Social support and health behaviors in cardiac rehabilitation: Depression as a mediator

Social support and psychological factors (i.e., depression) have been linked to negative outcomes, such as recurrence and mortality, following a cardiac event. Further, these constructs have been associated with health behaviors in both the general population and within samples of patients with cardiovascular disease. As suggested by a conceptual model, the purpose of this study was to examine the relationship between social support and health behaviors in individuals with cardiovascular disease, and the mediating roles adherence to cardiac rehabilitation (as measured by number of sessions completed) and depressive symptoms may play in this relationship. It was hypothesized that social support at the beginning of cardiac rehabilitation would be positively related to health behaviors 18 months after cardiac rehabilitation, and that adherence to cardiac rehabilitation and depressive symptoms at the end of cardiac rehabilitation would mediate this relationship. Participants (n=83) were recruited at the beginning of a cardiac rehabilitation program and completed questionnaires at Time 1 (beginning of their programs), Time 2 (end of their programs), and Time 3 (18 months following the end of their programs). Path analysis results did not support the hypothesized model as fitting these data. Further, parameter estimates of the path model indicated that both social support and adherence to cardiac rehabilitation were not related to any constructs within the model. Depressive symptoms were negatively related to health behaviors, confirming prior research. Results suggest that cardiac rehabilitation practitioners should identify individuals who are experiencing greater depressive symptoms following a cardiac event and promote intervention methods to address their heightened psychological distress. This approach would be complementary to the ultimate goal of cardiac rehabilitation--lifestyle modification to adhere to recommended health behaviors to reduce the likelihood of cardiac event recurrence and cardiac-related mortality.