Noa Vilchinsky1, Orna Reges, Morton Leibowitz, Abdulrahim Khaskia, Morris Mosseri, Jeremy D Kark. 1. Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel (Dr Vilchinsky); Hebrew University-Hadassah School of Public Health and Community Medicine, Jerusalem, Israel (Dr Reges and Dr Kark); Clalit Research Institute, Tel-Aviv, Israel (Dr Reges and Dr Leibowitz); Department of Cardiology, Meir Medical Center, Kfar-Saba, Israel (Dr Reges and Drs Khaskia and Mosseri); and New York University School of Medicine, New York, New York (Dr Leibowitz).
Abstract
PURPOSE: Despite its proven efficacy, low participation rates in cardiac prevention and rehabilitation programs (CPRPs) prevail worldwide, especially among ethnic minorities. This is strongly evident in Israel's Arab minority. Since psychological distress has been found to be associated with CPRP participation and minorities are subjected to higher levels of distress, it is plausible that distress may be an important barrier for CPRP participation among minority patients. The current prospective study assessed the contribution of depression and anxiety symptoms to participation in a CPRP after acute coronary syndrome, both in the enrollment phase and when considering adherence over time, among Jewish (majority) and Arab (minority) patients in Israel. METHODS: Patients were interviewed during hospitalization about their emotional status and at a 6-mo follow-up concerning participation in a CPRP. Analyses were performed on 397 patients. The Brief Symptom Inventory was used. Logistic regression modeling was applied. RESULTS: Symptoms of depression, but not anxiety, were frequently observed among Arab patients compared with their Jewish counterparts. In analyses adjusted for age, sex, ethnicity, and sociodemographic and clinical characteristics, having symptoms of anxiety was associated with less participation in a CPRP, evident for both Jews and Arabs; this association was less evident for symptoms of depression. Multivariable adjusted models did not show a significant association of symptoms of anxiety or depression with adherence in a CPRP. Accounting for psychological distress did not reduce the sharp difference between Jews and Arabs in CPRP participation. CONCLUSION: Symptoms of distress may serve as barriers to CPRP participation, regardless of ethnic origin.
PURPOSE: Despite its proven efficacy, low participation rates in cardiac prevention and rehabilitation programs (CPRPs) prevail worldwide, especially among ethnic minorities. This is strongly evident in Israel's Arab minority. Since psychological distress has been found to be associated with CPRP participation and minorities are subjected to higher levels of distress, it is plausible that distress may be an important barrier for CPRP participation among minority patients. The current prospective study assessed the contribution of depression and anxiety symptoms to participation in a CPRP after acute coronary syndrome, both in the enrollment phase and when considering adherence over time, among Jewish (majority) and Arab (minority) patients in Israel. METHODS:Patients were interviewed during hospitalization about their emotional status and at a 6-mo follow-up concerning participation in a CPRP. Analyses were performed on 397 patients. The Brief Symptom Inventory was used. Logistic regression modeling was applied. RESULTS: Symptoms of depression, but not anxiety, were frequently observed among Arab patients compared with their Jewish counterparts. In analyses adjusted for age, sex, ethnicity, and sociodemographic and clinical characteristics, having symptoms of anxiety was associated with less participation in a CPRP, evident for both Jews and Arabs; this association was less evident for symptoms of depression. Multivariable adjusted models did not show a significant association of symptoms of anxiety or depression with adherence in a CPRP. Accounting for psychological distress did not reduce the sharp difference between Jews and Arabs in CPRP participation. CONCLUSION: Symptoms of distress may serve as barriers to CPRP participation, regardless of ethnic origin.
Authors: Hannah M Malian; Patrick J Smith; Benson Hoffman; Wei Jiang; Katharine Ammerman; William E Kraus; Alan Hinderliter; Andrew Sherwood; James A Blumenthal Journal: J Cardiopulm Rehabil Prev Date: 2021-07-01 Impact factor: 3.646