Effects of stress, health competence, and social support on depressive symptoms after cardiac hospitalization
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.
KeywordsDepressive 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.
- Aiken, L. S., & West, S. G. (1991). Multiple regression: Testing and interpreting interactions. Newbury Park, CA: Sage.Google Scholar
- 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
- 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
- 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
- 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
- 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
- Lazarus, R. S. (1966). Psychological stress and the coping process. New York: McGraw-Hill.Google Scholar
- Mazure, C. M. (1998). Life stressors as risk factors in depression. Clinical Psychology: Science and Practice, 5, 291–313.Google Scholar
- 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
- 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
- Rao, P., & Miller, R. L. (1971). Applied econometrics. Belmont, CA: Wadsworth.Google Scholar
- 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
- 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