The Relationship between Depression, Anxiety, Stress, and Physical Activity with Cardiovascular Disease Risk, Using Structural Equation Modeling in Adults in Yazd City

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.