Brezinka V, Kittel F
Centre for Cardiopulmonary Rehabilitation, Rijnlands Zeehospitium, Katwijk ZH, The Netherlands.
Soc Sci Med. 1996 May;42(10):1351-65. doi: 10.1016/0277-9536(95)00284-7.
Although coronary heart disease is the leading cause of death in women in most industrialized countries, much less research has been carried out on this topic to date than in men. This article gives an overview of psychosocial factors of coronary heart disease in women, focussing on psychosocial risk factors for coronary heart disease in women such as socioeconomic status, employment status, chronic troubling emotions, social support and bereavement/widowhood. A second focus lies on psychosocial adjustment in women once coronary heart disease has become manifest, i.e. well-being, return to work, sexual activity and rehabilitation outcome after a myocardial infarction or coronary artery bypass grafting. Via a computerized literature research in Medline, Psychlit and Sociofile over the period 1980-1994 all studies on these topics were collected and reviewed. Comparatively more research has been undertaken on psychosocial risk factors for than on psychosocial adjustment to coronary heart disease in women. Low social class, low educational attainment, the double loads of work and family, chronic troubling emotions and lack of social support emerge as documented risk factors in women. Regarding psychosocial adjustment to coronary heart disease in women, there is a paucity of data, and studies including large samples of women and adjusting for gender are warranted. Psychosocial adjustment in women after a myocardial infarction seems to be worse than in men, whereas results on adjustment after coronary artery bypass grafting are inconclusive. Return to work rates after myocardial infarction or coronary artery bypass grafting are significantly lower in women than in men. Data on sexual activity of women after myocardial infarction or coronary artery bypass grafting are scarce, and there seems to be a complete lack of physician counseling on this topic. Studies on rehabilitation outcome report poorer programme uptake, poorer adherence and significantly higher drop-out rates for women than for men, yet those women who complete cardiac rehabilitation show the same or even greater functional improvements than men.
尽管在大多数工业化国家，冠心病是女性的主要死因，但迄今为止，针对这一主题的研究比男性少得多。本文概述了女性冠心病的心理社会因素，重点关注女性冠心病的心理社会风险因素，如社会经济地位、就业状况、长期困扰情绪、社会支持以及丧亲/丧偶。第二个重点是女性冠心病发病后的心理社会调适，即幸福感、重返工作岗位、性活动以及心肌梗死或冠状动脉搭桥术后的康复结果。通过对1980年至1994年期间Medline、Psychlit和Sociofile数据库进行计算机文献检索，收集并综述了所有关于这些主题的研究。相对于女性冠心病心理社会调适的研究，针对心理社会风险因素的研究相对较多。低社会阶层、低教育程度、工作和家庭的双重负担、长期困扰情绪以及缺乏社会支持是已被证实的女性风险因素。关于女性冠心病的心理社会调适，数据匮乏，因此有必要开展包括大量女性样本并进行性别校正的研究。心肌梗死后女性的心理社会调适似乎比男性差，而冠状动脉搭桥术后调适的结果尚无定论。心肌梗死或冠状动脉搭桥术后女性的重返工作率显著低于男性。关于心肌梗死或冠状动脉搭桥术后女性性活动的数据很少，而且在这个问题上似乎完全缺乏医生的咨询。关于康复结果的研究报告称，女性参与康复计划的情况较差、依从性较差且退出率显著高于男性，然而，那些完成心脏康复的女性功能改善程度与男性相同甚至更大。
