Gender Differences in Psychosocial
Factors influencing Care of CVD
Holly Mead, PhD
Assistant Research Professor
Department of Health Policy
The George Washington University
AcademyHealth
Annual Research Meeting
Gender Interest Group
June 26, 2009
Background
g
Psychosocial factors are significant risk factors
f CVD morbidity,
for
bidi mortality
li post event1

 Exacerbate behavioral risk factors
 Hamper lifestyle changes
 Impede adherence to medical recommendations

Poor self-management can lead to
 Secondary
y events
 Additional interventions
Re-hospitalization
hospitalization
 Re
2
Background
g
Women more likely to experience psychosocial
,
problems following cardiac event2,3

Depression
 Insomnia
 Anxiety

Women less likely to use available resources4
 Despite evidence, psychosocial factors are not
generally acknowledged as risk factors by MDs5

3
Objective
j
To examine psychosocial factors affecting
adjustment
dj
to, management off CVD
 To explore gender differences in how PS
factors affect CVD patients’ self-management

 Different factors affect illness, care
 Factors affect illness, care differently
To inform development, implementation of
effective interventions that address PS factors in
CVD recovery

4
Methodology
gy
Qualitative study investigating patient selfmanagement among CVD patients
i

 Convened 33 focus groups; 401 CVD patients
 Questions focused on challenges getting care,
coping with illness, managing disease
 Conducted thematic content analysis to identify
barriers to effective self-management
 Compared
C
d themes
h
by
b gender
d to examine
i
differences in experiences, perspectives
5
Participant
p Characteristics

Gender breakdown → 52% female; 48% male
 Women more likely to be minorities
 82% minority

O
Over
50% with
ith incomes
i
< $25K annually
ll
 Women more likely to report low household
incomes

Insurance
 1/3 Medicaid
 13% privately insured
 12%
% Medicaid
 12% uninsured
6
Findings
Table 1. Domains and Themes
Negative
1) Depression (n=58)
emotional
2) Fear (n=21)
states
3) Anger & hostility (n=9)
Chronic life
stressors
1) Disease stress (n=16)
2) Financial stress (n=16)
Social factors 1) Social isolation (n=11)
2)) Burden
u de to family
a y & friends
e ds ((n=12))
3) Social Support (n=48)
7
Findings:
g Psychosocial
y
Domains
Chart 1: Gender Analysis by Psychosocial Domains
100
Percen
ntage of Refe
erences
90
80
70
60
Male
50
Female
40
30
20
10
0
N
Negative
ti emotional
ti
l state
t t
Ch i lif
Chronic
life stressors
t
Psychosocial Dom ains
8
S i l ffactors
Social
t
Findings: Emotional States
P ercen tagg e o f
R eferen cces
Chart 2: Negative Emotional States by Gender
90
80
70
60
50
40
30
20
10
0
M l
Male
Female
depression
fear
Negative Emotional States
9
anger
Findings: Emotional States
Depression was the most commonly discussed
PS factor interfering with self-management

 Men slightly more likely than women to raise as
issue
“What you used to love you can’t do. I used to love to go
ffishing,
g huntingg and swimming,
g but I can’t do that now.
You get to where you don’t care if you wake up the next
morning.” – male participant
“I suffer from depression, and the more depressed I am,
the more…I can’t stop eating… I’m ashamed to say it, but
I don’t
don t know how to control myself
myself.” – female participant
10
Findings: Emotional States
Women were more likely
W
lik l to
t express fear
f related
l t d
to their disease; possibility of death

“The day I went home, that night I was scared. I
wouldn’t lie down to go to sleep. I was afraid to go to
sleep I just didn
sleep.
didn’tt know.
know There was the fear of the
unknown.” – female participant
11
Findings: Emotional States
Men were more likely to convey anger,
anger
frustration around loss of former life

“You’ve
You ve been working your whole life and they throw a
heart attack up on you and you can’t work…. Now my
wife
f is working,
g, paying
p y g all the groceries,
g
, all the bills byy
herself. Yes, this pisses me off.”– male participant
12
Findings: Life Stressors
Percentage
P
e of
Reference
es
Chart 3: Chronic Life Stressors by Gender
80
70
60
50
40
30
20
10
0
Male
Female
Disease stress
Financial Stress
Chronic Life Stressors
13
Findings: Life Stressors
Women were much more likely to discuss stress,
worryy related to disease,, management
g
of care

“I have high blood pressure and heart trouble, and
sometimes, though you take your medication, you have a
h d h [[and]
headache
d] you ddon’t
’ kknow if it’s
i ’ possible
ibl you might
i h
have a stroke or just a normal headache.” – female
p
participant
p
Men were more likely to discuss stress related to
financial burdens, employment issues

“The amount of bureaucratic red tape that people have to go
through [is] stressful. You worry about how you’re going to
pay for it and that only adds to it
it.” – male participant
14
Findings: Social Factors
Chart 4: Social Factors by Gender
Percentag
ge of
Referenc
ces
100
80
60
Male
40
Female
20
0
social isolation
burden on family,
friends
Social Factors
15
social support
Findings:
g Social Support
pp
Women more likely
y to feel sociallyy isolated;
worry about being a burden to family, friends

“I'm so afraid
f
off becomingg a recluse because I'm so
weak and tired. I'm afraid to go out and do anything.”
– female participant
“You worry about being a burden on your family, but you
don’t know what to do. So a lot off times…you
y don’t talk
to them because you don’t want them to know that it’s
really that bad.” – female participant
16
Findings:
g Social Support
pp
Men were more likely
y to talk of the critical role
their spouses play in their care

“Myy wife
f does all this stuff
ff like a nurse. That’s her first
f
priority. I say ‘why I gotta take 11 pills this morning’
and she says I wanna see you alive.”– male participant
Both men, women participating in cardiac
great benefit of program
p g
rehabilitation discussed g
“This group is very important… Prior to being in the

p g
program
we didn’t keepp our diets or our appointments
pp
and now we do it together.” – female participant
17
Conclusions
Both genders experience extensive
psychosocial issues

Affect ability to adjust to, cope with CVD
 Impede management of CVD
qualityy of life
 Alter q
18
Conclusions
Women, men experience psychosocial factors in
unique gender-specific
unique,
gender specific ways

 For women
More in
in-line
line with social role as caregivers6
Reflects women’s feelings of vulnerability to illness7, 8
 For men
More in-line with social roles as providers, head of
family9,10
Reflects undermining of notions of masculinity
19
Implications for Practice
 Acknowledge
g
psychosocial
py
factors as legitimate
g
risk factors
 Routinely screen for range of psychosocial issues
 Develop interventions targeted to unique
experiences of women,
women men
 Promote use of available resources
20
Implications for Policy
Support
HEART Act and other legislation to
st d diseases from uniquely
study
niq el female perspective
perspecti e
Reform finance and delivery models
 Shift to holistic model of care that encompasses biopsychosocial health model11
 Ensure adequate reimbursement for psychosocial
screenings, interventions
21
Acknowledgments
Coauthors: Ellie Andres, Christal Ramos,
Bruce Siegel,
Siegel Marsha Regenstein.
Regenstein

This research was generously funded by the
Robert Wood Johnson Foundations’ Expecting
Success: Excellence in Cardiac Care program


Contact information: khmead@gwu.edu
22
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