社会心理因素可预测冠心病，但什么因素能预测女性的社会心理风险呢？

Psychosocial factors predict coronary heart disease, but what predicts psychosocial risk in women.

作者信息

Linfante Allison H, Allan Robert, Smith Sidney C, Mosca Lori

机构信息

Columbia University, USA.

出版信息

J Am Med Womens Assoc (1972). 2003 Fall;58(4):248-53.

PMID:14640256

Abstract

OBJECTIVES

Psychosocial factors, including depression, anger, and social isolation, have been associated with increased morbidity and mortality from coronary heart disease (CHD), but predictors of psychosocial burden among women with CHD are poorly defined. The purpose of this study was to determine whether readily measured demographic and risk factors could identify women with psychosocial risk factors that are more difficult to assess in a clinical setting.

METHODS

Baseline data on 304 women (mean age 62 years, 52% minority) hospitalized with CHD at 3 academic medical centers participating in a clinical study of adherence to prevention guidelines were evaluated. Standardized questionnaires were used to measure depression (4-item self-report tool from the Primary Care Evaluation of Mental Disorders questionnaire) and anger (Spielberger Trait Anger Scale). One self-report question was used to assess social isolation.

RESULTS

Thirty-seven percent of women with CHD reported depression, 50% reported anger, and 41% reported social isolation. In a logistical model controlling for confounders, independent predictors of depression were having dependents (odds ratio [OR] = 2.27, p = .006), age (< or = 65 years) (OR = 1.91, p = .02), and exercise (< 3 days/week) (OR = 3.92, p < .001). Anger was associated with having dependents (OR = 3.16, p < .001), age (< or = 65 years) (OR = 1.95, p = .02), and smoking (OR = 2.05, p = .04). Subjects who had dependents (OR = 2.24, p = .005), were unemployed (OR = 1.93, p = .03), and who did not get enough exercise (< 3 days/week) (OR = 2.07, p = .03) reported higher isolation in adjusted models. Differences in prevalence of psychosocial factors by ethnicity were not statistically significant. However, there was a trend toward increased prevalence of psychosocial risk factors among white women, possibly reflecting the need for more culturally sensitive screening tools.

CONCLUSION

These data may be helpful in identifying women who are at risk of increased CHD morbidity and mortality because of psychosocial burden.

摘要

目的

心理社会因素，包括抑郁、愤怒和社会孤立，与冠心病（CHD）的发病率和死亡率增加有关，但冠心病女性患者心理社会负担的预测因素尚不明确。本研究的目的是确定易于测量的人口统计学和风险因素是否能够识别出在临床环境中更难评估的具有心理社会风险因素的女性。

方法

对参与预防指南依从性临床研究的3家学术医疗中心收治的304例冠心病女性患者（平均年龄62岁，52%为少数族裔）的基线数据进行评估。使用标准化问卷测量抑郁（来自精神障碍初级保健评估问卷的4项自我报告工具）和愤怒（斯皮尔伯格特质愤怒量表）。一个自我报告问题用于评估社会孤立。

结果

37%的冠心病女性报告有抑郁，50%报告有愤怒，41%报告有社会孤立。在控制混杂因素的逻辑模型中，抑郁的独立预测因素是有家属（比值比[OR]=2.27，p = .006）、年龄（≤65岁）（OR = 1.91，p = .02）和运动（每周<3天）（OR = 3.92，p < .001）。愤怒与有家属（OR = 3.16，p < .001）、年龄（≤65岁）（OR = 1.95，p = .02）和吸烟（OR = 2.05，p = .04）有关。在调整模型中，有家属（OR = 2.24，p = .005）、失业（OR = 1.93，p = .03）以及运动不足（每周<3天）（OR = 2.07，p = .03）的受试者报告的社会孤立程度更高。心理社会因素的患病率在种族之间的差异无统计学意义。然而，白人女性中心理社会风险因素的患病率有增加的趋势，这可能反映出需要更具文化敏感性的筛查工具。