Profiles of Performance On Transtheoretical Model Markers of Change As Predictors of Behavior Change Among Women Experiencing Depressive Symptomology

Purpose: Research has established that depression inhibits behavior change but offers little insight into howthis inhibition occurs. The transtheoretical model (TTM) of behavior change features markers of change that have been shown to interact in a consistent fashion when one changes a behavior: pros outweigh cons (decisional balance), confidence outweighs temptation (self-efficacy), and use of the processes of change is high.   Deviation from this profile is consistently associated with unsuccessful change attempts.  The current study clarifies the impact of depression on alcohol change by comparing profiles of performance on the TTM markers between depressed and non-depressed women in the CDC-funded CHOICES efficacy trial, which tested an intervention targeting reduction in alcohol consumption and/or adoption of effective contraception as avenues to reduce risk of alcohol exposed pregnancy (AEP).  We hypothesized that: 1) non-depressed women would be more likely than depressed women to reduce alcohol consumption and AEP risk by the 9-month follow-up; 2) non-depressed women would present with a TTM success profile; 3) in comparison, depressed women would present with higher cons for change, lower self-efficacy, and lower process use. 

Methods: In this secondary data analysis, the CHOICES intervention group (N=416) was divided into three groups based on BSI depression scores.  Participants were designated as depressed (N=51), not depressed (N=219), or experiencing subthreshold symptoms (N=137).  A chi square test of independence was used to compare alcohol change and AEP risk reduction at the 9-month follow-up.  The SPSS General Linear Model procedure with multivariate repeated measures was used to compare mean scores on TTM constructs and analyze profile patterns for changing alcohol use at baseline and 9 months.

Results: 71% of depressed women were drinking at risk levels at the 9-month follow up, as compared to 41% of non-depressed women and 63% of the subthreshold group (p=.001). 58% of depressed women remained at risk of AEP at 9 months, as compared to 25% of non-depressed women and 44% of the subthreshold group (p<.001).  Non-depressed women presented with a success profile at baseline and at 9 months, while depressed women presented with the opposite, as predicted.   The subthreshold group presented with a nonsuccess profile that mirrored the depressed group at both time points.   There were significant differences at baseline between the depressed and non-depressed groups on pros (p<.001), cons (p<.001), confidence p=.001), temptation (p<.001), and experiential process use (p=.003).  At 9 months, differences remained for pros (p=.029), cons (p<.001) and temptation (p<.001).  The depressed and subthreshold groups differed significantly on pros (p=.018) and cons (p=.001) only at baseline, and did not differ on any marker at 9 months. 

Implications: The TTM success profile can be seen as a roadmap to successful change.  Since neither mean levels nor profiles of TTM constructs differed significantly between the depressed and subthreshold groups, this study identifies the markers of change that are most problematic for women with varying degrees of depressive symptomology.  This information can be used to advance AEP prevention efforts and help practitioners target the unique needs of this vulnerable group.