183887 Do psychiatric illnesses affect adherence to lifestyle recommendations in hypertensive veterans? Impact on diet and mediating effect of perceived stress

Monday, October 27, 2008

Vanessa Leigh D'Orio, BA , Research & Development, VA New York Harbor Healthcare System, New York, NY
Jennifer P. Friedberg, PhD , Research & Development Service (151), VA New York Harbor Healthcare System/New York University School of Medicine, New York, NY
Donald Robinaugh, MA , Research & Development Service, VA New York Harbor Healthcare System, New York Campus, New York, NY
Marilena Antonopoulos, PharmD , Long Island University, Brooklyn, NY
Sundar Natarajan, MD, MSc , Research and Development Service, Department of Veterans Affairs New York Harbor Healthcare System & New York University, New York, NY
BACKGROUND: Primary care patients have a high prevalence of coexisting mental health conditions that may affect patients' abilities to follow lifestyle recommendations. We evaluated the ability of hypertensive veterans to adhere to appropriate diet and exercise guidelines.

METHODS: Diet was assessed by Willett Food Frequency Questionnaires and exercise by 7-day Physical Activity Recall. The Dietary Approaches to Stop Hypertension (DASH) Adherence Index (DAI; 0-100) was based on adherence to 10 components central to the DASH diet. Mental illness was determined from medical records. The 10-Item Perceived Stress Scale measured stress. Linear regression was used to determine if mental illness predicted poorer adherence to the DASH diet or exercise. Wilcoxon rank-sum tests compared differences between persons with and without psychiatric diagnoses.

RESULTS: We evaluated 175 hypertensive veterans (61 with major psychiatric illnesses such as depression, anxiety disorders, substance abuse, schizophrenia and PTSD). These psychiatric comorbidities were associated with poor adherence to the DASH diet (p<.03); but not with exercise. In particular, veterans with psychiatric comorbidities had lower Healthy Eating Index scores (p<.02), higher dietary sodium (p<.03) and higher saturated fat (p<.01). Once perceived stress was added to the Diet model, psychiatric comorbidities were no longer significant predictors of DASH adherence, which suggests that perceived stress is a mediating variable.

DISCUSSION: Patients with mental illnesses may be at greater risk for hypertensive complications due to poor adherence to DASH diet. By reducing perceived stress, we may help patients adhere to a heart-healthy diet.

Learning Objectives:
1.Understand issues relevant to adherence in patients with psychiatric illnesses. 2.Recognize the influence of perceived stress on adherence to diet and exercise in patients with major psychiatric illnesses. 3.Learn way to improve adherence through lowering stress in veterans with chronic conditions like hypertension.

Keywords: Mental Health, Adherence

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a researcher working on a federally funded grant targeting hypertension management in veterans. I'm an expert in the field.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.