Depressed Mood, Perceived Health Competence and Health Behaviors: aCross-Sectional Mediation Study in Outpatients with Coronary Heart Disease

  • Vivian M. Yeh
  • Lindsay S. Mayberry
  • Justin M. Bachmann
  • Kenneth A. Wallston
  • Christianne Roumie
  • Daniel Muñoz
  • Sunil Kripalani
Original Research



Identifying potential mechanisms that link depressed mood with worse health behaviors is important given the prevalence of depressed mood in patients with coronary heart disease (CHD) and its relationship with subsequent mortality. Perceived health competence is an individual’s confidence in his/her ability to successfully engineer solutions to achieve health goals and may explain how depressed mood affects multiple health behaviors.


Examine whether or not perceived health competence mediates the relationship between depressed mood and worse health behaviors.


A cross-sectional study conducted by the Patient-Centered Outcomes Research Institute–funded Mid-South Clinical Data Research Network between August 2014 and September 2015. Bootstrapped mediation was used.


Patients with coronary heart disease (n = 2334).

Main Measures

Two items assessing perceived health competence, a single item assessing depressed mood, and a Health Behaviors Index including: the International Physical Activity Questionnaire (IPAQ); select items from the National Adult Tobacco Survey and the Alcohol Use Disorder Inventory Test; and single items assessing diet and medication adherence.

Key Results

Depressed mood was associated with lower perceived health competence (a = − 0.21, p < .001) and lower perceived health competence was associated with worse performance on a Health Behaviors Index(b = 0.18, p < .001). Perceived health competence mediated the influence of depressed mood on health behaviors (ab = − 0.04, 95% CI = − 0.05 to − 0.03). The ratio of the indirect effect to the total effect was used as a measure of effect size (PM = 0.26, 95% CI: 0.18 to 0.39).


Depressed mood is associated with worse health behaviors directly and indirectly via lower perceived health competence. Interventions to increase perceived health competence may lessen the deleterious impact of depressed mood on health behaviors and cardiovascular outcomes.

Key Words

depressed mood perceived health competence health behavior cardiovascular disease 



There are no additional contributors to this manuscript.


Research reported in this publication was supported by grants from the Patient-Centered Outcomes Research Institute (PCORI, R-1306-04869 and 1501-26498) and in part by the National Center for Advancing Translational Sciences of the National Institute of Health under Award Number UL1 TR000445 and grant number K12HS022990 from the Agency for Healthcare Research and Quality (Bachmann).The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.

Compliance with Ethical Standards

Conflicts of Interest

Kenneth A. Wallston is a member of the Advisory Board of EdLogics, Inc.

Sunil Kripalani has consultancies with SAI Interactive and Verustat, as well as stock ownership in Bioscape Digital.

All other authors declare no conflicts of interest.


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Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Vivian M. Yeh
    • 1
    • 2
  • Lindsay S. Mayberry
    • 1
    • 2
    • 3
    • 4
  • Justin M. Bachmann
    • 5
  • Kenneth A. Wallston
    • 1
    • 6
  • Christianne Roumie
    • 2
    • 3
    • 7
  • Daniel Muñoz
    • 5
  • Sunil Kripalani
    • 1
    • 2
    • 3
  1. 1.Center for Health Services Research Vanderbilt University Medical CenterNashvilleUSA
  2. 2.Center for Clinical Quality and Implementation ResearchVanderbilt University Medical CenterNashvilleUSA
  3. 3.Department of MedicineVanderbilt University Medical CenterNashvilleUSA
  4. 4.Center for Health Behavior and Health EducationVanderbilt University Medical CenterNashvilleUSA
  5. 5.Division of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleUSA
  6. 6.School of NursingVanderbilt UniversityNashvilleUSA
  7. 7.Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC)NashvilleUSA

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