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Depressive Symptoms Impact Health-Promoting Lifestyle Behaviors and Quality of Life in Healthy Women

Savoy, Suzanne M. PhD, RN, ACNS-BC, CNL; Penckofer, Sue PhD, RN, FAAN

Journal of Cardiovascular Nursing: July/August 2015 - Volume 30 - Issue 4 - p 360–372
doi: 10.1097/JCN.0000000000000158

Background: Depressive symptoms are an independent risk factor of cardiovascular disease (CVD). More than 15% of persons with CVD have depressive symptoms, which are twice as likely to occur in women. Depressive symptoms in women being screened for CVD have not been well studied.

Objective: The relationships between depressive symptoms, health-promoting lifestyle behaviors, heart disease risk awareness, cardiac risk, and quality of life (QOL) in women were investigated. Whether the effect of depressive symptoms on QOL was mediated by cardiac risk and/or health-promoting lifestyle behaviors was also examined.

Methods: The Wilson-Cleary Health-Related Quality of Life Model guided this descriptive study. A convenience sample of 125 women was recruited from cardiac health screening events. The study measurements were the Center for Epidemiologic Studies Depression Scale; the Framingham risk score; the Ferrans-Powers Quality of Life Index Generic Version–III; the Health-Promoting Lifestyle Profile–II; and questions related to heart disease risk, awareness of heart disease risk, health history, and demographics. Body mass index, percentage of body fat, and lipid profile were also measured.

Results: More than one-third (34%) of the women reported significant depressive symptoms. Depressive symptoms were not associated with cardiac risk or risk awareness but were inversely associated with health-promoting lifestyle behaviors (r = −0.37, P < 0.01) and QOL (r = −0.51, P < 0.01). There was a dose-response relationship with health-promoting lifestyle behaviors (odds ratio, 0.92; 95% confidence interval, 0.88–0.97; P < 0.001) and QOL (odds ratio, 0.85; 95% confidence interval, 0.79–0.92; P < 0.001) and depressive symptoms. Health-promoting lifestyle behaviors mediated the association between depressive symptoms and QOL.

Conclusions: Depressive symptoms contribute significantly to health-promoting lifestyle behaviors and QOL for women. Early detection and treatment of depressive symptoms are important for participation in healthy lifestyle behaviors, which could result in improved QOL.

Suzanne M. Savoy, PhD, RN, ACNS-BC, CNL Associate Professor, Department of Nursing, College of Health and Human Services, Saginaw Valley State University, University Center, Michigan.

Sue Penckofer, PhD, RN, FAAN Professor and Faculty Scholar, School of Nursing, Loyola University Chicago Niehoff, Maywood, Illinois.

Supported by graduate scholarship from Columbia-Presbyterian Hospital School of Nursing Alumni Association, Inc, and by research grants from Saginaw Valley State University and Theta Chi Chapter, Sigma Theta Tau International.

The authors have no conflicts of interest to disclose.

Correspondence Suzanne M. Savoy, PhD, RN, ACNS-BC, CNL, Saginaw Valley State University, 7400 Bay Rd, HHS Rm 233, University Center, MI 48710 (e-mail:

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