Institute of Social and Preventive Medicine, Division of Social and Behavioural Health Research, University of Bern, and Cardiovascular Prevention and Rehabilitation, Bern University Hospital, Bern, Switzerland.
J Womens Health (Larchmt). 2009 Dec;18(12):2033-9. doi: 10.1089/jwh.2008.1058.
Psychological factors are important in the etiology and prognosis of coronary heart disease (CHD). Cardiac rehabilitation (CR) aims to reduce psychological distress, besides other somatic risk factors. Studies have shown that CR is effective in reducing psychological distress, but little is known about gender-specific outcome differences. Our objective was to examine whether women and men benefit equally from outpatient CR in terms of reduction in psychological distress and whether women show more impaired psychological health at baseline of CR than do men.
We enrolled 441 CHD patients (mean age 58+/-11 years, 79.8% men) who underwent a 12-week outpatient CR program. Psychological dimensions, namely, anxiety, depression, vital exhaustion, social inhibition, and negative affect, were assessed at baseline and post-CR. Multivariate analysis of variance (MANOVA), controlling for age, disease severity, and exercise capacity, was applied to test for gender-specific differences at baseline and change between baseline and post-CR. In addition, gender-specific effect sizes were calculated for the change on psychological dimensions.
Women and men did not differ on any psychological measure at baseline of CR. The effect sizes show small to moderate treatment effects on the psychological dimensions assessed. Gender had a significant impact on change on the dimensions vital exhaustion (F=5.040(df=1), p<0.05) and social inhibition (F=5.74(df=1), p<0.05). Women showed larger change on social inhibition and smaller change on vital exhaustion than men.
Women and men do not differ in the extent of psychological distress at baseline of CR, which could be explained also by the exclusion of highly distressed women from treatment. CR is less effective among women with regard to vital exhaustion and more effective with regard to social inhibition compared with men in a sample of low distressed patients.
心理因素在冠心病（CHD）的病因学和预后中起着重要作用。心脏康复（CR）的目的是除其他躯体危险因素外，减轻心理困扰。研究表明，CR 可有效减轻心理困扰，但对性别特异性结局差异知之甚少。我们的目的是检验女性和男性在门诊 CR 中是否能同等程度地减轻心理困扰，以及女性在 CR 开始时的心理健康是否比男性更受损。
我们招募了 441 名 CHD 患者（平均年龄 58+/-11 岁，79.8%为男性），他们接受了为期 12 周的门诊 CR 计划。在基线和 CR 后评估心理维度，包括焦虑、抑郁、生命衰竭、社交抑制和负性情绪。采用多元方差分析（MANOVA），控制年龄、疾病严重程度和运动能力，检验基线和 CR 前后的性别特异性差异。此外，还计算了心理维度变化的性别特异性效应量。
女性和男性在 CR 开始时的任何心理测量上均无差异。效应量显示出对评估的心理维度有小到中度的治疗效果。性别对生命衰竭（F=5.040(df=1)，p<0.05）和社交抑制（F=5.74(df=1)，p<0.05）维度的变化有显著影响。女性在社交抑制方面的变化较大，而在生命衰竭方面的变化较小。
女性和男性在 CR 开始时的心理困扰程度没有差异，这也可以解释为将高度困扰的女性排除在治疗之外。在一个低困扰患者样本中，CR 对女性的生命衰竭的效果较差，而对社交抑制的效果较好。
