Skip to main content

Advertisement

Log in

Depression in Women with Heart Disease: The Importance of Social Role Performance and Spirituality

  • Published:
Journal of Clinical Psychology in Medical Settings Aims and scope Submit manuscript

Compared with men, women are more likely to experience depression, and depression increases risk of morbidity and mortality in individuals with heart disease. Psychosocial interventions have been developed for depressed patients with heart disease; however, women's experience of chronic disease differs from men's and women may benefit from interventions tailored to address their difficulties. Spirituality and social roles have been related to depressive symptoms in other populations. To identify the relationship between depression and spirituality and social role performance (i.e., role concerns, role rewards and confidence in ability to fulfill roles) in women with heart disease, we assessed depressive symptoms, spirituality, social role functioning and medical history in 125 women with heart disease. After controlling for age and severity of medical conditions, spirituality, role confidence and role concerns were significantly associated with depressive symptoms. Consideration of spirituality and aspects of social role performance may be important when developing psychosocial interventions for depressed women with heart disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

REFERENCES

  • American Heart Association (2005). Heart Disease and Stroke Statistics—2005. Dallas, TX: American Heart Association.

    Google Scholar 

  • Ashing, K. T., Padilla, G., Tejero, J., & Kagawa-Singer, M. (2003). Understanding the breast cancer experience of Asian American women. Psycho-Oncology, 12, 38–58.

    Article  PubMed  Google Scholar 

  • Ashing-Giwa, K. (1999). Quality of life and psychosocial outcomes in long-term survivors of breast cancer: A focus on African-American women. Journal of Psychosocial Oncology, 17, 47–62.

    Article  Google Scholar 

  • Bandura, A. (1997). Self-efficacy: The exercise of control. New York: W.H. Freeman, Co.

    Google Scholar 

  • Baruch, G. K., & Barnett, R. (1986). Role quality, multiple role involvement, and psychological well-being in midlife women. Journal of Personality and Social Psychology, 51, 578–585.

    Article  Google Scholar 

  • Beekman, A. T. F., Deeg, D. J. H., Van Limbeek, J., Braam, A. W., DeVries, M. A., & Van Tilburg, W. (1997). Criterion validity of the Center for Epidemiologic Studies Depression scale (CES-D): Results from a community-based sample of older subjects in the Netherlands. Psychological Medicine, 27, 231.

    Article  PubMed  CAS  Google Scholar 

  • Borowicz, L., Royall, R., Grega, M., Selnes, O., Lyketsos, C., & McKhann, G. (2002). Depression and cardiac morbidity 5 years after coronary artery bypass surgery. Psychosomatics, 43, 464–471.

    Article  PubMed  Google Scholar 

  • Breznika, V., & Kittel, F. (1995). Psychosocial factors of coronary heart disease in women: A review. Social Science and Medicine, 42, 1351–1365.

    Article  Google Scholar 

  • Burker, E. J., Evon, D. M., Sedway, J. A., & Egan, R. (2004). Religious coping, psychological distress and disability among patients with end-stage pulmonary disease. Journal of Clinical Psychology in Medical Settings, 11, 179–193.

    Article  Google Scholar 

  • Cotton, S. P., Levine, E. G., Fitzpatrick, C. M., Dold, K. H., & Targ, E. (1999). Exploring the relationships among spiritual well-being, quality of life, and psychological adjustment in women with breast cancer. Psycho-Oncology, 8, 429–438.

    Article  PubMed  CAS  Google Scholar 

  • Clark, N. M., & Dodge, J. A. (1999). Exploring self-efficacy as a predictor of disease management. Health Education and Behavior, 26, 72–89.

    Article  PubMed  CAS  Google Scholar 

  • Contrada, R. J., Goyal, T. M., Cather, C., Rafalson, L., Idler, E. L., & Krause, T. J. (2004). Psychosocial factors in outcomes of heart surgery: The impact of Religious involvement and depressive symptoms. Health Psychology, 23, 227–238.

    Article  PubMed  Google Scholar 

  • Davidson, K. W., Rieckmann, N., & Rapp, M. A. (2005). Definitions and distinctions among depressive syndromes and symptoms: Implications for a better understanding of the depression-cardiovascular disease association. Psychosomatic Medicine, 67(Suppl. 1), S6–S9.

    Article  PubMed  Google Scholar 

  • Eaker, E. D., Sullivan, L. M., Kelly-Hayes, M., Agostino, R. B., & Benjamin, E. J. (2003). Does job strain increase the risk for coronary heart disease or death in men and women? The Framingham offspring study. American Journal of Epidemiology, 159, 950–958.

    Article  Google Scholar 

  • Emery, C. F., Frid, D. J., Engebretson, T. O., Alonzo, A. A., Fish, A., Ferketick, A. K., et al. (2004). Gender differences in quality of life among cardiac patients. Psychosomatic Medicine, 66, 190–197.

    Article  PubMed  Google Scholar 

  • Feher, S., & Maly, R. C. (1999). Coping with breast cancer in later life: The role of religious faith. Psycho-Oncology, 8, 408–416.

    Article  PubMed  CAS  Google Scholar 

  • Frasure-Smith, N., & Lesperance, F. (2003). Depression: A cardiac risk factor in search of a treatment. JAMA, 289, 3171–3173.

    Article  PubMed  Google Scholar 

  • Frasure-Smith, N., & Lesperance, F. (2005). Reflections on depression as a cardiac risk factor. Psychosomatic Medicine, 67(Suppl. 1), S19–S25.

    Article  PubMed  Google Scholar 

  • Frasure-Smith, N., Lesperance, F., Prince, R. H., Verrier, P., Garber, R. A., Juneau, M., et al. (1997). Randomised trial of home-based psychosocial nursing intervention for patients recovering from myocardial infarction. Lancet, 350, 473–479.

    Article  PubMed  CAS  Google Scholar 

  • Frasure-Smith, N., Lesperance, F., Juneau, M., Talajic, M., & Bourassa, M. G. (1999). Gender, depression, and one-year prognosis after myocardial infarction. Psychosomatic Medicine, 61, 26–37.

    PubMed  CAS  Google Scholar 

  • Gilboy, M. B. (1994). Multiple factors affect dietitians' counseling practices for high blood cholesterol. Journal of the American Dietetic Association, 94, 1278–1283.

    Article  PubMed  CAS  Google Scholar 

  • Gall, T. L., & Cornblat, M. W. (2002). Breast cancer survivors give voice: A qualitative analysis of spiritual factors in long-term adjustment. Psycho-Oncology, 11, 524–523.

    Article  PubMed  Google Scholar 

  • Glassman, A. H., O'Connor, C. M., Califf, R. M., Sedberg, K., Schwatz, P., Bigger, J. T., et al. (2002). Sertraline treatment of major depression in patients with acute myocardial infarction or unstable angina. JAMA, 288, 701–709.

    Article  PubMed  CAS  Google Scholar 

  • Grace, S. L., Abbey, S. E., Shnek, Z. M., Irvine, J., Franche, R., & Stewart, D. E. (2002). Cardiac rehabilitation I: Review of psychosocial factors. General Hospital Psychiatry, 24, 121–126.

    Article  PubMed  Google Scholar 

  • Hawks, S. R., Hull, M. L., Thalman, R. L., & Richins, P. M. (1995). Review of spiritual health: Definition, role and intervention strategies in health promotion. American Journal of Health Promotion, 9, 371–378.

    PubMed  CAS  Google Scholar 

  • Kennedy, J. E., Abbott, R. A., & Rosenberg, B. S. (2002). Changes in spirituality and well-being in a retreat program for cardiac patients. Alternative Therapies in Health and Medicine, 8, 64–70.

    PubMed  Google Scholar 

  • King, K. B. (2001). Emotional and functional outcomes in women with coronary heart disease. Journal of Cardiovascular Nursing, 15, 54–70.

    PubMed  CAS  Google Scholar 

  • Klein, M. J., Hyde, J. S., & Esses, M. J. (1998). Maternity leave, role quality, work involvement, and mental health one year after delivery. Psychology of Women Quarterly, 22, 239–266.

    Article  Google Scholar 

  • Koszycki, D., Lafontaine, S., Frasure-Smith, N., Swenson, R., & Lesperance, F. (2004). An open-label trial of interpersonal psychotherapy in depressed patients with coronary disease. Psychosomatics, 45, 319–324.

    Article  PubMed  Google Scholar 

  • Kristofferzon, M. L., Lofmark, R., & Carlsson, M. (2003). Myocardial infarction: Gender differences in coping and social support. Journal of Advanced Nursing, 44, 360–374.

    Article  PubMed  Google Scholar 

  • Kubzansky, L. D., Davidson, K. W., & Rozanski, A. (2005). The clinical impact of negative psychological states: Expanding the spectrum of risk for coronary artery disease. Psychosomatic Medicine, 67(Suppl. 1), S10–S14.

    Article  PubMed  Google Scholar 

  • LaCharity, L. A. (1999). The experiences of younger women with coronary artery disease. Journal of Women's Health and Gender-Based Medicine, 8, 773–785.

    Article  CAS  Google Scholar 

  • Linfante, A. H., Allan, R., Smith, S. C., & Mosca, L. (2003). Psychosocial factors predict coronary heart disease, but what predicts psychosocial risk in women? Journal of the American Medical Women's Association, 58, 248–253.

    PubMed  Google Scholar 

  • Lockyer, L., & Bury, M. (2002). The construction of a modern epidemic: The implications for women of the gendering of coronary heart disease. Journal of Advanced Nursing, 39, 432–440.

    Article  PubMed  Google Scholar 

  • Logsdon, M. C., Wisner, K., Hanusa, B. H., & Phillips, A. (2003). Role functioning and symptom remission in women with postpartum depression after antidepressant treatment. Archives of Psychiatric Nursing, 17, 276–283.

    Article  PubMed  Google Scholar 

  • McClain, C. S., Rosenfeld, B., & Breitbart, W. (2003). Effect of spiritual well-being on end-of-life despair in terminally-ill cancer patients. Lancet, 361, 1603–1607.

    Article  PubMed  Google Scholar 

  • Mendes de Leon, C. F., Harlan, M., Krumholz, H. M., Seeman, T. S., Vaccarino, V., Williams, C. S. et al. (1998). Depression and risk of coronary disease in elderly men and women. Archives of Internal Medicine, 168, 2341–2348.

    Article  Google Scholar 

  • Mueller, P. S., Plevak, D. J., & Rummans, T. A. (2001). Religious involvement, spirituality, and medicine: Implications for clinical practice. Mayo Clinic Proceedings, 76, 1225–1235.

    Article  PubMed  CAS  Google Scholar 

  • Murphy, P. E., Ciarrocchi, J. W., Piedmont, R. L., Cheston, S., Peyrot, M., & Fitchett, G. (2001). The relation of religious belief and practices, depression and hopelessness in persons with clinical depression. Journal of Consulting and Clinical Psychology, 68, 1102–1106.

    Article  Google Scholar 

  • Naqvi, T. Z., Naqvi, S. A., & Merz, N. B. (2005). Gender differences in the link between depression and cardiovascular disease. Psychosomatic Medicine, 67(Suppl. 1), S6–S9.

    Article  PubMed  Google Scholar 

  • Orth-Gomer, K., Wamala, S. P., Horsten, M., Schenck-Gustafsson, K., Schneiderman, N., & Mittleman, M. A. (2000). Marital stress worsens prognosis in women with coronary heart disease: The Stockholm Female Coronary Risk Study. JAMA, 284, 3008–3014.

    Article  PubMed  CAS  Google Scholar 

  • Peterman, A. H., Fitchett, G., Brady, M. J., Hernandez, L., & Cella, D. (2002). Measuring spiritual well-being in people with cancer: The functional assessment of chronic illness therapy—spiritual well-being scale (FACIT-Sp). Annals of Behavioral Medicine, 24, 49–58.

    Article  PubMed  Google Scholar 

  • Plach, S., & Heidrich, S. M. (2001). Women's perceptions of their social roles after heart surgery and coronary angioplasty. Heart and Lung, 30, 117–127.

    Article  CAS  Google Scholar 

  • Plach, S., & Heidrich, S. M. (2002). Social role quality, physical health, and psychological well-being in women after heart surgery. Research in Nursing and Health, 25, 189–2002.

    Article  Google Scholar 

  • Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Journal of Applied Psychosocial Measurement, 1, 385–401.

    Article  Google Scholar 

  • Reid, J., & Hardy, M. (1999). Multiple roles and well-being among midlife women: Testing role strain and role enhancement theories. Journal of Gerontology: Social Sciences, 54B, S329–S338.

    Google Scholar 

  • Riegel, B., & Gocka, I. (1995). Gender differences in adjustment to acute myocardial infarction. Heart and Lung, 24, 457–466.

    Article  PubMed  CAS  Google Scholar 

  • Robertson, D., & Keller, C. (1992). Relationships among health beliefs, self-efficacy, and exercise adherence in patients with coronary artery disease. Heart and Lung, 21, 56–63.

    CAS  Google Scholar 

  • Robinson-Smith, G., Johnston, M. V., & Allen, J. (2000). Self-care self-efficacy, quality of life, and depression after stroke. Archives of Physical Medicine and Rehabilitation, 81,460–464.

    Article  PubMed  CAS  Google Scholar 

  • Rosengren, A., Hawken, S., Ounpuu, S., Sliwa, K., Zubaid, M., Almahmeed, W. A., et al. (2004). Association of psychosocial risk factors with risk of acute myocardial infarction in 11,119 cases and 13,648 controls from 52 countries (the INTERHEART study). Lancet, 364, 953–962.

    Article  PubMed  Google Scholar 

  • Rozanski, A. (2005). Integrating psychologic approaches into the behavioral management of cardiac patients. Psychosomatic Medicine, 67(Suppl. 1), S67–S73.

    Article  PubMed  Google Scholar 

  • Smith, E. D., Stefanek, M. E., Joseph, M. V., Verdieck, M. J., Zabora, J. R., Fetting, J. H., et al. (1993). Spiritual awareness, personal perspectives on death, and psychosocial distress among cancer patients. Journal of Psychosocial Oncology, 11, 89–103.

    Article  Google Scholar 

  • Strawbridge, W. J., Shema, S. J., Cohen, R. D., & Kaplan, G. A. (2001). Religious attendance increases survival by improving and maintaining good health behaviors, mental health, and social relationships. Annals of Behavioral Medicine, 23, 68–74.

    Article  PubMed  CAS  Google Scholar 

  • Stefanek, M., McDonald, P. G., & Hess, S. A. (2005). Religion, spirituality and cancer: current status and methodological challenges. Psycho-Oncology, 14, 450–463.

    Article  PubMed  Google Scholar 

  • Stephens, M. A., & Townsend, A. L. (1997). Stress of parent care: Positive and negative effects of women's other roles. Psychology and Aging, 12, 376–386.

    Article  CAS  Google Scholar 

  • Stuart, S., & Cole, V. (1996). Treatment of depression following myocardial infarction with interpersonal psychotherapy. Annals of Clinical Psychiatry, 8, 203–206.

    Article  PubMed  CAS  Google Scholar 

  • Sullivan, M., LaCroix, A. Z., Russo, J., & Katon, W. J. (1998). Self-efficacy and self-reported functional status in coronary heart disease: A six-month prospective study. Psychosomatic Medicine, 60, 473–478.

    PubMed  CAS  Google Scholar 

  • Thornton, B., & Leo, R. (1992). Gender typing, importance of multiple roles, and mental health consequences for women. Sex Roles, 27, 307–317.

    Article  Google Scholar 

  • Vaccarino, V., Krumholz, H. M., Yarzebski, J., Gore, J. M., & Goldberg, R. J. (2001). Sex differences in 2-year mortality after hospital discharge for myocardial infarction. Annals of Internal Medicine, 134, 173–181.

    PubMed  CAS  Google Scholar 

  • Van Ness, P. H., & Larson, D. B. (2002). Religion, Senescence, and Mental Health: The end of life is not the end of hope. American Journal of Geriatric Psychiatry, 10, 386–397.

    Article  PubMed  Google Scholar 

  • Wassertheil-Smoller, S., Applegate, W. B., Berge, K., Chang, C. J., Davis, B. R., Grimm, R., et al. (1996). Change in depression as a precursor of cardiovascular events. Archives of Internal Medicine, 156, 553–561.

    Article  PubMed  CAS  Google Scholar 

  • Wassertheil-Smoller, S., Shumaker, S., Ockene, J., Talavera, G. A., Greenland, P., Cochrane, B., et al. (2004). Depression and cardiovascular sequelae in postmenopausal women: The Women's Health Initiative (WHI). Archives of Internal Medicine, 164, 289–298.

    Article  PubMed  Google Scholar 

  • Wiklund, I., Herlitz, J., Johansson, S., Bengtson, A., Karlson, B. W., & Persson, N. G. (1993). Subjective symptoms and well-being differ in women and men after myocardial infarction. European Heart Journal, 14, 1315–1319.

    PubMed  CAS  Google Scholar 

  • Woods, T. E., Antoni, M. H., Ironson, G. H., & Kling, D. W. (1999). Religiosity is associated with affective and immune status in symptomatic HIV-infected gay men. Journal of Psychosomatic Research, 45, 165–176.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kristin S. Vickers.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Larsen, K.E., Vickers, K.S., Sampson, S. et al. Depression in Women with Heart Disease: The Importance of Social Role Performance and Spirituality. J Clin Psychol Med Settings 13, 36–45 (2006). https://doi.org/10.1007/s10880-005-9008-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10880-005-9008-1

KEY WORDS:

Navigation