(PS2-9) Examining the Mediating Effects of Affective Distress, Illness Perceptions, and Health Promoting Behaviors Among Adults with Congenital Heart Disease

Abstract Text: Abstract Body

Approximately 2.4 million children and adults are living with congenital heart disease (CHD) in the United States. CHD requires consistent medical supervision and engagement in health-promoting behavior (HPB) to prevent or mediate the onset of disease or symptomatology. Though HPBs are especially crucial for patients with more severe CHD, these patients may face barriers to engaging in such behaviors, including low mood that can accompany severe CHD (Pauliks, 2013). However, studies examining the impact of CHD severity and mood on HPB among adults with CHD are limited (Rychik et al., 2019). The aim of the current study was to determine whether the association of CHD severity with HPB may be partially explained by depressed mood. A sample of adults (N=54) with CHD completed a survey of disease severity (mild, moderate, complex), depression (Patient Health Questionnaire (PHQ)-2), and a Health Behaviors Scale (HB) for CHD. To test for mediation, we calculated indirect effects of severity on HB via PHQ-2 using Hayes & Preacher’s bias-corrected bootstrap procedure via the PROCESS Macro for SPSS. Indicator coding of the three-level grouping variable (severity) was used. Indirect effects of severity on HB via PHQ-2 were determined significant when the mean of the indirect effect across all 5,000 bootstrap samples was associated with a bias-corrected confidence interval that did not include 0. Hayes & Preacher’s bias-corrected bootstrap test of indirect effect revealed that severity was indirectly associated with HB via PHQ-2. First, mild severity was associated with lower depression than moderate (a1 pathway; B= 0.997, p =.03) or, complex severity (a2 pathway; B= 1.177,p = .012). Second, depression was negatively associated with HB engagement (b pathway, p = .03). A bootstrap estimate of the indirect effect of severity on HB via PHQ-2 revealed a 95% bias-corrected and accelerated (BCa) confidence interval that did not cross zero for mild vs. moderate severity (B = -0.30; CI = -0.59,-0.49) and mild vs. complex severity (B= -0.36; CI = -0.73, -0.06). Findings indicate that young adults with moderate or complex CHD severity are at higher risk for depression than those with mild CHD severity, and depression in turn is associated with less heart healthy behaviors. Thus, CHD patients at greatest need for high engagement in health behaviors may be at risk for lower engagement due to increased depression, which often accompanies heart disease. Efforts to improve mood and motivation among CHD patients with more complicated disease may improve health behavior engagement and disease prognosis.