Capsule Commentary on Yeh, et al., Depressed Mood, Perceived Health Competence and Health Behaviors: a Cross-Sectional Mediation Study in Outpatients with Coronary Heart Disease.
Capsule Commentary on Yeh, et al., Depressed Mood, Perceived Health Competence and Health Behaviors: a Cross-Sectional Mediation Study in Outpatients with Coronary Heart Disease.
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对 Yeh 等人的《抑郁情绪、感知健康能力和健康行为：冠心病门诊患者的跨部门中介研究》的胶囊评论。
DOI：
10.1007/s11606-019-04917-8
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发表时间：
2019
影响因子：
5.7
通讯作者：
Roy,MichaelJ
中科院分区：
文献类型：
--
作者：
Roy,MichaelJ
在发达国家，冠心病是最常见的死亡原因，抑郁症是最常见的发病原因之一。1抑郁症和冠心病之间的关系是双向的，每一个都对另一个的预后产生不利影响。虽然我们对这种关系的潜在机制仍然缺乏足够的了解，但更糟糕的健康行为，包括饮食，运动和烟草和酒精使用模式，是非常重要的因素。Yeh等人对文献中感知健康能力的识别提供了有价值的贡献。2他们估计，感知健康能力对抑郁情绪对健康行为的总影响约占四分之一。从本质上讲，他们认为那些抑郁的人不太可能觉得他们有能力改变自己的行为，从而影响他们的健康，因此不坚持戒烟或改善饮食或锻炼方案。所识别的关系具有表面效度。然而，这项研究有一些重大的局限性，作者适当地承认了这一点。可以说，其中最突出的是，一个不可测量的因素，如悲观或绝望，可能与抑郁，感知健康能力和健康行为显着相关，实际上是这些因素之间关系的关键。Beck和Weissman之前开发了一个绝望量表3来衡量悲观情绪，这可能值得纳入未来的研究中，未来研究的最终目标是将这项工作转化为减少心脏事件和总体死亡率的干预措施。人们可能希望单独治疗抑郁症会改善健康行为以及随之而来的心脏结局，但正如Yeh等人在他们的讨论中所记录的那样，这种干预对前者几乎没有影响，而对后者的结果则好坏参半。也许双重干预，针对抑郁症和感知健康能力，可以使抑郁症患者逃离这个黑暗的心脏。
C oronary heart disease (CHD) is the most common cause of death, and depression is one of the most common causes of morbidity, in developed nations. 1 The relationship between depression and CHD is a two-way street, with each adversely impacting the prognosis of the other. While we still have an insufficient understanding of the underlying mechanisms involved in this relationship, worse health behaviors, including diet, exercise, and tobacco and alcohol use patterns, represent highly significant factors. Yeh et al. provide a valuable contribution to the literature in their identification of perceived health competence as a significant mediator. 2 They estimate that perceived health competence is responsible for about one-quarter of the total effect of depressed mood on health behaviors. Essentially, they are suggesting that those who are depressed are less likely to feel that it is within their power to change their behavior in such a manner to impact their health, and thus do not follow through on quitting smoking or improving their diet or exercise regimen. The identified relationship has face validity. However, there are some significant limitations to this study, which the authors appropriately acknowledge. Arguably, the most salient of these is that an unmeasured factor such as pessimism, or hopelessness, might be significantly related to depression, perceived health competence, and health behaviors, and is in fact the key to the relationship between these factors. Beck and Weissman previously developed a Hopelessness Scale 3 to measure pessimism, which might be worth incorporating in future studies of this relationship.The ultimate goal in future research would be to translate this work into interventions that reduce cardiac events and overall mortality. One might hope that treating depression alone would engender improvements in health behaviors as well as consequent cardiac outcomes, but as Yeh et al. document in their discussion, such intervention has had little impact on the former, and results have been mixed with regard to the latter. Perhaps a dual intervention, targeting both depression and perceived health competence, can enable depressed patients to escape this heart of darkness.