, F., Gravel, G., Masson, A., Juneau, M., Talajic, M., & Bourassa, M. G. (2000). Social support, depression, and mortality during the first year after myocardial infarction. Circulation, 101, 1919–1924.CrossRefPubMedGoogle Scholar
  19. Friedmann, E., Son, H., Thomas, S. A., Chapa, D. W., & Lee, H. J. (2014). Poor social support is associated with increases in depression but not anxiety over 2 years in heart failure outpatients. Journal of Cardiovascular Nursing, 29, 20–28.CrossRefPubMedGoogle Scholar
  20. Graven, L. J., & Grant, J. (2013). The impact of social support on depressive symptoms in individuals with heart failure: Update and review. Journal of Cardiovascular Nursing, 28, 429–443.CrossRefPubMedGoogle Scholar
  21. Hammash, M. H., Hall, L. A., Lennie, T. A., Heo, S., Chung, M. L., Lee, K. S., & Moser, D. K. (2012). Psychometrics of the PHQ-9 as a measure of depressive symptoms in patients with heart failure. European Journal of Cardiovascular Nursing, 12, 446–453.CrossRefPubMedGoogle Scholar
  22. Hammen, C. (2005). Stress and depression. Annual Review of Clinical Psychology, 1, 293–319.CrossRefPubMedGoogle Scholar
  23. Haworth, J. E., Moniz-Cook, E., Clark, A. L., Wang, M., Waddington, R., & Cleland, J. G. F. (2005). Prevalence and predictors of anxiety and depression in a sample of chronic heart failure patients with left ventricular systolic dysfunction. The European Journal of Heart Failure, 7, 803–808.CrossRefPubMedGoogle Scholar
  24. Hemingway, H., & Marmot, M. (1999). Psychosocial factors in the aetiology and prognosis of coronary heart disease: Systematic review of prospective cohort studies. BMJ, 318, 1460–1467.CrossRefPubMedPubMedCentralGoogle Scholar
  25. Heo, S., Lennie, T. A., Moser, D. K., & Kennedy, R. L. (2014). Types of social support and their relationships to physical and depressive symptoms and health-related quality of life in patients with heart failure. Heart and Lung, 43, 299–305.CrossRefPubMedGoogle Scholar
  26. Hsu, N., Tsao, H., Chen, H., & Chou, P. (2014). Anxiety and depression mediate the health-related quality of life differently in patients with cardiovascular disease and stroke—preliminary report of the Yilan study: A population-based community health survey. PLoS ONE, 9, 1–9.CrossRefGoogle Scholar
  27. Kendler, K. S., & Gardner, C. O. (2010). Dependent stressful life events and prior depressive episodes in the prediction of major depression: The problem of causal inference in psychiatric epidemiology. Archives of General Psychiatry, 67, 1120–1127.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Kendler, K. S., Karkowski, L. M., & Prescott, C. A. (1999). Causal relationship between stressful life events and the onset of major depression. American Journal of Psychiatry, 156, 837–841.CrossRefPubMedGoogle Scholar
  29. Kessler, R. C. (1997). The effects of stressful life events on depression. Annual Review of Psychology, 48, 191–214.CrossRefPubMedGoogle Scholar
  30. Kessler, R. C., & Magee, W. J. (1994). The disaggregation of vulnerability to depression as a function of the determinants of onset and recurrence. In W. R. Avison & I. H. Gotlib (Eds.), Stress and mental health: Contemporary issues and prospects for the future (pp. 239–258). New York: Plenum.CrossRefGoogle Scholar
  31. Kroenke, K., Spitzer, R. L., Williams, J. B. W., & Löwe, B. (2010). The Patient Health Questionnaire somatic, anxiety, and depressive symptom scales: A systematic review. General Hospital Psychiatry, 32, 345–359.CrossRefPubMedGoogle Scholar
  32. Kuiper, N. A., Olinger, L. J., & Lyons, L. M. (1986). Global perceived stress level as a moderator of the relationship between negative life events and depression. Journal of Human Stress, 12, 149–153.CrossRefPubMedGoogle Scholar
  33. Lazarus, R. S. (1966). Psychological stress and the coping process. New York: McGraw-Hill.Google Scholar
  34. Lesman-Leegte, I., Jaarsma, T., Sanderman, R., Linssen, G., & van Veldhuisen, D. J. (2006). Depressive symptoms are prominent among elderly hospitalised heart failure patients. European Journal of Heart Failure, 8, 634–640.CrossRefPubMedGoogle Scholar
  35. Lett, H. S., Blumenthal, J. A., Babyak, M. A., Catellier, D. J., Carney, R. M., Berkman, L. F., & Schneiderman, N. (2007). Social support and prognosis in patients at increased psychosocial risk recovering from myocardial infarction. Health Psychology, 26, 418–427.CrossRefPubMedGoogle Scholar
  36. Lett, H. S., Blumenthal, J. A., Babyak, M. A., Strauman, T. J., Robins, C., & Sherwood, A. (2005). Social support and coronary heart disease: Epidemiologic evidence and implications for treatment. Psychosomatic Medicine, 67, 869–878.CrossRefPubMedGoogle Scholar
  37. Maciejewski, P. K., Prigerson, H. G., & Mazure, C. M. (2000). Self-efficacy as a mediator between stressful life events and depressive symptoms. British Journal of Psychiatry, 176, 373–378.CrossRefPubMedGoogle Scholar
  38. Marks, G. R., & Lutgendorf, S. K. (1999). Perceived health competence and personality factors differentially predict health behaviors in older adults. Journal of Aging and Health, 11, 221–239.CrossRefPubMedGoogle Scholar
  39. Mazure, C. M. (1998). Life stressors as risk factors in depression. Clinical Psychology: Science and Practice, 5, 291–313.Google Scholar
  40. Meyer, T., Hussein, S., Lange, H. W., & Herrmann-Lingen, C. (2014). Transient impact of baseline depression on mortality in patients with stable coronary heart disease during long-term follow-up. Clinical Research in Cardiology, 103, 389–395.CrossRefPubMedGoogle Scholar
  41. Meyers, A. G., Salanitro, A., Wallston, K. A., Cawthon, C., Vasilevskis, E. E., Goggins, K. M., & Kripalani, S. (2014). Determinants of health after hospital discharge: Rationale and design of the Vanderbilt Inpatient Cohort Study (VICS). BMC Health Services Research, 14, 1–10.CrossRefGoogle Scholar
  42. Mitchell, A. J., Morgan, J. P., Petersen, D., Fabbri, S., Fayard, C., Stoletniy, L., & Chiong, J. (2012). Validation of simple visual-analogue thermometer screen for mood complications of cardiovascular disease: The emotion thermometers. Journal of Affective Disorders, 136, 1257–1263.CrossRefPubMedGoogle Scholar
  43. Mitchell, P. H., Powell, L., Blumenthal, J., Norten, J., Ironson, G., Pitula, C. R., & Berkman, L. F. (2003). A short social support measure for patients recovering from myocardial infarction. Journal of Cardiopulmonary Rehabilitation, 23, 398–403.CrossRefPubMedGoogle Scholar
  44. Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M., & Turner, M. B. (2015). Heart disease and stroke statistics–2015 Update: A report from the American Heart Association. Circulation, 131, e29–e322.CrossRefPubMedGoogle Scholar
  45. Ransom, S., Jacobsen, P. B., & Booth-Jones, M. (2006). Validation of the distress thermometer with bone marrow transplant patients. Psycho-Oncology, 15, 604–612.CrossRefPubMedGoogle Scholar
  46. Rao, P., & Miller, R. L. (1971). Applied econometrics. Belmont, CA: Wadsworth.Google Scholar
  47. Riegel, B., Moser, D. K., Anker, S. D., Appel, L. J., Dunbar, S. B., Grady, K. L., & Whellan, D. J. (2009). State of the science: Promoting self-care in oersons with heart failure: A scientific statement from the American Heart Association. Circulation, 120, 1141–1163.CrossRefPubMedGoogle Scholar
  48. Sanjuán, P., Arranz, H., & Castro, A. (2014). Effect of negative attributions on depressive symptoms of patients with coronary heart disease after controlling for physical functional impairment. British Journal of Health Psychology, 19, 380–392.CrossRefPubMedGoogle Scholar
  49. Shnek, Z. M., Irvine, J., Stewart, D., & Abbey, S. (2001). Psychological factors and depressive symptoms in ischemic heart disease. Health Psychology, 20, 141–145.CrossRefPubMedGoogle Scholar
  50. Smith, M. S., Wallston, K. A., & Smith, C. A. (1995). The development and validation of the Perceived Health Competence Scale. Health Education Research, 10, 51–64.CrossRefPubMedGoogle Scholar
  51. Stafford, L., Berk, M., & Jackson, H. J. (2013). Tobacco smoking predicts depression and poorer quality of life in heart disease. BMC Cardiovascular Disorders, 13, 35.CrossRefPubMedPubMedCentralGoogle Scholar
  52. Surtees, P., Wainwright, N., Luben, R., Wareham, N., Bingham, S., & Khaw, K. (2008). Depression and ischemic heart disease mortality: Evidence from the EPIC-Norfolk United Kingdom Prospective Cohort Study. American Journal of Psychiatry, 165, 515–523.CrossRefPubMedGoogle Scholar
  53. Thoits, P. A. (2010). Stress and health: Major findings and policy implications. Journal of Health and Social Behavior, 51, S41–S53.CrossRefPubMedGoogle Scholar
  54. Thomas, S. A., Friedmann, E., Gottlieb, S. S., Liu, F., Morton, P. G., Chapa, D. W., & Nahm, E. S. (2009). Changes in psychosocial distress in outpatients with heart failure with implantable cardioverter defibrillators. Heart and Lung, 38, 109–120.CrossRefPubMedGoogle Scholar
  55. Thurston, R. C., Kubzansky, L. D., Kawachi, I., & Berkman, L. (2006). Do depression and anxiety mediate the link between educational attainment and CHD? Psychosomatic Medicine, 68, 25–32.CrossRefPubMedGoogle Scholar
  56. Tully, P. J., Baker, R. A., Turnbull, D., & Winefield, H. (2008). The role of depression and anxiety symptoms in hospital readmissions after cardiac surgery. Journal of Behavioral Medicine, 31, 281–290.CrossRefPubMedGoogle Scholar
  57. Turner, R. J., & Brown, R. L. (2010). Social Support and Mental Health. In T. L. Scheid & T. N. Brown (Eds.), A handbook for the study of mental health: Social contexts, theories, and systems (2nd ed., pp. 200–212). New York: Cambridge University Press.Google Scholar
  58. Uchino, B. N. (2006). Social support and health: A review of physiological processes potentially underlying links to disease outcomes. Journal of Behavioral Medicine, 29, 377–387.CrossRefPubMedGoogle Scholar
  59. Umberson, D., Crosnoe, R., & Reczek, C. (2010). Social relationships and health behavior across the life course. Annual Review of Sociology, 36, 139–157.CrossRefPubMedPubMedCentralGoogle Scholar
  60. van Deursen, V. M., Urso, R., Laroche, C., Damman, K., Dahlstrom, U., Tavazzi, L., & Voors, A. A. (2014). Co-morbidities in patients with heart failure and its relation with venous congestion and prognosis: An analysis of the European Heart Failure Pilot Survey. European Journal of Heart Failure, 16, 103–111.CrossRefPubMedGoogle Scholar
  61. Wulsin, L. R., & Singal, B. M. (2003). Do depressive symptoms increase the risk for the onset of coronary disease? A systematic quantitative review. Psychosomatic Medicine, 65, 201–210.CrossRefPubMedGoogle Scholar
  62. Zautra, A. J., Parrish, B. P., Van Puymbroeck, C. M., Tennen, H., Davis, M. C., Reich, J. W., & Irwin, M. (2007). Depression history, stress, and pain in rheumatoid arthritis patients. Journal of Behavioral Medicine, 30, 187–197.CrossRefPubMedGoogle Scholar

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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