Abstract
Purpose: Despite its proven effi cacy, 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 signifi cant 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.
Original language | English |
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Pages (from-to) | 163-169 |
Number of pages | 7 |
Journal | Journal of Cardiopulmonary Rehabilitation and Prevention |
Volume | 38 |
Issue number | 3 |
DOIs | |
State | Published - 1 May 2018 |
Bibliographical note
Publisher Copyright:© 2018 Wolters Kluwer Health, Inc.
Funding
This study was supported by grants from the Israel National Institute for Health Policy and Health Services Research (NIHP), from the Israel Heart Fund, and from the Schnitzer Foundation for Research on the Israeli Economy and Society, Bar-Ilan University. The authors have certified they conformed to the Helsinki Declaration concerning human rights and informed consent and followed correct procedures concerning treatment of humans in research. All procedures followed were in accordance with the ethical standards of the Responsible Committee on Human Experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. The Meir Medical Center Institutional Review Board approved the use of an oral informed consent for all patients included in the study.
Funders | Funder number |
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Israel National Institute for Health Policy and Health Services Research | |
Israel Heart Fund | |
Bar-Ilan University | |
Israel National Institute for Health Policy Research | |
Schnitzer Foundation for Research on the Israeli Economy and Society |
Keywords
- Acute coronary syndrome
- Arab minority
- Israel
- anxiety
- cardiac rehabilitation
- depression