The association of social determinants of health and depressive symptoms with quality of life among rural patients with coronary heart disease and heart failure

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung Pub Date : 2025-09-17 DOI:10.1016/j.hrtlng.2025.09.006

Ashmita Thapa Ph.D., RN (Post-doctoral Research Associate) , Geunyeong Cha Ph.D., RN (Post-doctoral Research Associate) , Jia-Rong Wu Ph.D., RN, FAHA, FAAN (Professor) , Martha J. Biddle Ph.D., RN, APRN, CCNS, FAHA (Professor) , Abigail Latimer PhD, MSW, LCSW, APHSW-C (Assistant Professor) , Mark B Dignan PhD, MPH (Professor) , Chin-Yen Lin Ph.D., RN (Assistant Professor) , JungHee Kang Ph.D., RN (Assistant professor) , Debra K. Moser PhD, RN, FAHA, FAAN (Professor)

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引用次数: 0

Abstract

Background

There are significant health disparities among rural populations, especially in the prevalence and management of coronary heart disease and heart failure. Social determinants of health (SDOH) play a crucial role in these disparities, influencing access to care, mental health, and overall quality of life (QOL). Depressive symptoms, common among rural patients with coronary heart disease and heart failure, may further exacerbate these challenges by mediating the relationship between SDOH and QOL.

Objectives

We aimed to examine the association between SDOH and QOL among rural patients with coronary heart disease and heart failure, as well as to determine whether depressive symptoms mediate this relationship.

Methods

A cross-sectional analysis (N = 124) was conducted using data from a randomized controlled trial. The Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences questionnaire was used to measure SDOH, depressive symptoms were assessed using the Patient Health Questionnaire-9, and QOL was evaluated using Short Form-12. We performed hierarchical multiple regression and mediation analyses.

Results

Higher SDOH risk scores were significantly associated with lower QOL (B= -0.319; p < 0.001). Depressive symptoms mediated this relationship (indirect effect: a*b = -0.624, 95 % confidence interval (CI)= [-1.045, -0.273]), suggesting that individuals with higher SDOH risk had worse depressive symptoms, which in turn led to lower QOL.

Conclusion

The SDOH were associated with QOL in rural patients with coronary heart disease and heart failure, and depressive symptoms mediated this relationship. Findings highlight the need for targeted interventions addressing both social determinants and mental health to improve QOL.

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农村冠心病和心力衰竭患者健康和抑郁症状的社会决定因素与生活质量的关系

背景：农村人口之间存在显著的健康差异，特别是在冠心病和心力衰竭的患病率和管理方面。健康的社会决定因素（SDOH）在这些差异中发挥着至关重要的作用，影响着获得护理、心理健康和总体生活质量（QOL）的机会。抑郁症状在农村冠心病和心力衰竭患者中常见，可能通过介导SDOH和生活质量之间的关系进一步加剧这些挑战。目的：我们旨在研究农村冠心病心衰患者的SDOH与生活质量之间的关系，并确定抑郁症状是否介导了这种关系。方法：采用随机对照试验资料进行横断面分析（N = 124）。使用《患者资产、风险和经历响应和评估方案》问卷测量SDOH，使用《患者健康问卷-9》评估抑郁症状，使用短表-12评估生活质量。我们进行了层次多元回归和中介分析。结果：SDOH风险评分越高，生活质量越低（B= -0.319; p < 0.001）。抑郁症状介导了这一关系（间接效应：a*b = -0.624, 95%置信区间(CI)=[-1.045, -0.273]），表明SDOH风险越高的个体抑郁症状越严重，进而导致生活质量越低。结论：农村冠心病心衰患者SDOH与生活质量相关，抑郁症状在其中起中介作用。研究结果强调，需要针对社会决定因素和心理健康采取有针对性的干预措施，以改善生活质量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Heart & Lung 医学-呼吸系统

CiteScore

4.60

自引率

3.60%

发文量

184

审稿时长

35 days

期刊介绍： Heart & Lung: The Journal of Cardiopulmonary and Acute Care, the official publication of The American Association of Heart Failure Nurses, presents original, peer-reviewed articles on techniques, advances, investigations, and observations related to the care of patients with acute and critical illness and patients with chronic cardiac or pulmonary disorders. The Journal''s acute care articles focus on the care of hospitalized patients, including those in the critical and acute care settings. Because most patients who are hospitalized in acute and critical care settings have chronic conditions, we are also interested in the chronically critically ill, the care of patients with chronic cardiopulmonary disorders, their rehabilitation, and disease prevention. The Journal''s heart failure articles focus on all aspects of the care of patients with this condition. Manuscripts that are relevant to populations across the human lifespan are welcome.