Women with Heart Disease: Risk of Depression

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Table of Contents

Abstract
Introduction
Background
Heart Disease and Women
Literature Review
Conclusions
References

Abstract

Depression and heart disease are dangerous and debilitating diseases. Depression can cripple a person’s ability to think and act according to the situation, while heart disease can cause severe damage to a body and lead to death. The presence of heart disease can often lead to depression, as the person has to worry about his life and health every day, knowing that their heart is not as reliable as it used to be. Women are prone to heart diseases and depression more so than men, due to differences in mentality and physiology. The research shows that social and psychological support, age, physical health, and way of life can affect the development of depression at early stages positively or negatively.

Introduction

Depression and heart disease are not mutually exclusive. These dangerous diseases often come hand in hand, with one causing another or the other way around. Either of these diseases is very widespread among the population and equally debilitating. At the same time, the mechanisms of either disease are not completely understood by modern medicine. While pathological mechanisms of heart disease are relatively well-studied, depression is a much more intricate subject. So far, science can only suggest possible reasons for depression, but mechanisms of how exactly the disease appears, how it works, how it can be prevented, and how it affects the rest of the body are not completely understood. This creates difficulties when trying to establish visible connections between heart disease and depression.

Most women in the USA die from heart disease. This is due to the susceptibility of a female body to ailments that serve as the gateway to heart diseases, such as diabetes, blood lipids, and metabolic syndrome. The number of women in the US that have heart disease in some form fluctuates between 6 to 7 million people, out of which approximately 500,000 people die every year (Gregg, 2012). This is a very grim statistic, which only serves to underline the impact that heart disease has on women’s lives. Due to the symbiotic nature of these two ailments, it is not hard to extrapolate that women are in greater danger of depression related to heart disease. The purpose of this paper is to explore the relationship between heart disease and depression in women, analyze how it is affected by other factors, such as age, ethnicity, economic standing, social standing, and culture, and suggest what factors healthcare personnel should be focused on to reduce the appearance and potential escalation of depression in women.

Background

What is Heart Disease?

Heart disease is a collective term used to describe all kinds of diseases that affect the heart in one way or another. Since the heart is one of the most important organs in a human body, any heart-related problems have the potential to escalate and result in death. The most common types of heart diseases are (Pan, 2011):

Ischemic stroke – this disease happens when a blood clot blocks the vessel that feeds the brain. Without oxygen, the stroke causes brain cells to die, severely debilitating a person or even killing them, if the clot is not found and removed in time.
Heart failure – contrary to its name, this disease does not always mean complete heart failure. In the case with Congestive Heart Failure (CHF), the heart keeps working but is not supplying enough oxygen to the body, causing cells to die.
Arrhythmia – as the name suggests, this disease is described by an abnormal beat rate of a heart. Heartbeat can be either below 60 beats per minute, or above 100. Heartbeat rate can influence how a heart works. Bradycardia can cause oxygen deficiency in a body, while tachycardia can wear heart muscles out and increase the chances of heart failure.
Heart valve problems – this collective term covers a great load of subsequent heart problems, such as stenosis, regurgitation, mitral valve prolapses, and so on. When heart valves do not open or close properly, they alter the blood flow and allow oxygen-enriched blood to mix up with oxygen-depleted blood. This causes problems with healthy blood circulation.

What is Depression?

Depression is a mental disorder that is characterized by a persistent feeling of sadness, loss of interest, worthlessness, etc. Unlike sadness, which is a normal human emotion that occurs in response to certain events and life situations, depression is something more permanent and dangerous if left untreated. It can affect how a person thinks, acts, and functions (Miller, 2012). Studies show that depression can influence health both directly and indirectly. Depression can affect a person’s will to take medicine and exercise, thus indirectly causing damage to their physical health. It can also motivate a person to do self-harm or commit suicide. However, the mechanisms of how food affects the body directly are currently not so well-known or understood. Depression can affect a body by changing its nervous system and hormonal balance. This is one of the frequent reasons for the development of arrhythmia. According to Ziegelstein (2017), depression causes platelets to become sticky, which increases the chances of blood clots and atherosclerosis.

Depression can be caused by a great number of factors, such as biological differences, brain chemistry, hormones, inherited traits, or difficult psychological circumstances. Heart disease can serve as a cause for clinical depression, as it induces a feeling of worry, fear, and uncertainty about what is considered to be the most important and reliable part of the human body (Moffitt, 2010). Heartbeat is as natural to a person as breathing. If something is wrong with it, it can cause anxiety. A heart failure, if survived, counts as a near-death experience, which can trigger a depressive disorder. Statistics show that heart disease often triggers depression, and depression can be a direct or indirect reason for the development of heart disease.

Heart Disease and Women

In the USA, approximately 25% of all women die from heart disease (Miller, 2012). According to the Center for Disease Control and Prevention, about 5.7% of all white women, 7.7% of all Afro-American women, and 5.6% of all Mexican women in the country have coronary artery disease (Schnatz, 2011). The reason why Afro-American women are more prone to developing heart disease lies largely within the fact that a social discrepancy exists between an average white and an average African-American household. African-Americans, on average, tend to be poorer, which reflects on their ability to afford quality healthcare and screening services. Mexican and Latino population, on the other hand, is less prone to cardiovascular diseases because a great portion of that population is comprised of relatively young migrants that are either vying for or recently received US citizenship.

Coronary artery disease is the main cause of death in both men and women. This disease slowly narrows blood vessels over time, eventually leading to their blockage, preventing blood from being supplied to and from the heart. This disease is the number one reason for heart attacks. While heart diseases affect men and women almost equally, there are differences between them, motivated by physiological and psychological factors. Heart diseases that are more common to women rather than men include coronary microvascular disease and the so-called “broken heart” syndrome. This disease is classified as a brief heart failure caused by severe cases of stress and emotional response.

While heart disease can appear at any age, it tends to appear in women with age – as the body became weaker and worn out, and the organism becomes more susceptible to illness and disease. Menopause can affect the appearance and development of heart disease. Other factors that may play a role include unhealthy lifestyle, difficult and late pregnancy, and psychological disorders.

Until recently, differences between female and male physiology were not viewed as prominent in studies of cardiovascular diseases. However, several important differences are being acknowledged by official research, such as differences between symptoms and chances of survival after experiencing a heart attack. A woman is more likely than a man to die from a repeated attack within a year. Clot-busting drugs and specific types of surgery seem to have different effects on men and women. Women are more prone to diabetes and negative effects following it – obesity, high levels of cholesterol, and hypertension. Smoking increases the chances of developing heart disease in women much more so than it does in men. Women are also known to suffer more from clinical depression. Several types of research state a direct correlation between depression and heart disease. Depression helps develop heart disease, and heart disease, in turn, makes depression even worse. As more research is dedicated to the subject, medical practices start shifting and evolving to fine-tune heart treatments according to the patient’s gender.

Literature Review

Depression and heart disease in women

This article was published in 2012 as part of the Harvard Mental Health Letter. It provides statistics about heart disease and depression and establishes a connection between the two (Miller, 2012). It is a reliable and peer-reviewed source of information, which was used in this research as part of the introduction and background research. Data provided in this article is important for our research as it allows us to outline the issue and justify the necessity of the study.

Predictors of depressive symptoms among coronary heart disease patients: A cross-sectional study nine years after coronary artery bypass grafting

This research was published in 2010 in Heart & Lung: The Journal of Acute and Critical Care, which makes it a relatively recent, trustworthy, and peer-reviewed source. The article focuses on the development of depressive symptoms in heart disease patients of both genders. The study was conducted via a questionnaire sent to 152 patients that survived coronary heart disease and were implanted with a coronary artery bypass graft (Koivula, Halme, & Astedt-Kurki, 2010). The value of this study for our research lies in the fact that it compares and analyses the frequency and symptoms of depression in patients depending on their gender, age, race, and social standing. This research supports the hypothesis that women are more vulnerable to depression than men, as almost half of them (47%) reported feelings of depression, compared to 24% in men (Koivula, Halme, & Astedt-Kurki, 2010). Another important issue being touched in this research is the influence and importance of social support to prevent depression. Research indicates that receiving different kinds of support, be it social, emotional, concrete, and informational support helped either prevent depressive disorders from happening or stopped them in the early stages. Research also notes that depression in women was associated with feelings of discomfort, pain, and limited physical activity, while the most factor that leads to depression and anxiety in men was hospitalization.

Trajectories and predictors of anxiety and depression in women during the 12 months following an acute cardiac event

This study was published in 2010 by a body of researchers representing the Heart Research Centre located in Melbourne, Australia. This research, unlike the previous one, is women-centered, and analyses the development and treatment of depression in women during the first 12 months following an acute cardiac event. The primary method for this study was the interview of 226 available respondents (Murphy et al., 2010). The research showed that for the majority of respondents, initial levels of depression and anxiety were common but fairly low. Over 85% of all respondents experienced low levels of depression and anxiety and improved over time. The remaining 15% scored high on depression levels, which worsened over time (Murphy et al., 2010). This research shows that the dynamic of depression treatment is, overall, positive for the majority of female patients. In those cases where the condition worsened, it was associated with factors that accompany heart diseases, such as diabetes, obesity, and age. Support and culture shock was deemed important factors, as higher levels of depression were noted in those without social or emotional support, or those not speaking English as a native tongue. The importance of this article to our study lies in the fact that it confirms the initial statement about women having depression after experiencing heart disease, but also reflects on levels of such depression, and on factors that help reduce it.

Recurrent depression, cardiovascular disease, and diabetes among middle-aged and older adult women

This article was published in the Journal of Affective Disorders in 2013 and is dedicated to exploring the interconnected relationship between recurrent depression and cardiovascular disease. The respondents in this research were all middle-aged and older adult women, which are considered most vulnerable to cardiovascular diseases, due to numerous factors, such as diabetes, menopause, the overall weakness of the heart, and so on. The total number of respondents for this study was 557, with a mean age of around 56 years (Windle & Windle, 2013). The research found that singular cases of depression are less likely to create lasting heart-related problems when compared to recurring cases of depression. This coincides with previous research, as the majority of the respondents’ depression after a cardiac arrest was a singular occurrence. Perceived reasons for recurring depression repeat observations done in previous articles – social and emotional support, age, and overall health levels of the respondent largely determine the chances of recurrence of depression and its severity.

Depression in women with heart disease: The importance of social role performance and spirituality

This study was published in 2011 in the Journal of Clinical Psychology in Medical Settings. The authors operate the same statements voiced in previous researches – that heart diseases provoke depression, that women are more vulnerable to depression than men, and that the topic of differences between men and women regarding heart diseases and depression is currently understudied. However, the focus of this article is on the importance of social role performance, psychological assistance, and spirituality as a means of combating the negative psychological aspects of heart disease. The number of respondents for this study was 125 women with the mean age of 55 years, all diagnosed with heart disease. The researchers report that out of all respondents, approximately 31% reported having depression related to their heart problems (Larsen, Vickers, Sampson, Netzel, & Hayes, 2011). The results of the study confirm that social role performance, social support, and spirituality are effective tools in reducing feelings of anxiety and depression.

Methodology Analysis of an Article

The article titled “Recurrent depression, cardiovascular disease, and diabetes among middle-aged and older adult women” was written in 2013 by Michael Windle and Rebecca C. Windle, and published in the Journal of Affective Disorders.

Population

Middle-aged and older adult women between 40 and 76 years of age. Mean age of respondents – around 56 years. The total number of respondents – 557 (Windle & Windle, 2013).

Methods

Primary method of data collection – questionnaires and interviews. Primary methods of data analysis – Cross-sectional analysis, AOR, and T-tests (Windle & Windle, 2013).

Results

The researchers noted that “after controlling for a range of important covariates, cross-sectional analyses indicated that recurrent MDD, but not single-episode MDD, significantly predicted CVD risk and diabetes. Prospective analyses indicated that recurrent MDD, but not single-episode MDD, increased the risk for CVD and diabetes” (Windle & Windle, 2013, p. 899).

Discussion

The strength of this research lies in the fact that it has a large responder base and that it was done in waves within a 5-year interval, which allowed the researchers to perform a longitudinal study and see long-term effects of recurring depression on respondents diagnosed with heart disease. The limitations of the research are several. The main weakness of the research is that it relies largely on self-reported data, which means that bias is likely. Another limitation mentioned by the authors is that the respondent population was predominantly white, which means this study is not an accurate representation of the situation for minority groups. The authors state that “future research would benefit from a focus on the specific genetic, biological, and psychosocial mechanisms that account for the relationship between recurrent MDD and CVD and diabetes, and the evaluation of interventions designed to reduce recurrent MDD and its impact on CVD and diabetes” (Windle & Windle, 2013).

Personal Reflection

While performing this research, I noticed that many articles dedicated to the subject reflected on how the depression caused heart disease, but not the other way around. The articles I found and presented in the literature review section were few and far between. This indicates a lack of research in the field, especially regarding specialized information about women. It was a surprise to find out that the majority of heart disease-related material in the past years was largely performed on men, and that it was assumed that male and female physiology and psychology was similar in that regard. I cannot say what motivated such obvious gender bias, as it does not make sense from medical and psychological points of view.

My research showed me the importance of early psychological help and social support to prevent depression. In my experience with treating issues related to practically every facet of human health, early treatment proves much easier and cost-effective than later treatments of a fully-developed health problem. I was surprised to find out that spirituality and religiousness could be used as a treatment tool for depression along with standard psychological tactics. Although one of the articles proves its effectiveness, I believe that its effectiveness largely relies on a patient’s personal beliefs.

Conclusions

Literature analysis performed in this paper unanimously shows that women are vulnerable to depression caused by heart disease, as around 85% of respondents experience it in lesser forms, while the rest experience more acute forms of depression. All five articles reviewed in the literature section state that, in one way or another, more acute forms of depression are associated with age, social security, support, and overall health. In all presented studies, researchers remark that the presence of social and psychological support, as well as overall good health, has good effects on alleviating depression. Spirituality and connection to a divine entity have also been found to help alleviate feelings of depression and anxiety among women patients diagnosed with heart disease. These findings correspond with similar research regarding other grave diseases like cancer and major organ failures, where patients experienced severe cases of depression. Psychological help, social security, and spirituality were also very effective in reducing the amount of stress and anxiety for these patients.

References

Gregg, E.W. (2012). Trends in death rates among U.S. adults with and without diabetes between 1997 and 2006: findings from the National Health Interview Survey. Diabetes Care, 35(2012), 1252-1257.

Koivula, M., Halme, N., & Astedt-Kurki, P. (2010). Predictors of depressive symptoms among coronary heart disease patients: A cross-sectional study nine years after coronary artery bypass grafting. Heart & Lung: The Journal of Acute and Critical Care, 39(5), 421-431.

Larsen, K.E., Vickers, K.S., Sampson, S., Netzel, P., & Hayes, S.N. (2011). Depression in women with heart disease: The importance of social role performance and spirituality. Journal of Clinical Psychology in Medical Settings, 13(1), 39-48.

Miller, M.C. (2012). Depression and heart disease in women. Harvard Mental Health Letter, 28(8), 1-2.

Moffitt, T.E. (2010). How common are common mental disorders? Evidence that lifetime prevalence rates are doubled by prospective versus retrospective ascertainment. Psychological Medicine, 40, 899-909.

Murphy, B.M., Elliott, P.C., Worcester, M.U.C., Higgins, R.O., Le Grande, M.R., …Goble, A.J. (2010). Trajectories and predictors of anxiety and depression in women during the 12 months following an acute cardiac event. The British Psychological Society, 13, 135-153.

Pan, A. (2011). Depression and incident stroke in women. Stroke, 41(10), 2770-2775.

Schnatz, P.F. (2011). A Prospective Analysis of the Association Between Cardiovascular Disease and Depression in Middle-Aged Women. Menopause, 18(10), 1096-1100.

Windle, M., & Windle, R.C. (2013). Recurrent depression, cardiovascular disease, and diabetes among middle-aged and older adult women. Journal of Affective Disorders, 150(3), 895-902.

Ziegelstein, R.C. (2017). Depression and heart disease. Web.

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