Skip to main content

Advertisement

SpringerLink
Log in

Depression in Patients with Heart Diseases: Gender Differences and Association of Comorbidities, Optimism, and Spiritual Struggle

  • Full length manuscript
  • Published:
International Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Background

Depression is a well-established comorbidity of heart disease (HD) and is more prevalent in women than in men. Few studies have examined the gender effect on depression in patients with advanced heart disease prior to open heart surgery (OHS), controlling for cardiac indices. Previous studies indicated the health benefit of optimism but often lacked adjustment for medical confounders. This interdisciplinary study investigated gender differences in pre-OHS depression and the role of medical comorbidities and strength factors.

Method

Two waves of survey data were collected from 481 patients (mean age = 62, female 42%) along with medical indices in the Society of Thoracic Surgeon’s (STS) national database used by all US cardiac surgeons.

Results

A t test showed significantly higher levels of pre-OHS depressive symptoms in women than in men. In multivariate analyses, the gender effect on depression vanished after entry of other socio-demographics, medical comorbidities, objectively assessed cardiac indices in the STS database, and psychosocial strength factors. Depressive symptoms linked inversely with dispositional optimism and positively with medical comorbidities and religious/spiritual struggle, but not with any cardiac indices. A mediation analysis supported the role of comorbidities in the gender difference.

Conclusion

Women with heart disease were more depressed, but the gender difference may be partly explained by multiple comorbid conditions that could complicate disease burden. Reinforcing the literature, optimism, but not other strength factors, appeared to counteract depression after adjusting for health and cardiac conditions. The finding suggests that health providers should be more attentive to overall health of women with heart disease and to the positive expectations of OHS patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. News U. Some 300 million people suffer from depression, UN warns ahead of World Health Day. 2017; https://news.un.org/en/story/2017/03/554462-some-300-million-people-suffer-depression-un-warns-ahead-world-health-day. Accessed 6/12/2020.

  2. Michaud CM, Murray CJ, Bloom BR. Burden of disease--implications for future research. JAMA. 2001;285(5):535–9.

    CAS  PubMed  Google Scholar 

  3. American Heart Association. Heart Disease and Stroke Statistics 2017. 2018; https://professional.heart.org/idc/groups/ahamah-public, 2018.

  4. Daskalopoulou M, George J, Walters K, Osborn DP, Batty GD, Stogiannis D, et al. Depression as a risk factor for the initial presentation of twelve cardiac, cerebrovascular, and peripheral arterial diseases: data linkage study of 1.9 million women and men. PloS one. 2016;11(4):–e0153838-e0153838.

  5. Lichtman JH, Bigger JT Jr, Blumenthal JA, et al. Depression and coronary heart disease: recommendations for screening, referral, and treatment: a science advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Psychiatric Association. Circulation. 2008;118(17):1768–75.

    PubMed  Google Scholar 

  6. Lichtman JH, Froelicher ES, Blumenthal JA, et al. Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the American Heart Association. Circulation. 2014;129(12):1350–69.

    PubMed  Google Scholar 

  7. Baetta R, Pontremoli M, Fernandez AM, Spickett CM, Banfi C. Reprint of: Proteomics in cardiovascular diseases: unveiling sex and gender differences in the era of precision medicine. J Proteomics. 2018;178:57–72.

    CAS  PubMed  Google Scholar 

  8. Kim C, Redberg RF, Pavlic T, Eagle KA. A systematic review of gender differences in mortality after coronary artery bypass graft surgery and percutaneous coronary interventions. Clin Cardiol. 2007;30(10):491–5.

    PubMed  PubMed Central  Google Scholar 

  9. Lam L, Ahn HJ, Okajima K, et al. Gender differences in the rate of 30-day readmissions after percutaneous coronary intervention for acute coronary syndrome. Women’s health issues : official publication of the Jacobs Institute of Women's Health. 2019;29(1):17–22.

    Google Scholar 

  10. Meijer A, Conradi HJ, Bos EH, Thombs BD, van Melle JP, de Jonge P. Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis of 25 years of research. General hospital psychiatry. 2011;33(3):203–16.

    PubMed  Google Scholar 

  11. Shen BJ, Eisenberg SA, Maeda U, Farrell KA, Schwarz ER, Penedo FJ, et al. Depression and anxiety predict decline in physical health functioning in patients with heart failure. Ann Behav Med. 2011;41(3):373–82.

    PubMed  Google Scholar 

  12. Sin NL, Yaffe K, Whooley MA. Depressive symptoms, cardiovascular disease severity, and functional status in older adults with coronary heart disease: the heart and soul study. J Am Geriatr Soc. 2015;63(1):8–15.

    PubMed  Google Scholar 

  13. Xu Y. Ethnic variations in the relationship between socioeconomic status and psychological distress among Latino adults. Race and Social Problems. 2011;3(3):212–24.

    Google Scholar 

  14. Carr T, Teucher U, Mann J, Casson AG. Waiting for surgery from the patient perspective. Psychology research and behavior management. 2009;2:107–19.

    PubMed  PubMed Central  Google Scholar 

  15. McCormick KM, Naimark BJ, Tate RB. Uncertainty, symptom distress, anxiety, and functional status in patients awaiting coronary artery bypass surgery. Heart & lung : the journal of critical care. 2006;35(1):34–45.

    Google Scholar 

  16. Albert P. Why is depression more prevalent in women? J Psychiatry Neurosci. 2015;40(4):219–21.

    PubMed  PubMed Central  Google Scholar 

  17. Kabutoya T, Hoshide S, Davidson KW, Kario K. Sex differences and the prognosis of depressive and nondepressive patients with cardiovascular risk factors: the Japan Morning Surge-Home Blood Pressure (J-HOP) study. Hypertension research: official journal of the Japanese Society of Hypertension. 2018;41(11):965–72.

    CAS  Google Scholar 

  18. Shaw LJ, Min JK, Nasir K, Xie JX, Berman DS, Miedema MD, et al. Sex differences in calcified plaque and long-term cardiovascular mortality: observations from the CAC Consortium. Eur Heart J. 2018;39(41):3727–35.

    PubMed  PubMed Central  Google Scholar 

  19. Pulver S, Ulibarri N, Sobocinski KL, et al. Frontiers in socio-environmental research: components, connections, scale, and context. Ecol Soc. 2018;23(3).

  20. Moser DK, Kimble LP, Alberts MJ, et al. Reducing delay in seeking treatment by patients with acute coronary syndrome and stroke: a scientific statement from the American Heart Association Council on cardiovascular nursing and stroke council. Circulation. 2006;114(2):168–82.

    PubMed  Google Scholar 

  21. Ai AL, Peterson C, Dunkle RE, Saunders DG, Boiling SF, Buchtel HA. How gender affects psychological adjustment one year after coronary artery bypass graft surgery. Women Health. 1998;26(4):45–65.

    Google Scholar 

  22. Ai AL, Park CL, Huang B, Rodgers W, Tice TN. Psychosocial mediation of religious coping styles: a study of short-term psychological distress following cardiac surgery. Pers Soc Psychol Bull. 2007;33(6):867–82.

    PubMed  Google Scholar 

  23. Peterson C, Seligman ME. Explanatory style and illness. J Pers. 1987;55(2):237–65.

    CAS  PubMed  Google Scholar 

  24. Ai AL, Ardelt M, Wink P. Spirituality in aging: a journey for meaning through deep interconnection in humanity. In: Cavanaugh JC, Cavanaugh CK, editors. Aging in American: Volume 3: Societal Issues. Westport, CT: Praeger Publishers; 2010. p. 222–46.

    Google Scholar 

  25. Scheier MF, Carver CS. Optimism, coping, and health: assessment and implications of generalized outcome expectancies. Health Psychol. 1985;4(3):219–47.

    CAS  PubMed  Google Scholar 

  26. Scheier MF, Carver CS. Dispositional optimism and physical health: a long look back, a quick look forward. Am Psychol. 2018;73(9):1082–94.

    PubMed  PubMed Central  Google Scholar 

  27. Bouchard LC, Carver CS, Mens MC, Scheier MF. Optimism, health, and well-being. In: Positive psychology: established and emerging issues. New York, NY, US: Routledge/Taylor & Francis Group; 2018. p. 112–30.

    Google Scholar 

  28. Carver CS, Scheier MF, Segerstrom SC. Optimism. Clin Psychol Rev. 2010;30(7):879–89.

    PubMed  PubMed Central  Google Scholar 

  29. Kim ES, James P, Zevon ES, Trudel-Fitzgerald C, Kubzansky LD, Grodstein F. Optimism and healthy aging in women and men. Am J Epidemiol. 2019;188(6):1084–91.

    PubMed  PubMed Central  Google Scholar 

  30. Peterson C, Seligman MEP. Character strengths and virtues: a classification and handbook. New York: Oxford University Press; 2004.

    Google Scholar 

  31. Gillum RF, King DE, Obisesan TO, Koenig HG. Frequency of attendance at religious services and mortality in a U.S. national cohort. Ann Epidemiol. 2008;18(2):124–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  32. Hill TD, Angel JL, Ellison CG, Angel RJ. Religious attendance and mortality: an 8-year follow-up of older Mexican Americans. J Gerontol B Psychol Sci Soc Sci. 2005;60(2):S102–9.

    PubMed  Google Scholar 

  33. Hummer RA, Benjamins MR, Ellison CG, Rogers RG. Religious involvement and mortality risk among pre-retirement aged U.S. adults. In: Ellison CG, Hummer RA, editors. Religion, families, and health: population-based research in the United States. New Brunswick, NJ: Rutgers University Press; 2010. p. 273–91.

    Google Scholar 

  34. la Cour P, Avlund K, Schultz-Larsen K. Religion and survival in a secular region. A twenty year follow-up of 734 Danish adults born in 1914. Soc Sci Med. 2006;62(1):157–64.

    PubMed  Google Scholar 

  35. Li S, Stampfer MJ, Williams DR, VanderWeele TJ. Association of religious service attendance with mortality among women. JAMA Intern Med. 2016;176(6):777–85.

    PubMed  Google Scholar 

  36. Rasmussen HN, Scheier MF, Greenhouse JB. Optimism and physical health: a meta-analytic review. Ann Behav Med. 2009;37(3):239–56.

    PubMed  PubMed Central  Google Scholar 

  37. Schnall E, Wassertheil-Smoller S, Swencionis C, Zemon V, Tinker L, O'Sullivan MJ, et al. The relationship between religion and cardiovascular outcomes and all-cause mortality in the Women’s Health Initiative Observational Study. Psychol Health. 2010;25(2):249–63.

    PubMed  Google Scholar 

  38. Hill PC, Pargament KI. Advances in the conceptualization and measurement of religion and spirituality. Implications for physical and mental health research. Am Psychol. 2003;58(1):64–74.

    PubMed  Google Scholar 

  39. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement. 1977;1:385–401.

    Google Scholar 

  40. Snyder CER. Handbook of hope: theory, measures, and applications. San Diego: Academic; 2000.

    Google Scholar 

  41. Snyder CR, Sympson SC, Ybasco FC, Borders TF, Babyak MA, Higgins RL. Development and validation of the State Hope Scale. J Pers Soc Psychol. 1996;70(2):321–35.

    CAS  PubMed  Google Scholar 

  42. Zimet GD, Powell SS, Farley GK, Werkman S, Berkoff KA. Psychometric characteristics of the Multidimensional Scale of Perceived Social Support. J Pers Assess. Winter 1990;55(3–4):610–7.

    CAS  PubMed  Google Scholar 

  43. Chatters LM, Levin JS, Taylor RJ. Antecedents and dimensions of religious involvement among older black adults. J Gerontol. 1992;47(6):S269–78.

    CAS  PubMed  Google Scholar 

  44. Ai AL, Seymour EM, Kronfol Z, Bolling S. Moot states, coping factors, and interleukin-6 are related to psychiatric symptoms following cardiac surgery. Biol Psychiatry Psychopharmacol. 2011;13(1):2–9.

    Google Scholar 

  45. Pargament KI, Smith BW, Koenig HG, Perez L. Patterns of positive and negative religious coping with major life stressors. J Sci Stud Relig. 1998;37(4):710–24.

    Google Scholar 

  46. Ai AL, Peterson C, Bolling SF, Koenig H. Private prayer and optimism in middle-aged and older patients awaiting cardiac surgery. Gerontologist. 2002;42(1):70–81.

    PubMed  Google Scholar 

  47. Flack VF, Chang PC. Frequency of selecting noise variables in subset regression analysis: a simulation study. Am Statistician. 1987;41(1):84–6.

    Google Scholar 

  48. Segerstrom SC. Statistical guideline #3: designate and justify covariates a priori, and report results with and without covariates. International journal of behavioral medicine. 2019;26(6):577–9.

    PubMed  Google Scholar 

  49. Giltay EJ, Geleijnse JM, Zitman FG, Hoekstra T, Schouten EG. Dispositional optimism and all-cause and cardiovascular mortality in a prospective cohort of elderly Dutch men and women. Arch Gen Psychiatry. 2004;61(11):1126–35.

    PubMed  Google Scholar 

  50. Giltay EJ, Kamphuis MH, Kalmijn S, Zitman FG, Kromhout D. Dispositional optimism and the risk of cardiovascular death: the Zutphen Elderly Study. Arch Intern Med. 2006;166(4):431–6.

    PubMed  Google Scholar 

  51. Kubzansky LD, Sparrow D, Vokonas P, Kawachi I. Is the glass half empty or half full? A prospective study of optimism and coronary heart disease in the normative aging study. Psychosomatic medicine. 2001;63(6):910–6.

    CAS  PubMed  Google Scholar 

  52. Matthews KA, Räikkönen K, Sutton-Tyrrell K, LH. K. Optimistic attitudes protect against progression of carotid atherosclerosis in healthy middle-aged women. Psychosom Med. 2004;66(5):640–4.

    PubMed  Google Scholar 

  53. Tindle HA, Chang YF, Kuller LH, Manson JAE, Robinson JG, Rosal MC, et al. Optimism, cynical hostility, and incident coronary heart disease and mortality in the Women’s Health Initiative. Circulation. Aug 2009;120(8):656–62.

    PubMed  PubMed Central  Google Scholar 

  54. Galatzer-Levy IR, Bonanno GA. Optimism and death: predicting the course and consequences of depression trajectories in response to heart attack. Psychol Sci. 2014;25(12):2177–88.

    PubMed  Google Scholar 

  55. Vanderzanden K, Ruthig JC. Comparative optimism in older adults’ future health expectations. British Journal of Health Psychology. 2018;23(3):758–74.

    PubMed  Google Scholar 

  56. Exline JJ, Rose E. Religious and spiritual struggles. In: Handbook of the psychology of religion and spirituality. New York, NY, US: Guilford Press; 2005. p. 315–30.

    Google Scholar 

  57. Ai AL, Hall D, Pargament K, Tice TN. Posttraumatic growth in patients who survived cardiac surgery: the predictive and mediating roles of faith-based factors. J Behav Med. 2013;36(2):186–98.

    PubMed  Google Scholar 

  58. Dornelas EA, Sears SF. Living with heart despite recurrent challenges: psychological care for adults with advanced cardiac disease. Am Psychol. 2018;73(8):1007–18.

    PubMed  Google Scholar 

  59. Reavell J, Hopkinson M, Clarkesmith D, Lane DA. Effectiveness of cognitive behavioral therapy for depression and anxiety in patients with cardiovascular disease: a systematic review and meta-analysis. Psychosomatic medicine. 2018;80(8):742–53.

    PubMed  Google Scholar 

  60. Epstein RM, Street RL. The values and value of patient-centered care. Annals of Family Medicine. 2011;9(2):100–3.

    PubMed  PubMed Central  Google Scholar 

  61. VanderWeele TJ, Balboni TA, Koh HK. Health and spirituality. JAMA. 2017;318(6):519–20.

    PubMed  Google Scholar 

Download references

Acknowledgments

We gratefully acknowledge awards from the National Institutes of Health (R03 AG015686-01, R03 AG060212-01A1) for Amy L. Ai, PhD, to collect the existing data ion and to enable current analysis.

Author information

Authors and Affiliations

  1. Institute of Longevity, Department of Behavioral Sciences and Social Medicine, College of Medicine, College of Social Work, and College of Nursing, Florida State University, 2570 University Center Building C, Tallahassee, FL, 32306, USA

    Amy L. Ai & Henry Carretta

  2. Department of Behavioral Sciences and Social Medicine, College of Medicine, College of Social Work, Florida State University, Box 3064300, Tallahassee, FL, 32306, USA

    Amy L. Ai & Henry Carretta

Authors
  1. Amy L. Ai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Henry Carretta
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amy L. Ai.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Statement Regarding Informed Consent

Informed consent was obtained from the Florida State University while no recruitment of subjects was necessary for secondary analyses.

Statement Regarding Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Statement Regarding the Welfare of Animals (as Appropriate)

N/A

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ai, A.L., Carretta, H. Depression in Patients with Heart Diseases: Gender Differences and Association of Comorbidities, Optimism, and Spiritual Struggle. Int.J. Behav. Med. 28, 382–392 (2021). https://doi.org/10.1007/s12529-020-09915-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12529-020-09915-3

Keywords

Search

Navigation