Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health-Dallas Campus, The University of Texas Health Science Center at Houston, Dallas, Texas, USA.
Department of Epidemiology, Emory University, Atlanta, Georgia, USA.
J Womens Health (Larchmt). 2022 Oct;31(10):1440-1449. doi: 10.1089/jwh.2021.0505. Epub 2022 Aug 12.
Psychological stress disorders are twice as prevalent in women with ischemic heart disease compared to men. The disproportionate psychological health experience of these women is not well understood. The objective of this study was to examine whether neighborhood social factors are associated with disparities in psychological health by gender. We studied 286 patients with heart disease recruited from Emory-based hospitals in the Myocardial Infarction and Mental Stress 2 Study ( = 286). A global measure of psychological distress was calculated by taking an average of ranks across symptom scales for depression, post-traumatic stress disorder, anxiety, anger, and perceived stress. The social vulnerability index (SVI) was developed by the Centers for Disease Control and Prevention and was used to rank patients' census tracks on 14 social factors. Beta coefficients for mean ranks in psychological distress scores were estimated per 10-unit increase in SVI percentile ranking using multilevel regression models. The mean age of the sample was 51 years, 49% were women, and 66% African American. After adjusting for demographics, cardiovascular risk factors, and antidepressant use, each 10-unit increase in SVI percentile ranking was associated with 4.65 (95% CI: 0.61-8.69; = 0.02) unit increase in mean scores for psychological distress among women only (SVI-by-gender-interaction = 0.01). These associations were driven by the SVI themes of lower socioeconomic status and poorer access to housing and transportation. Neighborhood social vulnerability may be a psychosocial stressor that potentiates women's susceptibility to adverse psychological and cardiovascular health.
心理压力障碍在患有缺血性心脏病的女性中的发病率是男性的两倍。这些女性的不成比例的心理健康体验还没有得到很好的理解。本研究的目的是检验邻里社会因素是否与性别差异的心理健康状况有关。我们研究了 286 名来自埃默里医院的心脏病患者，他们参加了心肌梗死和精神压力 2 研究（ = 286）。通过对抑郁、创伤后应激障碍、焦虑、愤怒和感知压力症状量表的排名进行平均，计算出一个整体的心理困扰度量。社会脆弱性指数（SVI）是由疾病控制和预防中心开发的，用于根据 14 个社会因素对患者的普查轨迹进行排名。使用多层次回归模型，根据 SVI 百分位排名每增加 10 个单位，估计心理困扰评分平均秩的β系数。样本的平均年龄为 51 岁，49%是女性，66%是非裔美国人。在调整人口统计学、心血管危险因素和抗抑郁药使用后，SVI 百分位排名每增加 10 个单位，与女性的心理困扰平均评分增加 4.65（95%CI：0.61-8.69； = 0.02）（SVI-性别交互作用 = 0.01）。这些关联是由社会脆弱性指数的主题驱动的，即较低的社会经济地位和较差的住房和交通机会。邻里社会脆弱性可能是一种社会心理压力源，使女性更容易受到不良心理和心血管健康的影响。
