Scott-Storey Kelly A, Hodgins Marilyn, Wuest Judith
Faculty of Nursing, University of New Brunswick, P.O. Box 4400, Fredericton, New Brunswick, E3B 5A3, Canada.
BMC Cardiovasc Disord. 2019 Oct 16;19(1):224. doi: 10.1186/s12872-019-1196-y.
Cardiovascular disease (CVD) is one of the most significant health challenges facing women today. Abuse is a serious gendered issue also affecting the health of women. Despite beginning evidence that abuse may increase the risk of CVD among women, causal pathways linking abuse to CVD have received little attention. Our purpose was to test Scott-Storey's conceptual model showing direct and indirect pathways through which lifetime abuse severity may affect women's CVD risk.
Using data collected from a community sample of 227 Canadian women who had left an abusive partner, we conducted structural equation modeling with latent growth curve analysis using a phantom variable approach to test the direct effects of severity of lifetime abuse on CVD risk (indicated by measures of systolic and diastolic blood pressure) as well as its indirect effects through CVD risk behaviors and through women's initial level of depressive symptoms and the observed rate of change in their depressive symptoms over time.
Women in this sample had above average CVD risk factors (i.e., smoking, overweight/obesity, depressive symptoms, high blood pressure) in comparison to women in the general population. Further, CVD risk behaviors increased with severity of lifetime abuse and remained present long after leaving the abusive relationship. Results of the tested model provide preliminary evidence supporting many of the hypothesized pathways by which severity of lifetime abuse can increase CVD risk among women; the model fit the data reasonably well explaining 41% of the variance in CVD risk.
Findings support the growing recognition of the long-term effects of lifetime abuse on cardiovascular health, suggest important implications for clinicians working with women, and provide a novel approach for studying the concept of cumulative lifetime abuse through the use of a phantom variable.
心血管疾病（CVD）是当今女性面临的最重大健康挑战之一。虐待是一个严重的性别问题，也影响着女性的健康。尽管有初步证据表明虐待可能会增加女性患心血管疾病的风险，但将虐待与心血管疾病联系起来的因果途径却很少受到关注。我们的目的是检验斯科特 - 斯托里的概念模型，该模型展示了终生虐待严重程度可能影响女性心血管疾病风险的直接和间接途径。
我们使用从227名离开虐待伴侣的加拿大女性社区样本中收集的数据，采用虚拟变量方法进行结构方程建模和潜在增长曲线分析，以检验终生虐待严重程度对心血管疾病风险（通过收缩压和舒张压测量指标表示）的直接影响，以及通过心血管疾病风险行为、女性初始抑郁症状水平及其抑郁症状随时间的观察变化率产生的间接影响。
与一般人群中的女性相比，该样本中的女性具有高于平均水平的心血管疾病风险因素（即吸烟、超重/肥胖、抑郁症状、高血压）。此外，心血管疾病风险行为随着终生虐待严重程度的增加而增加，并且在离开虐待关系后很长时间仍然存在。测试模型的结果提供了初步证据，支持了许多假设的途径，即终生虐待严重程度可增加女性患心血管疾病的风险；该模型与数据拟合良好，解释了心血管疾病风险中41%的方差。
研究结果支持了对终生虐待对心血管健康长期影响的日益认识，对与女性打交道的临床医生具有重要意义，并通过使用虚拟变量为研究累积终生虐待的概念提供了一种新方法。
