Psychosocial Factors Affecting the Association between a Healthy Lifestyle Behavior Intervention and Depressive Symptoms in Low-Income Overweight or Obese Mothers with Young Children: A Mediational Analysis.

Abstract

Background:Depressive symptoms are particularly prevalent among low-income overweight or obese mothers with young children, indicating the importance of understanding and addressing this serious health condition. Although lifestyle behavior interventions are promising for alleviating depressive symptoms in low-income overweight or obese mothers with young children, mechanisms underlying the association between these interventions and depressive symptoms in this priority population remain unknown.Objective:A secondary analysis of data from a randomized controlled trial that tested a 16-week community-based lifestyle behavior intervention for low-income overweight or obese mothers with young children was conducted to examine whether autonomous motivation, coping self-efficacy, and emotional coping mediated the association between the intervention and depressive symptoms.Methods:The analysis included 338 participants who completed data collection at baseline and immediately after the intervention. Participants responded to validated surveys measuring autonomous motivation, coping self-efficacy, emotional coping, and depressive symptoms. To test mediation effects, composite indicator structural equation modeling was performed adjusting for baseline measures. The proportion of maximum possible (POMP) scores in the outcome variable per unit change in the predictor variables was used to calculate effect size.Results:The intervention alleviated depressive symptoms (B = −2.42, p = 0.015, POMP = −4.31%), and coping self-efficacy negatively and fully mediated the association between the intervention and depressive symptoms (B = −1.42, p = 0.002, POMP = −2.53%). Autonomous motivation and emotional coping were not significant mediators.Conclusions:Interventions aimed to alleviate depressive symptoms in low-income overweight or obese mothers with young children should include strategies to improve coping self-efficacy. However, continued research is needed to identify other mechanisms that may be contributing to the effect of lifestyle behavior interventions on depressive symptoms in this at-risk group. This information can then be used to simplify and strengthen the interventions and potentially lead to effective dissemination and implementation.