Graduation Date

Spring 5-4-2019

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Programs

Nursing

First Advisor

Dr. Bunny Pozehl

Second Advisor

Dr. Therese Mathews

Third Advisor

Dr. Ronald Shope

Fourth Advisor

Dr. Robin Lally

Abstract

Coronary heart disease (CHD) is the number one killer of women in the US. Women also experience roughly twice as much depression as men, and depression in CHD is associated with increased morbidity and mortality. Despite these facts, women continue to be under-represented in CHD research, and results by gender are not routinely reported.

Screening for depression in this population is problematic due to inconsistent inclusion of somatic symptoms on screening instruments and disagreement about appropriate cutoff scores.

This body of work clarifies the concept of depression in women with CHD, presents a systematic review of the longitudinal literature on depressive symptoms in women with CHD examined by instrument, and presents results of a 3-month feasibility study examining women’s depressive symptoms. The purpose of the study was to evaluate participant enrollment, data collection, preliminary quantitative trends, and qualitative surveys for qualitative data collection.

Participant recruitment by individuals other than the P.I. was generally poor and attrition was problematic (16.7 – 28%). Prevalence of mean depression screening scores ≥ cutoff values averaged 30% at baseline, 26% at month 2, and 25% at month 3. Trends in symptom severity over the course of the study reflected trends in somatic symptoms and distress but not cognitive symptoms. Current depression was strongly correlated with fatigue and sleep as well as younger age, comorbid diabetes, a history of anxiety, and acute coronary syndrome symptoms. It was less strongly correlated with a history of depression and cardiac rehabilitation attendance. No correlation was found between current depression and employment status. Qualitative survey uptake was poor and the original survey was too restrictive, requiring modification.

This dissertation clarifies our understanding of the concept of depression in women with CHD and summarizes the longitudinal descriptive literature on depression in women with CHD. The dissertation study enhances our understanding of depressive symptoms experienced in this population, gives some important preliminary data on use of the PROMIS Depression 8b instrument in this population, highlights the importance of screening for depressive symptoms in this population, and emphasizes the ongoing need for CHD studies which examine and report data by gender.

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copyright transfer agreement for manuscript 1

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open access status for manuscript 2

Available for download on Saturday, April 25, 2020

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