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1.
Nurs Res ; 70(1): 72-79, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32956255

RESUMO

BACKGROUND: Investigators conducting studies that include potentially suicidal individuals are obligated to develop a suicide risk management (SRM) protocol. There is little available in the literature to guide researchers in SRM protocol development. OBJECTIVES: The aim of the study was to describe an SRM protocol developed for a randomized controlled trial (RCT) currently enrolling cardiac patients who report moderate to severe levels of hopelessness. METHODS: The SRM protocol identifies suicidal ideation and measures ideation severity through use of the Columbia-Suicide Severity Rating Scale risk factor questions. Based on responses, study participants are deemed safe or at low, moderate, or high risk for suicide. The SRM protocol guides research staff through a plan of action based on risk level. The protocol further guides staff through a plan over the course of this prospective study-from hospital enrollment to home-based visits. RESULTS: Research staff are well trained to identify suicidal ideation risk factors, initiate specific questioning about suicidal intent, determine level of risk, identify protective factors and a safe environment, and make referrals if needed. Of the 51 patients hospitalized with cardiac disease who reported moderate to severe hopelessness, 43 scored at a safe suicide risk level and 8 scored at low risk. Thirty-five of the 51 patients enrolled in the RCT. Of the 35 participants who received home visits to date, there have been three instances of low and one instance of moderate suicide risk. The SRM protocol has been consistently and accurately used by research personnel in both hospital and home settings. One modification has been made to the protocol since study activation, namely, the addition of an assessment of counseling history and encouragement of continued counseling. Booster training sessions of research staff will continue throughout the course of the RCT. DISCUSSION: Use of the SRM protocol identifies study participants who are safe or at risk for suicide in both hospital and home settings, and research staff can refer participants accordingly. CONCLUSION: The SRM protocol developed for this RCT can serve as a model in the development of SRM protocols for future research in acute care, community, or home-based settings.


Assuntos
Cardiopatias/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Gestão de Riscos/métodos , Gestão de Riscos/normas , Estresse Psicológico/prevenção & controle , Suicídio/prevenção & controle , Suicídio/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Fatores de Risco , Estados Unidos
3.
Artigo em Inglês | MEDLINE | ID: mdl-32664632

RESUMO

Despite the fact that American Heart Association (AHA) recommended a systematic screening for depression in cardiovascular inpatients, poor attention has been given to this issue. Furthermore, no specific guidelines exist for anxiety screening in cardiovascular inpatients. Thus, the aims of this study were to verify the feasibility of a depressive and anxiety symptoms screening protocol in an Italian hospital specializing in cardiovascular diseases and to evaluate both anxiety and depressive symptoms prevalence. A group of 2009 consecutive inpatients completed the 9-item Patient Health Questionnaire (PHQ-9) and the 7-item Generalized Anxiety Disorder (GAD-7). The rates of depressive and anxiety symptoms were almost 9% and 16% respectively. Men were less likely than women to experience both depressive and anxiety symptoms. Patients who were admitted to the heart failure unit reported higher risk of experiencing both symptoms compared to patients in other wards. Similarly, patients admitted to the cardiac surgery unit showed a higher risk of experiencing anxiety symptoms compared to other patients. The proposed screening procedure showed a good feasibility and acceptance. This study highlighted the importance of implementing a short screening procedure in hospitals dealing with cardiovascular inpatients to identify those individuals who require specific attention and interventions.


Assuntos
Ansiedade/diagnóstico , Depressão/diagnóstico , Depressão/psicologia , Cardiopatias/diagnóstico , Cardiopatias/psicologia , Pacientes Internados/psicologia , Programas de Rastreamento/estatística & dados numéricos , Idoso , Transtornos de Ansiedade , Depressão/epidemiologia , Feminino , Cardiopatias/epidemiologia , Insuficiência Cardíaca , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Psicometria , Inquéritos e Questionários/normas
4.
Health Qual Life Outcomes ; 18(1): 189, 2020 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-32552773

RESUMO

BACKGROUND: Patients with cardiac disease with or without depression may also have major physical and mental problems. This study assesses and compares the quality of life (QOL) of patients with cardiac disease with and without depression and accompanying comorbidities. METHODS: A cross-sectional study was conducted with a convenience sample of 388 patients with cardiac disease. The 12-item Short-Form (SF-12)-patient was used to measure physical component scale (PCS) and mental component scale (MCS) QOL, and the Patient Health Questionnaire (PHQ-9) was used to measure depression. The Charlson Comorbidity Index was used to estimate 10-year survival probability. Descriptive statistics, analysis of covariance (ANCOVA), chi-square tests, and binary logistic regression were used for analysis. RESULTS: The prevalence of minimal to mild depression was 65.7% [(95% CI (60.8, 70.4)] and that of moderate to severe depression was 34.3% [95% CI (29.6, 39.2)]. There was no significant association between the level of PHQ-categorised depression and age (p = 0.171), sex (p = 0.079), or ethnicity (p = 0.407). The overall mean PCS and MCS QOL was 32.5 [95% CI (24.4, 40.64)] and 45.4 [95% CI (44.4, 46.4)], respectively, with no significant correlation between PCS and MCS [r (Pearson's) = 0.011; p = 0.830)]. There were QOL differences among the five PHQ categories (PCS: p = 0.028; MCS: p ≤ 0.001) with both MCS and PCS decreasing with increasing depression. ANCOVA (with number of comorbidities as the covariate) showed a significant age × ethnicity interaction for PCS (p = 0.044) and MCS (p = 0.039), respectively. Young Indo-Trinidadians had significantly lower PCS than did Afro-Trinidadians, while the converse was true for MCS. Depression, age, and number of comorbidities were predictors of PCS, while depression, age, and sex were predictors of MCS. CONCLUSIONS: Increasing severity of depression worsened both PCS and MCS QOL. Age and level of clinical depression predicted QOL, with number of comorbidities predicting only PCS and sex predicting only MCS. Efforts must be made to treat depression in all age groups of patients with cardiac disease.


Assuntos
Depressão/epidemiologia , Cardiopatias/epidemiologia , Qualidade de Vida , Adulto , Idoso , Estudos de Casos e Controles , Comorbidade , Estudos Transversais , Depressão/psicologia , Feminino , Cardiopatias/psicologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Questionário de Saúde do Paciente , Prevalência
5.
J Psychol ; 154(6): 411-425, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32484755

RESUMO

Prior research suggests a potential moderated mediation effect between self-efficacy and psychological well-being. Based on the Meaning Making Model and the Broaden-and-Build Theory, this study examines the relationship between self-efficacy and psychological well-being in the moderated mediation perspective of affect and meaning-making in coronary heart disease patients. The questionnaires measuring self-efficacy, psychological well-being, affect, and meaning-making were used to collect data from one hundred and fifty six patients (73 women and 83 men) who were suffering from coronary heart disease. The patients had a history of coronary heart disease in the previous .1‒7.9 years and were aged 47‒82. Findings demonstrated that meaning-making mediated the indirect relationship between self-efficacy and psychological well-being. In addition, the moderated mediation effect of positive affect, but not of negative affect was significant. Positive affect moderated the indirect effect between self-efficacy and psychological well-being through meaning-making; the indirect effect was stronger when positive affect was high as opposed to low. The results suggest the interplay of affective and meaning-making processes in the relationship between self-efficacy and well-being.


Assuntos
Afeto , Cardiopatias/psicologia , Autoeficácia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
6.
BMC Public Health ; 20(1): 684, 2020 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-32410708

RESUMO

BACKGROUND: Toxic stress (TS), minority race and their interaction are evaluated as determinants of change in quality of life (QOL) over 8 years follow-up in a nationally representative sample of United States (US) adults (≥50 years old) with heart disease (HD) and/or type-2 diabetes (T2DM) diagnosed by 2006 as part of the Health and Retirement Study (HRS). METHODS: Recent and life-course stress plus experiences of lifetime discrimination were measured every 2 years using the stressful life experiences questionnaire. QOL was assessed by participant self-rated health (SRH) and operationally defined as improved, unchanged or declined in current year versus two years prior. Repeated measures multinomial logistic regressionusing generalized estimating equations (GEEs) was implemented to estimate race-, TS and their interaction- related odds of worse SRH from2006-2014. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated with adjustment for time, age, sex and socio-economic status. RESULTS: Three thousand nine hundred four adults with HD/T2DM, mean age 71.1 ± 9.3 years old, 80.9, 14.7 and 4.4% that respectively self-identified as Caucasian, African-American and Other race, were included. Over the eight-year follow-up, the odds of worse SRH for African-American and Other race were respectively 1.46 (95% CI: 1.25-1.70) and 1.43 (95% CI, 1.10-1.86) times higher relative to Caucasians. Relative to older Americans that reported ≥2 lifetime discrimination events, the odds of poor SRH was respectively 33% (OR = 0.67, 95%CI: 0.50-0.89) and 17% (OR = 0.83, 95%CI: 0.59-1.17) lower for those that reported none vs one lifetime discrimination experience. Furthermore, the relationship of life-course stress to SRH decline over 8 years varied by race (time*stress*race, p = 0.1173). Specifically, increasing life-course stress predicted worse QOL among Caucasians (p = 0.0063) and among African-American (p = 0.0820) but not among Other race (p = 0.9943). CONCLUSION: Toxic stress and minority race are social determinants of deterioration in QOL among older Americans with chronic diseases (HD/T2DM). The types and prevalence of toxic stressors varied by race/ethnicity. Policy interventions to address root causes of TS while targeted at proximate drivers of TS by race/ethnicity represent a viable strategy for mitigating racial disparities in overall wellbeing and improving QOL in all aging Americans regardless of race.


Assuntos
Grupos de Populações Continentais , Diabetes Mellitus Tipo 2 , Cardiopatias , Grupos Minoritários , Qualidade de Vida , Racismo , Estresse Psicológico/complicações , Afro-Americanos , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/psicologia , Grupos Étnicos , Grupo com Ancestrais do Continente Europeu , Feminino , Cardiopatias/etnologia , Cardiopatias/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Aposentadoria , Classe Social , Determinantes Sociais da Saúde , Inquéritos e Questionários , Estados Unidos
7.
PLoS One ; 15(3): e0230839, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32226019

RESUMO

Depression is common among cardiac patients and associated with adverse cardiovascular outcomes. Bright light therapy has emerged as a promising treatment for depressive symptoms, however it has not yet been investigated in this population. We conducted a double-blind, randomized, placebo-controlled pilot trial to assess the feasibility of a larger-scale trial testing bright light therapy for depressive symptoms in cardiac patients. Patients hospitalized for an acute coronary syndrome or undergoing cardiac surgery were randomized to either bright light (10,000 lux) or dim light placebo (500 lux) lamps for 30 minutes each day over 4 weeks, beginning in-hospital. Depression was quantified using the Patient Health Questionnaire 9 (PHQ-9) and Depression Anxiety and Stress Scales (DASS-21). The Short-Form Health Survey 36 (SF-36) was used to measure quality of life. A total of 175 patients were screened and 15 were randomized (8 treatment, 7 placebo) (8.6%) over 10 months. Despite protocol amendments which broadened the inclusion criteria, the trial was terminated early for infeasibility based on the rate of enrollment (1-2 participants/month), with 39.5% of the target sample (38 participants) enrolled. Future trials should take into account the timing of the onset of depressive symptoms in these patients, and consider a less conservative approach to eligibility as well as ways to increase the acceptability of bright light therapy in hospitalized cardiac patients. Once enrolled, our findings suggest that most participants will adhere to the assigned treatment and complete follow-up.


Assuntos
Depressão/complicações , Depressão/terapia , Cardiopatias/complicações , Hospitalização , Fototerapia , Adulto , Idoso , Método Duplo-Cego , Feminino , Cardiopatias/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida
8.
Open Heart ; 7(1): e001184, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32076564

RESUMO

Objectives: To enhance adherence to cardiac rehabilitation (CR), a patient education programme called 'learning and coping' (LC-programme) was implemented in three hospitals in Denmark. The aim of this study was to investigate the cost-utility of the LC-programme compared with the standard CR-programme. Methods: 825 patients with ischaemic heart disease or heart failure were randomised to the LC-programme or the standard CR-programme and were followed for 3 years.A societal cost perspective was applied and quality-adjusted life years (QALY) were based on SF-6D measurements. Multiple imputation technique was used to handle missing data on the SF-6D. The statistical analyses were based on means and bootstrapped SEs. Regression framework was employed to estimate the net benefit and to illustrate cost-effectiveness acceptability curves. Results: No statistically significant differences were found between the two programmes in total societal costs (4353 Euros; 95% CI -3828 to 12 533) or in QALY (-0.006; 95% CI -0.053 to 0.042). At a threshold of 40 000 Euros, the LC-programme was found to be cost-effective at 15% probability; however, for patients with heart failure, due to increased cost savings, the probability of cost-effectiveness increased to 91%. Conclusions: While the LC-programme did not appear to be cost-effective in CR, important heterogeneity was noted for subgroups of patients. The LC-programme was demonstrated to increase adherence to the rehabilitation programme and to be cost-effective among patients with heart failure. However, further research is needed to study the dynamic value of heterogeneity due to the small sample size in this subgroup.


Assuntos
Adaptação Psicológica , Reabilitação Cardíaca/economia , Custos de Cuidados de Saúde , Cardiopatias/economia , Cardiopatias/reabilitação , Aprendizagem , Educação de Pacientes como Assunto/economia , Análise Custo-Benefício , Dinamarca , Conhecimentos, Atitudes e Prática em Saúde , Cardiopatias/fisiopatologia , Cardiopatias/psicologia , Humanos , Modelos Econômicos , Cooperação do Paciente , Anos de Vida Ajustados por Qualidade de Vida , Fatores de Tempo , Resultado do Tratamento
9.
Creat Nurs ; 26(1): 48-55, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32024739

RESUMO

PURPOSE: Following angioplasty for coronary artery disease, patients may search for a new meaning of life. The purpose of this study was to determine patients' meaning of life related to heart disease and its relationship to quality of life after repeat coronary artery angioplasty. METHODS: The current descriptive-correlation study recruited 144 patients with coronary artery disease admitted to hospitals in Karaj, Iran. Data were collected using a demographics questionnaire, the Meaning in Heart Disease (MHD) instrument, and the Iranian version of the Short Form Health Survey (SF-12), and were analyzed with descriptive statistics and the Pearson correlation. FINDINGS: There was a significant relationship between the meaning of life related to heart disease (creating illusions, changing goals, reattribution, and meaning congruence) and quality of life scores (p <.05). CONCLUSION: The majority of the patients undergoing repeat angioplasty used the creation of illusions to support a positive attitude toward their heart disease. Nursing interventions based on the individual patient's meaning of life can promote health and life quality.


Assuntos
Angioplastia com Balão/psicologia , Atitude Frente a Saúde , Cardiopatias/psicologia , Cardiopatias/cirurgia , Qualidade de Vida/psicologia , Adulto , Idoso , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Recidiva , Inquéritos e Questionários
10.
Am J Prev Med ; 58(2): e39-e50, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31959325

RESUMO

INTRODUCTION: This study examines the prospective association between a range of psychosocial factors and common noncommunicable diseases. METHODS: In October 2018, nationally representative data were analyzed from 11,637 adults followed annually between 2003 and 2013. Participants reported on psychosocial factors they experienced in the 12 months preceding each wave. The onset of noncommunicable diseases was defined based on self-reported physician's diagnosis. Generalized estimating equations estimated the ORs and 95% CIs of psychosocial factors on noncommunicable diseases, controlling for other confounders. RESULTS: Social support index was inversely associated with the onset of anxiety or depression in men (OR=0.95, 95% CI=0.93, 0.98) and women (OR=0.96, 95% CI=0.95, 0.98) and with emphysema in women (OR=0.96, 95% CI=0.93, 0.99). Psychological distress was positively associated with the onset of heart diseases (OR=2.38, 95% CI=1.16, 4.89 for men; OR=2.30, 95% CI=1.10, 4.78 for women), emphysema (OR=1.11, 95% CI=1.03, 1.20 for men; OR=1.08, 95% CI=1.04, 1.12 for women), and circulatory diseases (OR=1.04, 95% CI=1.02, 1.08 for women). Financial stress increased the onset of anxiety or depression (OR=1.36, 95% CI=1.26, 1.63 for men; OR=1.30, 95% CI=1.10, 1.52 for women) and type 2 diabetes in women (OR=1.60, 95% CI=1.18, 2.18). Significant associations of parenting stress and the likelihood of the onset of anxiety or depression were only evident in women. CONCLUSIONS: These findings suggest that several adverse psychosocial risk factors are independently associated with the onset of noncommunicable diseases.


Assuntos
Doença Crônica/psicologia , Apoio Social , Estresse Psicológico/psicologia , Adulto , Ansiedade/psicologia , Depressão/psicologia , Diabetes Mellitus Tipo 2/psicologia , Feminino , Cardiopatias/psicologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores Sexuais , Inquéritos e Questionários
11.
J Cardiovasc Med (Hagerstown) ; 21(4): 286-291, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31977538

RESUMO

: Cancer patients are increasingly referred for cardiology evaluations. These patients differ from those routinely seen in cardiology clinics because of their psychological burden and because the therapies and cancer itself can cause cardiac symptoms. A humane approach is critical to managing these patients. Cardiologists may see patients who are newly diagnosed with cancer or are in various phases of treatment; these patients may or may not have preexisting cardiac disease, and may develop cardiotoxicity from chemoimmunotherapy or radiotherapy. Each of these situations presents unique communication challenges for cardiologists. Although some oncology centers provide training in communication skills for their personnel, including cardiologists, this training is not widely available to physicians in general hospitals or private practice. This article examines the psychological aspects of cardio-oncology. It offers practical suggestions on how to best communicate with cancer patients in different phases of oncology care, and discusses when professional psychological help is needed.


Assuntos
Atitude do Pessoal de Saúde , Cardiologistas/psicologia , Comunicação , Conhecimentos, Atitudes e Prática em Saúde , Necessidades e Demandas de Serviços de Saúde , Cardiopatias/terapia , Neoplasias/terapia , Relações Médico-Paciente , Cardiopatias/epidemiologia , Cardiopatias/psicologia , Humanos , Neoplasias/epidemiologia , Neoplasias/psicologia , Fatores de Risco
12.
J Relig Health ; 59(4): 2135-2148, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31894523

RESUMO

Individuals with heart disease have been found to have more negative psychological and physical effects that impact their quality of life (QoL) than the general population. Spiritual well-being is considered a protective factor associated with QoL in people with heart disease. Therefore, the current research seeks to evaluate whether sociodemographic factors and spiritual well-being predict QoL among patients with heart disease. A total of 500 patients who were selected through a convenient sampling method from an Iranian hospital participated in this descriptive-correlational study. Data were collected using the McGill QoL Questionnaire, the Spiritual Well-being Scale, and demographic variables. The data analysis included descriptive and inferential statistics powered by SPSS (v. 23). Following multivariate analyses, findings revealed that those participants with their main source of income derived from family or a government pension and with College or intermediate educational levels were more likely to have higher QoL. Those participants with average or poor socioeconomic status reported higher QoL than those who were more affluent. Furthermore, younger patients (- 0.2, 95% CI - 0.3 to - 0.003, p = 0.016) and those with higher social support (0.7, 95% CI 0.2 to 1.3, p = 0.006) and spiritual well-being (0.2, 95% CI 0.1 to 0.3, p < 0.001) had significantly better QoL. In the current study, spiritual well-being and social support led to reduced negative psychological sequelae and improved QoL in cardiac patients.


Assuntos
Cardiopatias , Qualidade de Vida , Cardiopatias/psicologia , Humanos , Irã (Geográfico) , Qualidade de Vida/psicologia , Espiritualidade , Inquéritos e Questionários
13.
Curr Opin Support Palliat Care ; 14(1): 19-24, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31815767

RESUMO

PURPOSE OF REVIEW: The number of patients who die in the hospital in the Western world is high, and 20-30% of them are admitted to an ICU in the last month of life, including those in cardiac ICUs (CICUs) where invasive procedures are performed and mortality is high. Palliative consultation is provided in only a few cases. The ethical and decisional aspects associated with the advanced stages of illness are very rarely discussed. RECENT FINDINGS: The epidemiological and clinical landscape of CICUs has changed in the last decade; the incidence of acute coronary syndromes has decreased, whereas noncardiovascular diseases, comorbidities, the patients' age and clinical and therapeutic complexity have increased. The use of advanced and invasive treatments, such as mechanical ventilation, mechanical circulatory support and renal replacement therapies, has increased. This evolution increases the possibility of developing a life-threatening clinical event. SUMMARY: This review aimed to analyze the main epidemiological, clinical, ethical and training aspects that can facilitate the introduction of supportive/palliative care programs in the CICU to improve symptom management during the advanced/terminal stages of illness, and address such issues as advance care planning, withdrawing/withholding life-sustaining treatments, deactivation of implantable defibrillators and palliative sedation.


Assuntos
Cardiopatias/psicologia , Cardiopatias/terapia , Unidades de Terapia Intensiva/organização & administração , Cuidados Paliativos/organização & administração , Planejamento Antecipado de Cuidados/organização & administração , Fatores Etários , Comorbidade , Tomada de Decisões , Humanos , Qualidade de Vida , Índice de Gravidade de Doença , Assistência Terminal/organização & administração , Estados Unidos , Suspensão de Tratamento
14.
Curr Cardiol Rev ; 16(2): 125-131, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31775601

RESUMO

Depressive symptoms are highly prevalent in patients with cardiac diseases. Co-morbid Depression in cardiac patients causes a significant reduction in health-related quality of life for the patients and inflicts an economic burden on the society. Two types of mechanisms that may explain the link between depression and cardiac diseases are the psychosocial and physiopathological mechanisms. Physiopathological mechanisms are direct biological mechanisms, which include hyperactivity of non-adrenergic and Hypothalamic Pituitary Adrenal Axis (HPA), abnormal platelet activation, endothelial dysfunction, and inflammatory process. Psychosocial factors include behavioral or lifestyle factors like smoking alcoholism and physical inactivity. Pharmacologic and therapeutic interventions are effective at reducing symptoms of depression in patients with cardiac disorders. Among pharmacological treatment, SSRIs seems to be effective for the reduction of depressive symptoms among patients with cardiac disorders because of their good efficacy and minimal cardiovascular side effects. Mechanisms of action of SSRI's in depressive patients with cardiac disorders are associated with their ability to reduce inflammation, platelet, and endothelial dysfunction. This review focuses on the potential pathophysiological and psychosocial links between cardiac diseases and depression, the treatment options, and the importance of routine screening of depressive symptoms in cardiac settings.


Assuntos
Sistema Cardiovascular/fisiopatologia , Transtorno Depressivo/psicologia , Cardiopatias/psicologia , Sistema Hipotálamo-Hipofisário/fisiopatologia , Inflamação/fisiopatologia , Qualidade de Vida/psicologia , Comorbidade , Humanos
15.
Heart ; 106(2): 140-146, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31685646

RESUMO

OBJECTIVE: To explore whether living alone and loneliness 1) are associated with poor patient-reported outcomes at hospital discharge and 2) predict cardiac events and mortality 1 year after hospital discharge in women and men with ischaemic heart disease, arrhythmia, heart failure or heart valve disease. METHODS: A national cross-sectional survey including patients with known cardiac disease at hospital discharge combined with national register data at baseline and 1-year follow-up. Loneliness was evaluated using one self-reported question, and information on cohabitation was available from national registers. Patient-reported outcomes were Short Form-12, Hospital Anxiety and Depression Scale and HeartQoL. Clinical outcomes were 1-year cardiac events (myocardial infarction, stroke, cardiac arrest, ventricular tachycardia/fibrillation) and all-cause mortality from national registers. RESULTS: A total of 13 443 patients (53%) with ischaemic heart disease, arrhythmia, heart failure or heart valve disease completed the survey. Of these, 70% were male, and mean age was 66.1 among women and 64.9 among men. Across cardiac diagnoses, loneliness was associated with significantly poorer patient-reported outcomes in men and women. Loneliness predicted all-cause mortality among women and men (HR 2.92 (95% CI 1.55 to 5.49) and HR 2.14 (95% CI 1.43 to 3.22), respectively). Living alone predicted cardiac events in men only (HR 1.39 (95% CI 1.05 to 1.85)). CONCLUSIONS: A strong association between loneliness and poor patient-reported outcomes and 1-year mortality was found in both men and women across cardiac diagnoses. The results suggest that loneliness should be a priority for public health initiatives, and should also be included in clinical risk assessment in cardiac patients.


Assuntos
Cardiopatias/mortalidade , Cardiopatias/psicologia , Solidão , Estado Civil , Saúde Mental , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Estudos Transversais , Dinamarca/epidemiologia , Feminino , Inquéritos Epidemiológicos , Cardiopatias/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fatores de Tempo
16.
Womens Health Issues ; 30(1): 35-40, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31727443

RESUMO

OBJECTIVE: Depression is a common comorbidity in patients with cardiovascular conditions. This study aims to assess the association between comorbid depression and health-promoting behavior in middle-aged and older Australian women with hypertension or heart disease. METHODS: Data are from a subset of 45 and Up Study participants with diagnosed chronic illness (n = 1,925). Health behaviors including smoking status, alcohol consumption, and physical activity were assessed. Associations of depression with health behaviors in women with hypertension or heart disease were analyzed using unadjusted and adjusted (for chronic conditions and demographic measures) logistic regression models. RESULTS: A total of 666 women with hypertension and 220 women with heart disease were included in the analysis. In adjusted analyses, women with hypertension and comorbid depression were 2.36 (95% confidence interval, 1.02-5.46) times more likely to be risky or high-risk drinkers and 55% (adjusted odds ratio, 0.45; 95% confidence interval, 0.27-0.73) less likely to be highly physically active, compared with women without depression. Women with heart disease and comorbid depression were 65% (adjusted odds ratio, 0.35; 95% confidence interval, 0.12-0.95) less likely to be highly physically active, compared with women without depression. CONCLUSIONS: This study provides the first data indicating that depression may be a barrier to health-promoting behavior in middle-aged and older women with hypertension or heart disease. Given that physical inactivity and risky alcohol consumption are important risk factors for aggravation of cardiologic conditions, health-promoting behaviors should be specifically targeted in the treatment of women with comorbid depression.


Assuntos
Depressão/epidemiologia , Comportamentos Relacionados com a Saúde , Cardiopatias/epidemiologia , Hipertensão/epidemiologia , Fumar/efeitos adversos , Adulto , Idoso , Consumo de Bebidas Alcoólicas/efeitos adversos , Austrália/epidemiologia , Doença Crônica , Comorbidade , Depressão/etiologia , Depressão/psicologia , Feminino , Cardiopatias/psicologia , Humanos , Hipertensão/psicologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco
18.
Bull Hist Med ; 93(4): 577-609, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31885017

RESUMO

The medical community and broader public have historically focused on heart disease as a concern for men, even though it has been the leading cause of death in women for decades. Through an analysis of medical publications, women's health literature, and mainstream media, this article traces the interactions of gender and age on perceptions of heart disease during the twentieth century. I argue that attention to middle-age mortality rates accentuated men's susceptibility to heart disease over women's, even as these differences diminished at older ages, when the majority of deaths occurred. Age and gender biases combined to frame heart disease as a man's disease on one hand, while the women's health movement marginalized older women's health on the other. It was not until the following decades that older women began to attract clinical concern and greater public attention, which ultimately expanded narrow frameworks of both heart disease and women's health.


Assuntos
Cardiopatias/história , Cardiopatias/psicologia , Saúde da Mulher/história , Saúde da Mulher/tendências , Fatores Etários , Idoso , Feminino , História do Século XX , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Obras Pictóricas como Assunto , Fatores Sexuais , Estados Unidos/epidemiologia
19.
BMC Cardiovasc Disord ; 19(1): 304, 2019 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-31881981

RESUMO

BACKGROUND: Adverse childhood experiences (ACEs) are associated with risk of poor adult health, including cardiometabolic diseases. Little is known about the correlates of ACEs for adults who have already developed cardiometabolic diseases, or who are at elevated risk. METHODS: Adult primary care patients with cardiometabolic disease (hypertension, diabetes, stroke, angina, myocardial infarction, coronary artery bypass graft, angioplasty) or with a risk factor (obesity, smoking, high cholesterol, family history) were surveyed regarding ACEs, psychological distress, attachment insecurity, quality of life, behavior change goals, stages of change, and attitudes toward potential prevention strategies. RESULTS: Of 387 eligible patients, 74% completed the ACEs survey. Exposure to ACEs was reported by 174 participants (61%). Controlling for age, gender, relationship status and income, number of ACEs was associated with psychological distress (F = 3.7, p = .01), quality of life (F = 8.9, p = .001), attachment anxiety (F = 3.4, p = .02), drinking alcohol most days (F = 4.0, p = .008) and smoking (F = 2.7, p = .04). Greater ACE exposure was associated with less likelihood of selecting diet or physical activity as a behavior change goal (linear-by-linear association p = .009). Stage of change was not associated with ACEs. ACEs exposure was not related to preferred resources for behavior change. CONCLUSIONS: ACEs are common among patients at cardiometabolic risk and are related to quality of life, psychological factors that influence cardiometabolic outcomes and behavior change goals. ACEs should be taken into account when managing cardiometabolic risk in family medicine.


Assuntos
Experiências Adversas da Infância , Cardiopatias/epidemiologia , Síndrome Metabólica/epidemiologia , Atenção Primária à Saúde , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/psicologia , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Nível de Saúde , Cardiopatias/diagnóstico , Cardiopatias/psicologia , Cardiopatias/terapia , Humanos , Masculino , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/psicologia , Síndrome Metabólica/terapia , Pessoa de Meia-Idade , Apego ao Objeto , Ontário/epidemiologia , Prevalência , Prognóstico , Angústia Psicológica , Qualidade de Vida , Medição de Risco , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Fumar/psicologia , Adulto Jovem
20.
J Cardiopulm Rehabil Prev ; 39(6): 381-385, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31689265

RESUMO

PURPOSE: Cardiac rehabilitation (CR) session attendance and rates of completion remain suboptimal. Greater distress (ie, depression and anxiety) has been associated with both better and poorer adherence. Will to live (ie, desire, determination and effort to survive) has been associated with survival among cardiac patients and thus may be relevant for CR adherence. It was hypothesized that depression and anxiety would be negatively associated with adherence, and that will to live would moderate these relationships. METHODS: Sixty patients (mean age = 56.9 ± 10.8 yr; 38 males) entering outpatient CR completed self-report measures of will to live (Wish to Prolong Life Questionnaire) and distress (Hospital Anxiety and Depression Scale). Hierarchical regression analyses were performed to predict CR session attendance (%) and program completion (yes/no) from depression and anxiety, as well as the interaction of those variables with will to live. RESULTS: Neither depression nor anxiety was associated with CR adherence (Ps > .33). However, there was a significant interaction of will to live with anxiety in predicting attendance (ß= -0.31, P = .03, Model R = .19, P = .01), reflecting that anxiety predicted lower attendance only among patients reporting greater will to live. CONCLUSIONS: These data help clarify the complex relationship between distress and CR adherence. Findings suggest that higher anxiety is associated with poorer adherence, but only in combination with greater motivation for living. Patients higher in anxiety and will to live may benefit from additional strategies to make actionable behavioral change in the context of CR.


Assuntos
Transtornos de Ansiedade/psicologia , Reabilitação Cardíaca/métodos , Reabilitação Cardíaca/psicologia , Motivação , Cooperação do Paciente/psicologia , Cooperação do Paciente/estatística & dados numéricos , Transtornos de Ansiedade/complicações , Feminino , Cardiopatias/complicações , Cardiopatias/psicologia , Cardiopatias/reabilitação , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
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