Mediators of gender effects on depression among cardiovascular disease patients in Palestine

Abstract

Background Among patients suffering from coronary heart disease (CHD) and comorbid depression, women experience a higher burden compared to men. Little is known on the characteristics that differentiate men and women with both diseases and whether these factors mediate gender effects on depression. This study assessed whether women are more likely to suffer from depression and which characteristics mediate gender effects on depression among a cardiac population in Palestine, specifically addressing the role of post-traumatic stress disorder (PTSD). Methods Using a cross-sectional design, patients consecutively admitted with a CHD to one of the four main hospitals in Nablus, Palestine, were interviewed using a structured questionnaire with validated instruments. Data was also obtained from hospital medical records. Patients were assessed for depression using the Cardiac Depression Scale (CDS). Bivariate analysis was conducted to compare characteristics of women and men with and without depressive symptoms. Mediators (direct and indirect effects) of the association between gender and depression were evaluated using a structural equation model (SEM). Results Women were more likely to suffer from severe depression than men (28.7% vs. 18.8%). Female gender was positively associated with higher PTSD symptoms, comorbidities, somatic symptoms and income, and with lower resilience, self-esteem, quality of life, education, prevalence of smoking and physical activity. Structural equation modeling revealed negative indirect effects of gender on depression (CDS score) through resilience, self-esteem and physical activity, whereas positive indirect effects of gender on depression were observed through PTSD, comorbidities, somatic symptoms and smoking. There was no direct effect of gender on depression. Conclusion This study found a higher prevalence of severe depression in female patients with cardiac disease compared to male cardiac patients. Our findings provide novel information on mediating factors of the association between gender and depression among cardiac patients, in particular PTSD. The results emphasize the need for further research on potential mediating factors that could account for gender differences in depression and the need to provide support programs for female patients with comorbid CHD and depression to improve their psycho-social well-being.

Resilience and Depressive Symptoms in Adults With Cardiac Disease

“…The remaining 5 depression scales used in the studies in this analysis also can be used as continuous measurements, with higher scores indicating increased severity of depressive symptoms 62,68,74 . Three studies used the Cardiac Depression Scale 49–51 . Three studies used the Patient Health Questionnaire 44,46,54 .…”

“…47,48 Four studies included patients with "cardiac diagnoses," which included CHD, HF, atrial fibrillation, and/or arrythmia. [49][50][51][52] One study examined patients who were admitted to a cardiac rehabilitation program with a cardiac diagnosis. 53…”

“…Details on validity and reliability of each resilience scale are provided in Table 1. Five studies used the Wagnild and Young Resilience Scale, either 13-, 14-, or 25-item versions, [47][48][49]51,52,54 first established from a qualitative study of 24 women who had adapted successfully after a major adverse event. 61 From their narratives, 5 interrelated components were identified that constitute resilience: equanimity, perseverance, self-reliance, meaningfulness, and existential aloneness.…”

Sex specificities of medical and social parameters in patients with coronary artery disease with different severity of depression

“…В палестинском исследовании 2019г у женщин симптомы тяжелой депрессии диагностировались в 1,5 раза чаще, чем у мужчин -28,7 vs 18,8%, что соответствует результатам нашего исследования. В женской популяции преобладали такие психосоциальные факторы, как низкая стрессоустойчивость и самооценка, низкий уровень КЖ, отсутствие высшего образования, курение и гиподинамия, а также наличие коморбидных патологий [7].…”

Psychosocial Functioning, BMI, and Nutritional Behaviors in Women at Cardiovascular Risk

“…Psychological functioning appears to have a differential effect on health behaviors for men and for women. One study of cardiac patients found that women with cardiovascular disease and comorbid depression were less likely to engage in physical activity compared with their male counterparts ( Allabadi et al, 2019 ). In one particularly striking study, higher levels of anxiety for women were associated with a significant decrease in a score measuring healthy lifestyle (i.e., physical activity, diet, BMI, and alcohol and tobacco consumption) over 20 years.…”