Volume 20, Issue 3 (9-2021)
TB 2021, 20(3): 59-74 |
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Fallah M H, Hossieni H, Fallahzadeh H, Mirzaei M. The Relationship between Depression, Anxiety, Stress, and Physical Activity with Cardiovascular Disease Risk, Using Structural Equation Modeling in Adults in Yazd City. TB 2021; 20 (3) :59-74
URL: http://tbj.ssu.ac.ir/article-1-2518-en.html
URL: http://tbj.ssu.ac.ir/article-1-2518-en.html
school of health , fallahzadeh.ho@gmail.com
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The Relationship between Depression, Anxiety, Stress, and Physical Activity with Cardiovascular Disease Risk, Using Structural Equation Modeling in Adults in Yazd City
Mohammad Hossein Fallah(P.hD.)1 , Hakimeh Hosseini(M.Sc.)2, Hossein Fallahzadeh(P.hD.)3, Masoud Mirzaei(P.hD.)3
1.Associate Professor, Department of Educational Sciences and Psychology, Yazd Branch, Islamic Azad University of Yazd, Iran. Email:fallahyazd@iauyazd.ac.ir Tel:09132559467
2.M.Sc., of consultation and guidance, Yazd Branch, Islamic Azad University of Yazd, Iran.
3.Professor, Center for Healthcare Data Modeling, Departments of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Introduction: Cardiovascular disease is one of the most common causes of death worldwide. In recent years, the role of psychological factors in the onset and exacerbation of cardiovascular disease, particularly coronary artery, has been widely taken into consideration. This study aimed to investigate the role of depression, anxiety, stress, and physical activity on the risk of cardiovascular disease using structural equation modeling in adults in Yazd city.
Methods: This correlational study was carried out using data from the health survey of people in Yazd province in 2014-2015. The sample size of this study was 3514 people. The DASS21 questionnaire was used to measure stress, anxiety, and depression, and the 10-year risk of cardiovascular disease was calculated using the Framingham risk score. Total cholesterol, HDL, blood sugar, and blood pressure were measured to calculate the components of the risk score. The data were analyzed by SPSS23 and AMOS 23 using structural equation modeling.
Results: The prevalence of depression, anxiety, and stress in diabetic patients were 34.6%, 35.9%, and 39.2%, respectively. The final model fit indices included CMIN/DF=5.07, CFI=0.862, GFI=0.91, NFI=0.83, TLI=0.835, and RMSEA=0.052, indicating the suitability of the model. Depression, and stress items had a significant effect on cardiovascular disease risk score mediated by physical activity index.
Conclusion: The prevalence of depression, anxiety, and stress were high in Yazd city. Physical activity plays a mediating role between psychological constructs and the risk of cardiovascular disease.
Cardiovascular Disease, Anxiety, Depression, Stress, Structural Equation Modeling.
1-Maton D, Hopkins J, McLaughlin Ch W, et al. Human Biology and Health. Englewood Cliffs, New Jersey, US. 1997;323:1-13.
2-Arghami S, Seraji JN, Mohammad K, et al. Mental health in high-tech system. Iranian Journal of Public Health. 2005;34(1):31-7.
3-Sadock VA. Synopsis of" sychiatry: Department of Psychiatry, New York University; 2007.
4-Kooshan M VB. Stressors and their association with some of the most common physical complaints. Journal of Sabzevar School of Medical Sciences. 2002;9(4):21-30.
5-Wilkinson G. stress. 1. 1 ed. Tehran: Arjomand Publications.1951.
6-Azevedo R. Understanding the complex nature of self-regulatory processes in learning with computer-based learning environments: An introduction. Metacognition and Learning. 2007;2(2-3):57-65.
7-Hamman RF, Wing RR, Edelstein SL, et al. Effect of weight loss with lifestyle intervention on risk of diabetes. Diabetes care. 2006;29(9):2102-7.
8-Mora S, Cook N, Buring JE, et al. Physical activity and reduced risk of cardiovascular events: potential mediating mechanisms. Circulation.2007;116(19):2110-8.
9-Committee P. Physical Activity Guidelines Advisory Committee Report. Washington, DC: U.S. Department of Health and Human Service.2008;1-683.
10-Thombs BD, Bass EB, Ford DE, et al. Prevalence of depression in survivors of acute myocardial infarction. Journal of general internal medicine. 2006;21(1):30-8.
11-Sorensenf C, Friis-Hasche E, Haghfelt T, Bech P. Postmyocardial infarction mortality in relation to depression: a systematic critical review. Psychotherapy and psychosomatics. 2005;74(2):69-80.
12-Frasure-Smith N, Lesperance F. Depression and anxiety as predictors of 2-year cardiac events in patients with stable coronary artery disease. Archives of general psychiatry. 2008;65(1):62-71.
13-Roest AM, Martens EJ, de Jonge P, Denollet J. Anxiety and risk of incident coronary heart disease: a meta-analysis. Journal of the American College of Cardiology. 2010;56(1):38-46.
14-Brotman DJ, Golden SH, Wittstein IS. The cardiovascular toll of stress. The Lancet. 2007;370(9592):100-8.
15-Gidding SS. Physical activity, physical fitness, and cardiovascular risk factors in childhood. American Journal of Lifestyle Medicine.2007;1(6):499-505.
16-Naghii MR, Alem Aref M, Hedayati M. Effect of regular physical activity on non-lipid (novel) cardiovascular risk factors. Medical Science Journal of Islamic Azad Univesity-Tehran Medical Branch. 2013;22(4):294-300.
17-Antonogeorgos G, Panagiotakos DB, Pitsavos C, et al. Understanding the role of depression and anxiety on cardiovascular disease risk, using structural equation modeling; the mediating effect of the Mediterranean diet and physical activity: the ATTICA study. Annals of epidemiology.2012;22(9):630-7.
18-Karimzadeh K, Shirazi N, Heydarnia A. Effects of a TTM-based osteoporosis preventive physical activity education, on increasing muscle. Hakim Research Journal. 2007;10(2):34-42.
19-Agostino RB, Grundy S, Sullivan LM, et al. Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic groups investigation.2001;286(2):180-7.
20-Baron RM, Kenny DA. The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of personality and social psychology. 1986;51(6):1173.
21-Stephen JB DM, Murray DE, Ian BH, et al. Stress and coronary heart disease: Psychosocial risk factors. MJA. 2003;178:272- 6.
22-Paul Black LG. Stress, inflammation and cardiovascular disease. Journal Of Psychosomatic Research. 2002;52:1-23.
23-Jabalameli Sh HH, Mostafavi S. Effectiveness of cognitive - behavioral stress management on public health in cardiac patients. Behavioral Sciences Research.1390;9(5): 475-80.
24-Molloy GJ SE, Randall G, Hamer M. Marital status, gender and cardiovascular mortality: Behavioural, psychological distress and metabolic explanations. Soci Scie Medic. 2009;69:223-8.
25-Rozanski A BJ, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy Circulation. 1999;99:219-7.
26-Rugulies R. Depression as a predictor for coronary heart disease: A review and meta-analysis. Am J Prev Med. 2002;23:51-61.
27-Hans G. Thiel DP, Thomas A. Stress factors and the risk of myocardial infarction. J Psychosom Res. 1973;17(1):43-57.
28-Mark H GJ, Emmanuel S. Psychological distress as a risk factor for cardiovascular events. Journal Of The American College of Cardiology. 2008;52(25):2165-2.
29-Sarokhani D, Delpisheh A, Veisani Y, et al. Prevalence of depression among university students: a systematic review and meta-analysis study. Depression research and treatment. 2013;2013.
30-Moy F, Ab Sallam A, Wong M. Framingham risk scores and anthropometric measurements in predicting cardiovascular risks among Malay men. Malaysian journal of nutrition. 2008;14(1):57-63.
Mohammad Hossein Fallah(P.hD.)1 , Hakimeh Hosseini(M.Sc.)2, Hossein Fallahzadeh(P.hD.)3, Masoud Mirzaei(P.hD.)3
1.Associate Professor, Department of Educational Sciences and Psychology, Yazd Branch, Islamic Azad University of Yazd, Iran. Email:fallahyazd@iauyazd.ac.ir Tel:09132559467
2.M.Sc., of consultation and guidance, Yazd Branch, Islamic Azad University of Yazd, Iran.
3.Professor, Center for Healthcare Data Modeling, Departments of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Introduction: Cardiovascular disease is one of the most common causes of death worldwide. In recent years, the role of psychological factors in the onset and exacerbation of cardiovascular disease, particularly coronary artery, has been widely taken into consideration. This study aimed to investigate the role of depression, anxiety, stress, and physical activity on the risk of cardiovascular disease using structural equation modeling in adults in Yazd city.
Methods: This correlational study was carried out using data from the health survey of people in Yazd province in 2014-2015. The sample size of this study was 3514 people. The DASS21 questionnaire was used to measure stress, anxiety, and depression, and the 10-year risk of cardiovascular disease was calculated using the Framingham risk score. Total cholesterol, HDL, blood sugar, and blood pressure were measured to calculate the components of the risk score. The data were analyzed by SPSS23 and AMOS 23 using structural equation modeling.
Results: The prevalence of depression, anxiety, and stress in diabetic patients were 34.6%, 35.9%, and 39.2%, respectively. The final model fit indices included CMIN/DF=5.07, CFI=0.862, GFI=0.91, NFI=0.83, TLI=0.835, and RMSEA=0.052, indicating the suitability of the model. Depression, and stress items had a significant effect on cardiovascular disease risk score mediated by physical activity index.
Conclusion: The prevalence of depression, anxiety, and stress were high in Yazd city. Physical activity plays a mediating role between psychological constructs and the risk of cardiovascular disease.
Cardiovascular Disease, Anxiety, Depression, Stress, Structural Equation Modeling.
1-Maton D, Hopkins J, McLaughlin Ch W, et al. Human Biology and Health. Englewood Cliffs, New Jersey, US. 1997;323:1-13.
2-Arghami S, Seraji JN, Mohammad K, et al. Mental health in high-tech system. Iranian Journal of Public Health. 2005;34(1):31-7.
3-Sadock VA. Synopsis of" sychiatry: Department of Psychiatry, New York University; 2007.
4-Kooshan M VB. Stressors and their association with some of the most common physical complaints. Journal of Sabzevar School of Medical Sciences. 2002;9(4):21-30.
5-Wilkinson G. stress. 1. 1 ed. Tehran: Arjomand Publications.1951.
6-Azevedo R. Understanding the complex nature of self-regulatory processes in learning with computer-based learning environments: An introduction. Metacognition and Learning. 2007;2(2-3):57-65.
7-Hamman RF, Wing RR, Edelstein SL, et al. Effect of weight loss with lifestyle intervention on risk of diabetes. Diabetes care. 2006;29(9):2102-7.
8-Mora S, Cook N, Buring JE, et al. Physical activity and reduced risk of cardiovascular events: potential mediating mechanisms. Circulation.2007;116(19):2110-8.
9-Committee P. Physical Activity Guidelines Advisory Committee Report. Washington, DC: U.S. Department of Health and Human Service.2008;1-683.
10-Thombs BD, Bass EB, Ford DE, et al. Prevalence of depression in survivors of acute myocardial infarction. Journal of general internal medicine. 2006;21(1):30-8.
11-Sorensenf C, Friis-Hasche E, Haghfelt T, Bech P. Postmyocardial infarction mortality in relation to depression: a systematic critical review. Psychotherapy and psychosomatics. 2005;74(2):69-80.
12-Frasure-Smith N, Lesperance F. Depression and anxiety as predictors of 2-year cardiac events in patients with stable coronary artery disease. Archives of general psychiatry. 2008;65(1):62-71.
13-Roest AM, Martens EJ, de Jonge P, Denollet J. Anxiety and risk of incident coronary heart disease: a meta-analysis. Journal of the American College of Cardiology. 2010;56(1):38-46.
14-Brotman DJ, Golden SH, Wittstein IS. The cardiovascular toll of stress. The Lancet. 2007;370(9592):100-8.
15-Gidding SS. Physical activity, physical fitness, and cardiovascular risk factors in childhood. American Journal of Lifestyle Medicine.2007;1(6):499-505.
16-Naghii MR, Alem Aref M, Hedayati M. Effect of regular physical activity on non-lipid (novel) cardiovascular risk factors. Medical Science Journal of Islamic Azad Univesity-Tehran Medical Branch. 2013;22(4):294-300.
17-Antonogeorgos G, Panagiotakos DB, Pitsavos C, et al. Understanding the role of depression and anxiety on cardiovascular disease risk, using structural equation modeling; the mediating effect of the Mediterranean diet and physical activity: the ATTICA study. Annals of epidemiology.2012;22(9):630-7.
18-Karimzadeh K, Shirazi N, Heydarnia A. Effects of a TTM-based osteoporosis preventive physical activity education, on increasing muscle. Hakim Research Journal. 2007;10(2):34-42.
19-Agostino RB, Grundy S, Sullivan LM, et al. Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic groups investigation.2001;286(2):180-7.
20-Baron RM, Kenny DA. The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of personality and social psychology. 1986;51(6):1173.
21-Stephen JB DM, Murray DE, Ian BH, et al. Stress and coronary heart disease: Psychosocial risk factors. MJA. 2003;178:272- 6.
22-Paul Black LG. Stress, inflammation and cardiovascular disease. Journal Of Psychosomatic Research. 2002;52:1-23.
23-Jabalameli Sh HH, Mostafavi S. Effectiveness of cognitive - behavioral stress management on public health in cardiac patients. Behavioral Sciences Research.1390;9(5): 475-80.
24-Molloy GJ SE, Randall G, Hamer M. Marital status, gender and cardiovascular mortality: Behavioural, psychological distress and metabolic explanations. Soci Scie Medic. 2009;69:223-8.
25-Rozanski A BJ, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy Circulation. 1999;99:219-7.
26-Rugulies R. Depression as a predictor for coronary heart disease: A review and meta-analysis. Am J Prev Med. 2002;23:51-61.
27-Hans G. Thiel DP, Thomas A. Stress factors and the risk of myocardial infarction. J Psychosom Res. 1973;17(1):43-57.
28-Mark H GJ, Emmanuel S. Psychological distress as a risk factor for cardiovascular events. Journal Of The American College of Cardiology. 2008;52(25):2165-2.
29-Sarokhani D, Delpisheh A, Veisani Y, et al. Prevalence of depression among university students: a systematic review and meta-analysis study. Depression research and treatment. 2013;2013.
30-Moy F, Ab Sallam A, Wong M. Framingham risk scores and anthropometric measurements in predicting cardiovascular risks among Malay men. Malaysian journal of nutrition. 2008;14(1):57-63.
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Received: 2017/06/1 | Accepted: 2017/06/25 | Published: 2021/09/1
Received: 2017/06/1 | Accepted: 2017/06/25 | Published: 2021/09/1
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