Long-Term Impact of Depression on Health Behaviors in Midlife and Older Adulthood

Background and Purpose: The importance of engaging in healthy lifestyle behaviors, including non-smoking, regular physical activity, and moderate drinking, has been widely recognized. Depression may discourage older adults from engaging in health behaviors through decreased self-efficacy and motivation. Although epidemiological studies have consistently documented the cross-sectional association of depression and health risk behaviors, there has been limited evidence from population-based prospective studies regarding the long-term impact of depression on health behaviors. This study aimed to examine whether middle-aged and older adults with major or persistent depression were less likely to engage in healthy behaviors in the long-term. Elucidating the long-term impact of depression on health behaviors has important implications for chronic disease prevention and management and health promotion in older life.

Methods: Data came from 1996 to 2010 waves of the Health and Retirement Study (HRS). Study sample consisted of 11,439 participants aged 50 through 80 in 1996. Participants younger than 50 years of age were excluded because they were not part of the probability sample of the HRS. Participants older than 80 years of age at baseline were excluded to reduce the potential influence of attrition and survival bias. Major or persistent depression was determined by a score of ≥ 3 on the short-form Composite International Diagnostic Interview (CIDI-SF) at baseline, or a score of ≥ 3 on the 8-item Center for Epidemiologic Studies Depression Scale (CES-D) at baseline and the immediate follow-up. Combing the two scale was needed due to concerns about sample size. CES-D had a sensitivity of 56.4% and a specificity of 84.3% to predict major depression assessed by CIDI-SF in the study sample, suggesting that the two scales were relatively comparable. Current smoking was ascertained from answers of “yes” to “do you currently smoker?” Drinking level was classified into two categories (moderate vs. excessive) based on the 2010 Dietary Guidelines for Americans. Physically active was defined as engaging in vigorous physical activity three times or more per week. Mixed-effects logistic regression was applied to analyze the longitudinal impact of depression on health behaviors.

Results: Major or persistent depression at baseline was associated with more than 4-fold increase (OR=5.4, 95% confidence interval [CI] = 3.13-9.32, p<.001) in the odds of smoking during the 14 years of follow-up. Compared with their non-depressed counterparts, middle-aged and older adults with major or persistent depression at baseline were half as likely (OR=0.48, 95% CI=0.42-0.56, p<.001) to continue engaging in vigorous physical activity during follow-up. Adults with major or persistent depression at baseline tended to have higher level of alcohol consumption (OR=1.25, 95% CI=0.94-1.66). However, this relationship was not statistically significant at p<.05.

Conclusions and Implications: Depression at baseline had long-term impact on health behaviors. Engaging middle-aged and older adults with depression in health behavior counseling and programs is important. Developing community and population-based strategies to promote physical activity in older life is particularly important because physical activity can alleviate depressive symptoms.