History of major depression as a barrier to health behavior changes after a chronic disease diagnosis

Abstract

Objective: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Health and retirement study; Health behavior; Major depression; Older adults; Teachable moment.