Ladwig K H, Mühlberger N, Walter H, Schumacher K, Popp K, Holle R, Zitzmann-Roth E, Schömig A
Institut und Poliklinik für Psychosomatische Medizin, Medizinische Psychologie und Psychotherapie des Klinikums Rechts der Isar der Technischen Universität München, Langerstraáe 3, 81675, München, Germany.
J Psychosom Res. 2000 Apr-May;48(4-5):501-8. doi: 10.1016/s0022-3999(99)00111-7.
In this study we evaluate gender differences in affective adaptation and health perception in patients 6 months after stent implantation.
Assessment of gender-specific behavioral strategies to cope with serious cardiac disease conditions has not been given much attention until now. Preliminary data suggest greater impairments in female patients, which might be of clinical relevance.
Three hundred seventeen patients were eligible for the 6-month follow-up investigation, 78 (24.6%) of whom were women. The women were significantly older but did not differ from men in their cardiac risk features and treatment procedures. There were no gender differences in prevalence of hypertension, hypercholesterolemia, and family history. Men had a significantly higher prevalence of smoking than women, whereas women had a significantly higher prevalence of diabetes than men. A structured interview and a standardized psychodiagnostic assessment was carried out, which covered domains of affective dysfunction (depression, anxiety, intrusion, and avoidance), vegetative symptoms (sleeping disorders), and parameters of negative health perception.
There were no significant gender differences in the prevalence of depressive symptoms. Women exhibited higher mean values of anxiety than men, which did not reach significance. Sleeping disorders were significantly more prevalent in women. The absolute level of being distressed by intrusive thoughts and avoidance behavior related to the severe underlying disease process was low in the total group of patients examined. Measurable gender differences did not emerge. Fifty-one (16.5%) patients exhibited pessimistic anticipation of dire consequences and severe signs of negative health perception (NHP group). There was a trend, although not statistically significant, toward more women being in the NHP group. The distribution of cardiac risk factors, however, was completely balanced in the NHP(+) and NHP(-) patient groups. Objective somatic cardiac disease parameters did not account for the negative health perception. NHP was, however, associated with significantly more prestent angina pectoris (p < 0.040) and poststent angina pectoris (p < 0.0001). High levels of anxiety, depression, and of disturbed sleep also led to a sharp separation between patients with high degrees of an anticipated incapacitation due to the disease process. Univariate regression analysis suggested an effect of female gender on the occurrence of NHP (odds ratio 1. 70; 95% CI 0.88 to 3.25), which was of borderline significance. Control for confounders in a multiple regression model, however, eliminated the gender effect (odds ratio 1.04, 95% CI 0.48 to 2.23). Poststent chest pain (odds ratio 7.75, 95% CI 3.28 to 18.32) and sleeping disorders (odds ratio 1.32, 95% CI 1.16 to 1.51) were identified as the most powerful confounders of the gender-NHP association.
Contrary to expectation, women were not per se more distressed than men in all areas of adaptation of the midterm course after stent implantation, although the higher levels of anxiety and sleeping disorders in women deserve attention. A considerable proportion of patients exhibited a pessimistic disease perspective independent of their somatic status, which was associated with affective morbidity. The tendency toward more negative health perception in women may be due to their more frequent occurrence of chest pain and sleeping disorders.
在本研究中，我们评估了支架植入术后6个月患者在情感适应和健康认知方面的性别差异。
迄今为止，针对应对严重心脏疾病状况的性别特异性行为策略的评估尚未受到足够重视。初步数据表明女性患者存在更大的损伤，这可能具有临床意义。
317例患者符合6个月随访调查条件，其中78例（24.6%）为女性。女性年龄显著更大，但在心脏风险特征和治疗程序方面与男性无差异。高血压、高胆固醇血症和家族病史的患病率无性别差异。男性吸烟患病率显著高于女性，而女性糖尿病患病率显著高于男性。进行了结构化访谈和标准化心理诊断评估，涵盖情感功能障碍（抑郁、焦虑、侵入和回避）、植物神经症状（睡眠障碍）以及负面健康认知参数等领域。
抑郁症状的患病率无显著性别差异。女性焦虑平均值高于男性，但未达到显著水平。睡眠障碍在女性中显著更常见。在接受检查的患者总体中，与严重基础疾病过程相关的侵入性思维和回避行为所导致的痛苦绝对水平较低。未出现可测量的性别差异。51例（16.5%）患者表现出对可怕后果的悲观预期和负面健康认知的严重迹象（NHP组）。女性在NHP组中的比例有上升趋势，尽管无统计学意义。然而，在NHP（+）和NHP（-）患者组中，心脏风险因素的分布完全平衡。客观的躯体心脏疾病参数并不能解释负面健康认知。然而，NHP与支架植入术前心绞痛（p < 0.040）和支架植入术后心绞痛（p < 0.0001）显著相关。高水平的焦虑、抑郁和睡眠障碍也导致了因疾病过程而预期丧失能力程度较高的患者之间的明显区分。单因素回归分析表明女性性别对NHP的发生有影响（比值比1.70；95%可信区间0.88至3.25），具有临界显著性。然而，在多元回归模型中对混杂因素进行控制后，消除了性别效应（比值比1.04，95%可信区间0.48至2.23）。支架植入术后胸痛（比值比7.75，95%可信区间3.28至18.32）和睡眠障碍（比值比1.32，95%可信区间1.16至1.51）被确定为性别与NHP关联的最有力混杂因素。
与预期相反，尽管女性较高水平的焦虑和睡眠障碍值得关注，但在支架植入术后中期适应的所有方面，女性本身并不比男性更痛苦。相当一部分患者表现出与躯体状况无关的悲观疾病观，这与情感发病率相关。女性负面健康认知更明显的倾向可能是由于她们更频繁地出现胸痛和睡眠障碍。
