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

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.

health Behavior/Chronic Disease/Major depression/Teachable moment/Health behavior/Older adults

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