YPMED-03958; No. of pages: 4; 4C: Preventive Medicine xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
Preventive Medicine journal homepage: www.elsevier.com/locate/ypmed
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Keywords: Mental health Exercise Intention Organismic Integration Theory
University of Toronto, 55 Harbord St., Toronto, Ontario M5S 2W6, Canada Centre de recherche CHUM, University of Montreal, 3850 Saint-Urbain Street, Montreal, Quebec H2W 1T7, Canada Concordia University, 7141 Sherbrooke West, Montreal, Quebec H4B 1R6, Canada d University of Ottawa, 125 University Private, Ottawa, Ontario K1N 6N5, Canada e Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada b c
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Tanya M.F. Scarapicchia a, Catherine M. Sabiston a,⁎, Erin O'Loughlin b,c, Jennifer Brunet d, Michael Chaiton a,e, Jennifer L. O'Loughlin b
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Physical activity motivation mediates the association between depression symptoms and moderate-to-vigorous physical activity
a b s t r a c t
Objective. To test if motivational regulations (i.e., amotivation, external, introjected, identified, and intrinsic) mediate the association between depression symptoms and moderate-to-vigorous physical activity (MVPA) in young adults. Method. A total of 319 young adults from Montreal, Quebec participating in the Nicotine Dependence in Teens (NDIT) study provided self-report data on depression symptoms at age 20 (SD = 0.7 years) and motivational regulations at age 24 (SD = 0.7 years). MVPA was assessed using a self-report questionnaire at age 20 (i.e., at the same time motivation was measured) and using accelerometers one month later. Multiple mediation analysis with bootstrapping was employed to analyze the data. Results. Controlling for age, sex and self-reported MVPA at age 20 years; introjected regulation was a significant mediator of the association between depression symptoms and MVPA (R2 adj = 0.12; point estimate = −0.0011; BCa CI = −0.15 to −0.01). Conclusion. Depression symptoms may undermine controlling forms of motivation, resulting in decreased MVPA. Intervention strategies may be needed to address depression symptoms in young adults to promote sustained MVPA. © 2014 Published by Elsevier Inc.
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Brief Original Report
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Introduction
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Adults should accumulate at least 150 min of moderate-to-vigorous physical activity (MVPA) per week to achieve health benefits (Tremblay et al., 2011). However less than 15% of adults attain these recommendations (Colley et al., 2011). One factor that may contribute to the high prevalence of physical inactivity is depression (Roshanaei-Moghaddam et al., 2009). Depression is an important public health burden worldwide (Ferrari et al., 2013). A common symptom of depression is anhedonia, which is characterized by diminished pleasure in activities such as physical activity (PA) that are usually found enjoyable (American Psychiatric Association, 2011). Further, depression symptoms often include motor delay and low energy, both of which may affect the ability to engage in PA
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⁎ Corresponding author at: 55 Harbord Street, Toronto, Ontario M5S 2W6, Canada. E-mail addresses: [email protected] (T.M.F. Scarapicchia), [email protected] (C.M. Sabiston), [email protected] (E. O'Loughlin), [email protected] (J. Brunet), [email protected] (M. Chaiton).
(Jerstad et al., 2010). There has been indirect evidence from longitudinal studies to support these associations (Brunet et al., 2013; Jerstad et al., 2010). Little is known about mechanisms that may underpin the association between depression and PA. In the current study, motivation is proposed as one such mechanism. This association is essential to examine among young adults, as during this time often the first symptoms of depression arise (Eisenberg et al., 2007). Lack of motivation is a common symptom of depression (Beck and Alford, 2009), and motivation is a consistent predictor of PA (Wilson et al., 2012). The Organismic Integration Theory (OIT; Ryan and Deci, 2000a, 2000b) posits six motivational regulations for PA, along a selfdetermination continuum. Amotivation, at one end of the continuum, is a lack of motivation whereby an individual has no intention to act (Deci and Ryan, 2002). There are four distinct forms of extrinsic motivation that sequentially increase in their degree of self-determination from more controlling to more autonomous forms of regulation (Deci and Ryan, 2002; Wilson et al., 2004). External regulation involves engaging in behaviors that are performed because of external demands or possible rewards (Ryan and Deci, 2000a, 2000b). Introjected regulation is characterized by behaviors that are reinforced by internal
http://dx.doi.org/10.1016/j.ypmed.2014.05.017 0091-7435/© 2014 Published by Elsevier Inc.
Please cite this article as: Scarapicchia, T.M.F., et al., Physical activity motivation mediates the association between depression symptoms and moderate-to-vigorous physical activity, Prev. Med. (2014), http://dx.doi.org/10.1016/j.ypmed.2014.05.017
52 53 54 55 56 Q4 57 58 59 60 61 Q5 62 63 64 65 66 67 68 69 70 71
79 80 81 82 83 Q6 84 85 86 87 88 89 90 91 Q7 92 93
Methods
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Participants and procedures
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The Nicotine Dependence in Teens (NDIT) study is an ongoing prospective cohort study (O'Loughlin et al., 2009). We analyzed data collected via mailed self-report questionnaires when participants were age 20 years (2007–08) and age 24 years (2010–11), as well as data collected via accelerometer in (2010–2011).
Multiple mediation analysis with bootstrapping procedures (Preacher and Hayes, 2008) was used to test if motivational regulations mediated the association between depression symptoms and MVPA using SPSS, version 22. Evidence for mediation in the bootstrap samples (k = 5000) was observed with the absence of zero in the 95% bias corrected and accelerated confidence interval (BCa CI; Preacher and Hayes, 2008). Indirect effects and pairwise contrasts using BCa CIs examined the unique contribution and strength of each regulation in the multiple mediator model analysis. Age, sex and self-report MVPA assessed in 2007–2008 were included as covariates.
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Results
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The final analytic sample included 319 participants (54% female; Mage 2007–08 = 20, SD = 0.68; Mage 2010–11 = 24, SD = .07). Most (78%) self-identified as Caucasian, 74% were single, and 18% reported an annual household income of less than $20,000, the median number of days worn was four at an average wear time of 13 h per day. Amotivation was highly skewed and was excluded from the analyses given that no transformation normalized the variable. Descriptive statistics and bivariate correlations are presented in Table 1. Depression symptoms were positively associated with external (p = .03) and introjected (p = .04) regulations, and negatively associated with intrinsic motivation (p = .01; Table 1). Introjected regulation (p = .04) was negatively associated with MVPA, while identified regulation (p = .01) was positively associated with MVPA. Intrinsic motivation was positively associated with MVPA (p = .01). Introjected regulation was a statistically significant mediator in the relationship between depression symptoms and MVPA (R2 adj = 0.12; point estimate = − 0.0011; BCa CI = − 0.15 to − 0.01). Participants who had higher depression symptom scores reported higher levels of introjected regulation, and in turn, engaged in less MVPA. However, depression symptoms were not directly related to MVPA. The final model accounted for 12% of the variance in MVPA (Table 2).
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Discussion
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This study shows that individuals who experienced more frequent depression symptoms reported more introjected regulation and engaged in less MVPA. These longitudinal results support the notion that depression symptoms may influence motivational regulations and in turn, MVPA participation. This is the first study to report longitudinal data on the association between depression symptoms and introjected regulation. Depression symptoms have been linked to loss of confidence and self-esteem, elevated feelings of self-criticism and excessive inappropriate guilt
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and MVPA participation in 2007–2008 using The International PA Questionnaire 117 — Short Form (Craig et al., 2003). 118
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pressures or to avoid guilt, ego threat or shame (Ryan and Deci, 2000a, 2000b). Identified regulation concerns sanctions that motivate behaviors that are assumed to be important and done willingly, yet for extrinsic reasons (Ryan and Deci, 2000a, 2000b). Integrated regulation is described as engaging in activities that are important to the individual and directed towards a desired outcome (Ryan and Deci, 2000a, 2000b). Intrinsic motivation, at the most self-determined end of the continuum, refers to behaviors that are determined by interest or enjoyment (Ryan and Deci, 2000a, 2000b). Amotivation, external and introjected regulations are associated with numerous maladaptive outcomes such as negative affect (Ryan and Deci, 2000a, 2000b; Vallerand and Ratelle, 2002) and lower PA levels (Teixeira et al., 2012; Vallerand et al., 2008), whereas the other regulations are associated with greater psychological wellbeing and PA participation (Ng et al., 2012; Standage et al., 2012; Wilson et al., 2006). Based on empirical research and theoretical tenets, it is possible that motivational regulations mediate the association between depression symptoms and MVPA (Beck and Alford, 2009; Brunet et al., 2013). However, there are no direct tests of this proposition. The purpose of this study was to test the motivational regulations embedded in OIT as mediators of the relationships between depression symptoms and MVPA in young adults over a 4-year timespan.
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Study variables
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The Major Depression Inventory (Bech et al., 1997) was used to assess symptoms of depression at age 20 years. Participants rated the frequency with which they experienced each of ten depression symptoms in the past two weeks. Motivational regulations for PA were assessed using the 19-item Behavioral Regulation in Exercise Questionnaire-2 (BREQ-2; Markland and Tobin, 2004) at age 24 years. The BREQ-2 does not assess integrated regulation. MVPA was assessed using an Actical accelerometer (Phillips-Respironics, Oregon, USA) one month after the self-report questionnaire was administered to assess motivational regulations. Participants wore the device on their right hip on an elasticized belt during waking hours for seven days. Data cleaning was conducted following established criteria (Colley et al., 2011). MVPA was computed as minutes with accelerometer counts over 1952 (Healy et al., 2008). In addition, participants reported their age in 2007–08 and 2010–11, sex, ethnicity, current marital status and annual household income in 2010–2011,
t1:1 t1:2 t1:3
Table 1 Descriptive statistics and correlations between depression symptoms (assessed in 2007–2008), PA regulations (assessed in 2010–2011) and accelerometer-derived MVPA (assessed in 2010–2011).
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Cronbach alpha
10.00 (8.11) 0.54 (0.69) 1.31 (1.01) 2.47 (1.01) 2.54 (1.18) 36.09 (23.51)
.86 .80 .79 .83 .93
t1:5 t1:6 t1:7 t1:8 t1:9 t1:10 t1:11 t1:12 t1:13 t1:14 t1:15
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Depression symptoms External Introjected Identified Intrinsic Accelerometer MVPA (min)
Correlation 1
2
– .12⁎ .13⁎
– .30⁎⁎
−.01 −.15⁎⁎ −.07
.05 −.07 −.01
3
4
5
6
– .53⁎⁎ .28⁎⁎ −.02⁎
– .76⁎⁎ .17⁎⁎
– .17⁎⁎
–
Means, standard deviations (SD), alpha values and correlations for continuous variables for males (n = 147) and females (n = 172) living in Montreal, Quebec. Score range for depression symptoms 0–41, external 0–3.50, introjected 0–4, identified 0–4, intrinsic 0–4 and accelerometer MVPA 0–123 min. ⁎ p b .05. ⁎⁎ p b .01.
Please cite this article as: Scarapicchia, T.M.F., et al., Physical activity motivation mediates the association between depression symptoms and moderate-to-vigorous physical activity, Prev. Med. (2014), http://dx.doi.org/10.1016/j.ypmed.2014.05.017
132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 Q9
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Point estimate
BCa CIa
Accelerometer MVPA (minutes) Totalb External Introjected Identified Intrinsic C1 (contrast between external and introjected) C2 (contrast between external and identified) C3 (contrast between external and intrinsic) C4 (contrast between introjected and identified) C5 (contrast between introjected and intrinsic) C6 (contrast between identified and intrinsic)
−0.0052 −0.0007 −0.0011 −0.0014 −0.0021 0.0004 0.0007 0.0014 0.0003 0.0010 0.0007
−0.19–0.05 −0.04–0.07 −0.15–−0.01 −0.07–0.09 −0.13–0.04 −0.02–0.18 −0.09–0.10 −0.05–0.14 −0.21–0.04 −0.13–0.09 −0.13–0.10
F
0.12⁎⁎
Note. BCa CI = Bias Corrected and Accelerated Confidence Intervals. ⁎⁎ p b .001. a Number of bootstrap resamples = 5000. b Controlling for age, sex and self-report MVPA assessed at age 20 years.
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(American Psychiatric Association, 2011). These aspects are consistent with the operationalization of introjected regulation (i.e., engaged in behaviors to avoid negative emotions or protect one's ego identity and self-worth; Deci and Ryan, 2000). Intervention research should therefore be developed to target depression symptoms, to attenuate more extrinsic forms of motivation such as introjected regulation, as these may have negative implications on MVPA participation among young adults. Similar to previous research (Duncan et al., 2010; Gillison et al., 2009), introjected regulation was negatively associated with MVPA, and it mediated the association between depression symptoms and MVPA. Nonetheless, introjected regulation is associated with short but not long-term persistence in PA (Gillison et al., 2009). It may therefore be a driving force for individuals to begin engaging in PA but may not be sustainable in the long-term (Pelletier et al., 2001). Identified regulation, which is often associated with positive PA outcomes such as increased exercise frequency (Duncan et al., 2010), was associated with MVPA in this current analysis. This is consistent with previous findings demonstrating that individuals may value PA but may not find it inherently enjoyable (Deci and Ryan, 2000). Limitations of this analysis include the utilization of self-report for depression symptoms and past MVPA, which may be subject to misclassification. Furthermore, amotivation was not assessed in this study, which prevents inference about how this motivation regulation links to depression symptoms. Moreover, the cohort is from Montreal, Quebec which may limit the generalizability of the results.
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Conclusion
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The present study extends previous research by testing mediation in the association between depression and MVPA longitudinally. Depression symptoms may undermine controlling forms of motivational regulations, resulting in decreased MVPA. Intervention strategies may be needed to address depression symptoms in young adults in order to promote sustained MVPA participation.
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Conflict of interest
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Acknowledgments
The authors declare that there are no conflicts of interests.
198 Q10 This work was supported by the Canadian Cancer Society. TMFS is 199 supported by the CIHR Strategic Training Program in Public Health 200
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Policy; JOL holds a Canada Research Chair in the Early Determinants of
References
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American Psychiatric Association, 2011. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. text rev. American Psychiatric Publishing, Arlington,. Bech, P., Stage, K.B., Nair, N.P.V., Larsen, J.K., Kragh-Sørensen, P., Gjerris, A., 1997. The Major Depression Rating Scale (MDS): inter-rater reliability and validity across different settings in randomized moclobemide trials. J. Affect. Disord. 42, 39–48. Beck, A.T., Alford, B.A., 2009. Depression: Causes and Treatment, 2nd ed. University of Pennsylvania Press, Philadelphia,. Brunet, J., Sabiston, C.M., O'Loughlin, E., Chaiton, M., Low, N.C.P., O'Loughlin, J.L., 2013. Symptoms of depression are longitudinally associated with sedentary behaviors among young men but not among young women. Prev. Med. Colley, R.C., Garriguet, D., Janssen, I., Craig, C.L., Clarke, J., Tremblay, M.S., 2011. Physical activity of Canadian adults: accelerometer results from the 2007 to 2009 Canadian Health Measures Survey. Health Rep. 22, 7–14. Craig, C.L., Marshall, A.L., Sjöström, M., et al., 2003. International physical activity questionnaire: 12-country reliability and validity. Med. Sci. Sports Exerc. 35, 1381–1395. Deci, E.L., Ryan, R.M., 2000. The “what” and “why” of goal pursuits: human needs and the self-determination of behavior. Psychol. Inq. 11, 227–268. Deci, E.L., Ryan, R.M., 2002. Handbook of Self-determination Research. University of Rocherster Press, Rochester,. Duncan, L.R., Hall, C.R., Wilson, P.M., Jenny, O., 2010. Exercise motivation: a cross-sectional analysis examining its relationship with frequency, intensity and duration of exercise. Int. J. Behav. Nutr. Phys. Act. 7. Eisenberg, D., Gollust, S.E., Golberstein, E., Hefner, J.L., 2007. Prevalence and correlates of depression, anxiety, and suicidality among university students. Am. J. Orthopsychiatry 77, 534–542. Ferrari, A.J., Charlson, F.J., Norman, R.E., et al., 2013. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Med. 10, e1001547. Gillison, F., Osborn, M., Standage, M., Skevington, S., 2009. Exploring the experience of introjected regulation for exercise across gender in adolescence. Psychol. Sport Exerc. 10, 309–319. Healy, G.N., Wijndaele, K., Dunstan, D.W., et al., 2008. Objectively measured sedentary time, physical activity, and metabolic risk: the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Diabetes Care 31, 369–371. Jerstad, S.J., Boutelle, K.N., Ness, K.K., Stice, E., 2010. Prospective reciprocal relations between physical activity and depression in female adolescents. J. Consult. Clin. Psychol. 78, 268–272. Markland, D., Tobin, V., 2004. A modification to the behavioural regulation in exercise questionnaire to include an assessment of amotivation. J. Sport Exerc. Psychol. 26, 191–196. Ng, J.J.Y., Thogersen-Ntoumani, C., Ntoumanis, N., 2012. Motivation contagion when instructing obese individuals: a test in exercise settings. J. Sport Exerc. Psychol. 34, 525–538. O'Loughlin, J., Karp, I., Koulis, T., Paradis, G., Difranza, J., 2009. Determinants of first puff and daily cigarette smoking in adolescents. Am. J. Epidemiol. 170, 585–597. Pelletier, L.G., Fortier, M.S., Vallerand, R.J., Brière, N.M., 2001. Associations among perceived autonomy support, forms of self-regulation, and persistence: a prospective study. Motiv. Emot. 25, 279–306. Preacher, K.J., Hayes, A.F., 2008. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav. Res. Methods 40, 879–891. Roshanaei-Moghaddam, B., Katon, W.J., Russo, J., 2009. The longitudinal effects of depression on physical activity. Gen. Hosp. Psychiatry 31, 306–315.
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Table 2 Bootstrap indirect effects of depression symptoms on minutes of weekly accelerometer MVPA through PA regulations.
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Ryan, E.L., Deci, R.M., 2000a. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am. Psychol. 55, 68–78. Ryan, R.L., Deci, R.M., 2000b. Intrinsic and extrinsic motivations: classic definitions and new directions. Contemp. Educ. Psychol. 25, 54–67. Standage, M., Gillison, F.B., Ntoumanis, N., Treasure, D.C., 2012. Predicting students' physical activity and health-related well-being: a prospective cross-domain investigation of motivation across school physical education and exercise settings. J. Sport Exerc. Psychol. 34, 37–60. Teixeira, P.J., Carraça, E.V., Markland, D., Silva, M.N., Ryan, R.M., 2012. Exercise, physical activity, and self-determination theory: a systematic review. Int. J. Behav. Nutr. Phys. Act. 9. Tremblay, M.S., Warburton, D.E.R., Janssen, I., et al., 2011. New Canadian physical activity guidelines. Appl. Physiol. Nutr. Metab. 36, 36–46.
Vallerand, R.J., Ratelle, C.F., 2002. Intrinsic and extrinsic motivation: a hierarchical model. In: Deci, E.L., Ryan, R.M. (Eds.), Handbook of Self-determination Research. University Rochester Press, pp. 37–63. Wilson, P.M., Rodgers, W.M., Fraser, S.N., Murray, T.C., 2004. Relationship between exercise regulations and motivational consequences in university students. Res. Q. Exerc. Sport 75, 81–91. Wilson, P.M., Rodgers, W.M., Loitz, C.C., Scime, G., 2006. “It's who I am … really!” The importance of integrated regulation in exercise contexts. J. Appl. Behav. Res. 11, 79–104. Wilson, P.M., Sabiston, C.M., Mack, D.E., Blanchard, C.M., 2012. On the nature and function of scoring protocols used in exercise motivation research: an empirical study of the behavioral regulation in exercise questionnaire. Psychol. Sport Exerc. 13, 614–622.
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Contents lists available at ScienceDirect
Preventive Medicine journal homepage: www.elsevier.com/locate/ypmed
F
6 7 8 9 10
a
1 1
a r t i c l e
12 13
Available online xxxx
14 15 16 17 18
Keywords: Mental health Exercise Intention Organismic Integration Theory
University of Toronto, 55 Harbord St., Toronto, Ontario M5S 2W6, Canada Centre de recherche CHUM, University of Montreal, 3850 Saint-Urbain Street, Montreal, Quebec H2W 1T7, Canada Concordia University, 7141 Sherbrooke West, Montreal, Quebec H4B 1R6, Canada d University of Ottawa, 125 University Private, Ottawa, Ontario K1N 6N5, Canada e Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada b c
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Tanya M.F. Scarapicchia a, Catherine M. Sabiston a,⁎, Erin O'Loughlin b,c, Jennifer Brunet d, Michael Chaiton a,e, Jennifer L. O'Loughlin b
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Physical activity motivation mediates the association between depression symptoms and moderate-to-vigorous physical activity
a b s t r a c t
Objective. To test if motivational regulations (i.e., amotivation, external, introjected, identified, and intrinsic) mediate the association between depression symptoms and moderate-to-vigorous physical activity (MVPA) in young adults. Method. A total of 319 young adults from Montreal, Quebec participating in the Nicotine Dependence in Teens (NDIT) study provided self-report data on depression symptoms at age 20 (SD = 0.7 years) and motivational regulations at age 24 (SD = 0.7 years). MVPA was assessed using a self-report questionnaire at age 20 (i.e., at the same time motivation was measured) and using accelerometers one month later. Multiple mediation analysis with bootstrapping was employed to analyze the data. Results. Controlling for age, sex and self-reported MVPA at age 20 years; introjected regulation was a significant mediator of the association between depression symptoms and MVPA (R2 adj = 0.12; point estimate = −0.0011; BCa CI = −0.15 to −0.01). Conclusion. Depression symptoms may undermine controlling forms of motivation, resulting in decreased MVPA. Intervention strategies may be needed to address depression symptoms in young adults to promote sustained MVPA. © 2014 Published by Elsevier Inc.
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Introduction
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Adults should accumulate at least 150 min of moderate-to-vigorous physical activity (MVPA) per week to achieve health benefits (Tremblay et al., 2011). However less than 15% of adults attain these recommendations (Colley et al., 2011). One factor that may contribute to the high prevalence of physical inactivity is depression (Roshanaei-Moghaddam et al., 2009). Depression is an important public health burden worldwide (Ferrari et al., 2013). A common symptom of depression is anhedonia, which is characterized by diminished pleasure in activities such as physical activity (PA) that are usually found enjoyable (American Psychiatric Association, 2011). Further, depression symptoms often include motor delay and low energy, both of which may affect the ability to engage in PA
46 47 48 49 50 51
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⁎ Corresponding author at: 55 Harbord Street, Toronto, Ontario M5S 2W6, Canada. E-mail addresses: [email protected] (T.M.F. Scarapicchia), [email protected] (C.M. Sabiston), [email protected] (E. O'Loughlin), [email protected] (J. Brunet), [email protected] (M. Chaiton).
(Jerstad et al., 2010). There has been indirect evidence from longitudinal studies to support these associations (Brunet et al., 2013; Jerstad et al., 2010). Little is known about mechanisms that may underpin the association between depression and PA. In the current study, motivation is proposed as one such mechanism. This association is essential to examine among young adults, as during this time often the first symptoms of depression arise (Eisenberg et al., 2007). Lack of motivation is a common symptom of depression (Beck and Alford, 2009), and motivation is a consistent predictor of PA (Wilson et al., 2012). The Organismic Integration Theory (OIT; Ryan and Deci, 2000a, 2000b) posits six motivational regulations for PA, along a selfdetermination continuum. Amotivation, at one end of the continuum, is a lack of motivation whereby an individual has no intention to act (Deci and Ryan, 2002). There are four distinct forms of extrinsic motivation that sequentially increase in their degree of self-determination from more controlling to more autonomous forms of regulation (Deci and Ryan, 2002; Wilson et al., 2004). External regulation involves engaging in behaviors that are performed because of external demands or possible rewards (Ryan and Deci, 2000a, 2000b). Introjected regulation is characterized by behaviors that are reinforced by internal
http://dx.doi.org/10.1016/j.ypmed.2014.05.017 0091-7435/© 2014 Published by Elsevier Inc.
Please cite this article as: Scarapicchia, T.M.F., et al., Physical activity motivation mediates the association between depression symptoms and moderate-to-vigorous physical activity, Prev. Med. (2014), http://dx.doi.org/10.1016/j.ypmed.2014.05.017
52 53 54 55 56 Q4 57 58 59 60 61 Q5 62 63 64 65 66 67 68 69 70 71
79 80 81 82 83 Q6 84 85 86 87 88 89 90 91 Q7 92 93
Methods
95
Participants and procedures
96 97 98 99 100
The Nicotine Dependence in Teens (NDIT) study is an ongoing prospective cohort study (O'Loughlin et al., 2009). We analyzed data collected via mailed self-report questionnaires when participants were age 20 years (2007–08) and age 24 years (2010–11), as well as data collected via accelerometer in (2010–2011).
Multiple mediation analysis with bootstrapping procedures (Preacher and Hayes, 2008) was used to test if motivational regulations mediated the association between depression symptoms and MVPA using SPSS, version 22. Evidence for mediation in the bootstrap samples (k = 5000) was observed with the absence of zero in the 95% bias corrected and accelerated confidence interval (BCa CI; Preacher and Hayes, 2008). Indirect effects and pairwise contrasts using BCa CIs examined the unique contribution and strength of each regulation in the multiple mediator model analysis. Age, sex and self-report MVPA assessed in 2007–2008 were included as covariates.
120 121 122 123 124 125 126 127 128
Results
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The final analytic sample included 319 participants (54% female; Mage 2007–08 = 20, SD = 0.68; Mage 2010–11 = 24, SD = .07). Most (78%) self-identified as Caucasian, 74% were single, and 18% reported an annual household income of less than $20,000, the median number of days worn was four at an average wear time of 13 h per day. Amotivation was highly skewed and was excluded from the analyses given that no transformation normalized the variable. Descriptive statistics and bivariate correlations are presented in Table 1. Depression symptoms were positively associated with external (p = .03) and introjected (p = .04) regulations, and negatively associated with intrinsic motivation (p = .01; Table 1). Introjected regulation (p = .04) was negatively associated with MVPA, while identified regulation (p = .01) was positively associated with MVPA. Intrinsic motivation was positively associated with MVPA (p = .01). Introjected regulation was a statistically significant mediator in the relationship between depression symptoms and MVPA (R2 adj = 0.12; point estimate = − 0.0011; BCa CI = − 0.15 to − 0.01). Participants who had higher depression symptom scores reported higher levels of introjected regulation, and in turn, engaged in less MVPA. However, depression symptoms were not directly related to MVPA. The final model accounted for 12% of the variance in MVPA (Table 2).
130 131
Discussion
151
This study shows that individuals who experienced more frequent depression symptoms reported more introjected regulation and engaged in less MVPA. These longitudinal results support the notion that depression symptoms may influence motivational regulations and in turn, MVPA participation. This is the first study to report longitudinal data on the association between depression symptoms and introjected regulation. Depression symptoms have been linked to loss of confidence and self-esteem, elevated feelings of self-criticism and excessive inappropriate guilt
152 153
P
94
119
F
78
Data analysis
O
76 77
and MVPA participation in 2007–2008 using The International PA Questionnaire 117 — Short Form (Craig et al., 2003). 118
D
74 75
pressures or to avoid guilt, ego threat or shame (Ryan and Deci, 2000a, 2000b). Identified regulation concerns sanctions that motivate behaviors that are assumed to be important and done willingly, yet for extrinsic reasons (Ryan and Deci, 2000a, 2000b). Integrated regulation is described as engaging in activities that are important to the individual and directed towards a desired outcome (Ryan and Deci, 2000a, 2000b). Intrinsic motivation, at the most self-determined end of the continuum, refers to behaviors that are determined by interest or enjoyment (Ryan and Deci, 2000a, 2000b). Amotivation, external and introjected regulations are associated with numerous maladaptive outcomes such as negative affect (Ryan and Deci, 2000a, 2000b; Vallerand and Ratelle, 2002) and lower PA levels (Teixeira et al., 2012; Vallerand et al., 2008), whereas the other regulations are associated with greater psychological wellbeing and PA participation (Ng et al., 2012; Standage et al., 2012; Wilson et al., 2006). Based on empirical research and theoretical tenets, it is possible that motivational regulations mediate the association between depression symptoms and MVPA (Beck and Alford, 2009; Brunet et al., 2013). However, there are no direct tests of this proposition. The purpose of this study was to test the motivational regulations embedded in OIT as mediators of the relationships between depression symptoms and MVPA in young adults over a 4-year timespan.
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R O
2
Study variables
102 103 104 105 106 107 108 109 Q8 110 111 112 113 114 115 116
The Major Depression Inventory (Bech et al., 1997) was used to assess symptoms of depression at age 20 years. Participants rated the frequency with which they experienced each of ten depression symptoms in the past two weeks. Motivational regulations for PA were assessed using the 19-item Behavioral Regulation in Exercise Questionnaire-2 (BREQ-2; Markland and Tobin, 2004) at age 24 years. The BREQ-2 does not assess integrated regulation. MVPA was assessed using an Actical accelerometer (Phillips-Respironics, Oregon, USA) one month after the self-report questionnaire was administered to assess motivational regulations. Participants wore the device on their right hip on an elasticized belt during waking hours for seven days. Data cleaning was conducted following established criteria (Colley et al., 2011). MVPA was computed as minutes with accelerometer counts over 1952 (Healy et al., 2008). In addition, participants reported their age in 2007–08 and 2010–11, sex, ethnicity, current marital status and annual household income in 2010–2011,
t1:1 t1:2 t1:3
Table 1 Descriptive statistics and correlations between depression symptoms (assessed in 2007–2008), PA regulations (assessed in 2010–2011) and accelerometer-derived MVPA (assessed in 2010–2011).
U
N
C
O
R
R
E
C
101
t1:4
Mean (SD)
Cronbach alpha
10.00 (8.11) 0.54 (0.69) 1.31 (1.01) 2.47 (1.01) 2.54 (1.18) 36.09 (23.51)
.86 .80 .79 .83 .93
t1:5 t1:6 t1:7 t1:8 t1:9 t1:10 t1:11 t1:12 t1:13 t1:14 t1:15
1 2 3 4 5 6
Depression symptoms External Introjected Identified Intrinsic Accelerometer MVPA (min)
Correlation 1
2
– .12⁎ .13⁎
– .30⁎⁎
−.01 −.15⁎⁎ −.07
.05 −.07 −.01
3
4
5
6
– .53⁎⁎ .28⁎⁎ −.02⁎
– .76⁎⁎ .17⁎⁎
– .17⁎⁎
–
Means, standard deviations (SD), alpha values and correlations for continuous variables for males (n = 147) and females (n = 172) living in Montreal, Quebec. Score range for depression symptoms 0–41, external 0–3.50, introjected 0–4, identified 0–4, intrinsic 0–4 and accelerometer MVPA 0–123 min. ⁎ p b .05. ⁎⁎ p b .01.
Please cite this article as: Scarapicchia, T.M.F., et al., Physical activity motivation mediates the association between depression symptoms and moderate-to-vigorous physical activity, Prev. Med. (2014), http://dx.doi.org/10.1016/j.ypmed.2014.05.017
132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 Q9
154 155 156 157 158 159 160
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Point estimate
BCa CIa
Accelerometer MVPA (minutes) Totalb External Introjected Identified Intrinsic C1 (contrast between external and introjected) C2 (contrast between external and identified) C3 (contrast between external and intrinsic) C4 (contrast between introjected and identified) C5 (contrast between introjected and intrinsic) C6 (contrast between identified and intrinsic)
−0.0052 −0.0007 −0.0011 −0.0014 −0.0021 0.0004 0.0007 0.0014 0.0003 0.0010 0.0007
−0.19–0.05 −0.04–0.07 −0.15–−0.01 −0.07–0.09 −0.13–0.04 −0.02–0.18 −0.09–0.10 −0.05–0.14 −0.21–0.04 −0.13–0.09 −0.13–0.10
F
0.12⁎⁎
Note. BCa CI = Bias Corrected and Accelerated Confidence Intervals. ⁎⁎ p b .001. a Number of bootstrap resamples = 5000. b Controlling for age, sex and self-report MVPA assessed at age 20 years.
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(American Psychiatric Association, 2011). These aspects are consistent with the operationalization of introjected regulation (i.e., engaged in behaviors to avoid negative emotions or protect one's ego identity and self-worth; Deci and Ryan, 2000). Intervention research should therefore be developed to target depression symptoms, to attenuate more extrinsic forms of motivation such as introjected regulation, as these may have negative implications on MVPA participation among young adults. Similar to previous research (Duncan et al., 2010; Gillison et al., 2009), introjected regulation was negatively associated with MVPA, and it mediated the association between depression symptoms and MVPA. Nonetheless, introjected regulation is associated with short but not long-term persistence in PA (Gillison et al., 2009). It may therefore be a driving force for individuals to begin engaging in PA but may not be sustainable in the long-term (Pelletier et al., 2001). Identified regulation, which is often associated with positive PA outcomes such as increased exercise frequency (Duncan et al., 2010), was associated with MVPA in this current analysis. This is consistent with previous findings demonstrating that individuals may value PA but may not find it inherently enjoyable (Deci and Ryan, 2000). Limitations of this analysis include the utilization of self-report for depression symptoms and past MVPA, which may be subject to misclassification. Furthermore, amotivation was not assessed in this study, which prevents inference about how this motivation regulation links to depression symptoms. Moreover, the cohort is from Montreal, Quebec which may limit the generalizability of the results.
188
Conclusion
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The present study extends previous research by testing mediation in the association between depression and MVPA longitudinally. Depression symptoms may undermine controlling forms of motivational regulations, resulting in decreased MVPA. Intervention strategies may be needed to address depression symptoms in young adults in order to promote sustained MVPA participation.
176 177 178 179 180 181 182 183 184 185 186
190 191 192 193 194 195 196
Conflict of interest
197
Acknowledgments
The authors declare that there are no conflicts of interests.
198 Q10 This work was supported by the Canadian Cancer Society. TMFS is 199 supported by the CIHR Strategic Training Program in Public Health 200
R O
Adult Chronic Disease and JB is supported by the Canadian Cancer 201 Society Career Development Award in Prevention. 202
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174 175
E
172 173
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170 171
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168 169
N C O
166 167
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164 165
O
t2:16 t2:17 t2:18 t2:19
162 163
R2 adj
P
t2:4 t2:5 t2:6 t2:7 t2:8 t2:9 t2:10 t2:11 t2:12 t2:13 t2:14 t2:15
Variable
Policy; JOL holds a Canada Research Chair in the Early Determinants of
References
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