PMID- 31510958 OWN - NLM STAT- MEDLINE DCOM- 20200520 LR - 20200520 IS - 1471-244X (Electronic) IS - 1471-244X (Linking) VI - 19 IP - 1 DP - 2019 Sep 12 TI - Mediators of gender effects on depression among cardiovascular disease patients in Palestine. PG - 284 LID - 10.1186/s12888-019-2267-4 [doi] LID - 284 AB - BACKGROUND: Among patients suffering from coronary heart disease (CHD) and comorbid depression, women experience a higher burden compared to men. Little is known on the characteristics that differentiate men and women with both diseases and whether these factors mediate gender effects on depression. This study assessed whether women are more likely to suffer from depression and which characteristics mediate gender effects on depression among a cardiac population in Palestine, specifically addressing the role of post-traumatic stress disorder (PTSD). METHODS: Using a cross-sectional design, patients consecutively admitted with a CHD to one of the four main hospitals in Nablus, Palestine, were interviewed using a structured questionnaire with validated instruments. Data was also obtained from hospital medical records. Patients were assessed for depression using the Cardiac Depression Scale (CDS). Bivariate analysis was conducted to compare characteristics of women and men with and without depressive symptoms. Mediators (direct and indirect effects) of the association between gender and depression were evaluated using a structural equation model (SEM). RESULTS: Women were more likely to suffer from severe depression than men (28.7% vs. 18.8%). Female gender was positively associated with higher PTSD symptoms, comorbidities, somatic symptoms and income, and with lower resilience, self-esteem, quality of life, education, prevalence of smoking and physical activity. Structural equation modeling revealed negative indirect effects of gender on depression (CDS score) through resilience, self-esteem and physical activity, whereas positive indirect effects of gender on depression were observed through PTSD, comorbidities, somatic symptoms and smoking. There was no direct effect of gender on depression. CONCLUSION: This study found a higher prevalence of severe depression in female patients with cardiac disease compared to male cardiac patients. Our findings provide novel information on mediating factors of the association between gender and depression among cardiac patients, in particular PTSD. The results emphasize the need for further research on potential mediating factors that could account for gender differences in depression and the need to provide support programs for female patients with comorbid CHD and depression to improve their psycho-social well-being. FAU - Allabadi, Hala AU - Allabadi H AD - Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, 4002, Basel, Switzerland. hala.allabadi@swisstph.ch. AD - University of Basel, Petersplatz 1, 4001, Basel, Switzerland. hala.allabadi@swisstph.ch. AD - Faculty of Medicine and Health Sciences, An-Najah National University, Rafidia Street, P.O. Box 7, Nablus, Palestine. hala.allabadi@swisstph.ch. FAU - Probst-Hensch, Nicole AU - Probst-Hensch N AD - Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, 4002, Basel, Switzerland. AD - University of Basel, Petersplatz 1, 4001, Basel, Switzerland. FAU - Alkaiyat, Abdulsalam AU - Alkaiyat A AD - Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, 4002, Basel, Switzerland. AD - University of Basel, Petersplatz 1, 4001, Basel, Switzerland. AD - Faculty of Medicine and Health Sciences, An-Najah National University, Rafidia Street, P.O. Box 7, Nablus, Palestine. FAU - Haj-Yahia, Saleem AU - Haj-Yahia S AD - An-Najah National University Hospital, Asira Street, Nablus, Palestine. AD - School of Clinical Sciences, University of Bristol, 69 St Michael's Hill, Bristol, BS2 8DZ, UK. AD - Institute of Cardiovascular and Medical Sciences, Glasgow University, 126 University Place, Glasgow, G12 8TA, UK. FAU - Schindler, Christian AU - Schindler C AD - Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, 4002, Basel, Switzerland. AD - University of Basel, Petersplatz 1, 4001, Basel, Switzerland. FAU - Kwiatkowski, Marek AU - Kwiatkowski M AD - Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, 4002, Basel, Switzerland. AD - University of Basel, Petersplatz 1, 4001, Basel, Switzerland. FAU - Zemp, Elisabeth AU - Zemp E AD - Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, 4002, Basel, Switzerland. AD - University of Basel, Petersplatz 1, 4001, Basel, Switzerland. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20190912 PL - England TA - BMC Psychiatry JT - BMC psychiatry JID - 100968559 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Arabs/*psychology MH - Cardiovascular Diseases/diagnosis/*epidemiology/*psychology MH - Cross-Sectional Studies MH - Depressive Disorder/diagnosis/*epidemiology/*psychology MH - Female MH - Humans MH - Male MH - Middle Aged MH - Psychiatric Status Rating Scales MH - Quality of Life/psychology MH - Self Concept MH - *Sex Characteristics MH - Surveys and Questionnaires PMC - PMC6739957 OTO - NOTNLM OT - Cardiovascular disease OT - Depression OT - Gender OT - Mediators OT - Post-traumatic stress disorder COIS- The authors declare that they have no competing interests. EDAT- 2019/09/13 06:00 MHDA- 2020/05/21 06:00 PMCR- 2019/09/12 CRDT- 2019/09/13 06:00 PHST- 2019/03/16 00:00 [received] PHST- 2019/08/29 00:00 [accepted] PHST- 2019/09/13 06:00 [entrez] PHST- 2019/09/13 06:00 [pubmed] PHST- 2020/05/21 06:00 [medline] PHST- 2019/09/12 00:00 [pmc-release] AID - 10.1186/s12888-019-2267-4 [pii] AID - 2267 [pii] AID - 10.1186/s12888-019-2267-4 [doi] PST - epublish SO - BMC Psychiatry. 2019 Sep 12;19(1):284. doi: 10.1186/s12888-019-2267-4.