Psychosocial Factors in the Development of Heart Disease in Women: Current Research and Future Directions

Abstract

Objective-To review the recent (1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)) literature on psychosocial risk and protective factors for coronary heart disease (CHD) among women, including negative emotions, stress, social relationships, and positive psychological factors.Methods-Articles for the review were identified using PubMed and bibliographies of relevant articles. Eligible studies included at least 100 women and either focused on (a) exclusively female participants or (b) both men and women, conducting either gender-stratified analyses or examining interactions with gender. Sixty-seven published reports were identified that examined prospective associations with incident or recurrent CHD.Results-In general, evidence suggests that depression, anxiety disorders, anger suppression, and stress associated with relationships or family responsibilities are associated with elevated CHD risk among women, that supportive social relationships and positive psychological factors may be associated with reduced risk, and that general anxiety, hostility, and work-related stress are less consistently associated with CHD among women relative to men.Conclusions-A growing literature supports the significance of psychosocial factors for the development of CHD among women. Consideration of both traditional psychosocial factors (e.g., depression) and factors that may be especially important for women (e.g., stress associated with responsibilities at home or multiple roles) may improve identification of women at elevated risk as well as the development of effective psychological interventions for women with or at risk for CHD. Keywordscoronary heart disease; women's health; depression; hostility; psychological stress; social support Over the past decade, a number of reviews have summarized the growing literature on psychosocial risk factors for coronary heart disease (CHD), which include negative emotional states, psychological stress, and lack of supportive social relationships (1,2,3,4). Although these important reviews note some differences in risk factors for men and women, they do not evaluate the results systematically by gender. The goal of this review is to summarize the results of studies that examine the relationship between psychosocial risk factors and CHD for women specifically.Address correspondence to Carissa A. Low, PhD, 3811 O'Hara Street, Pittsburgh, PA 15213. Telephone: (412) 648-7160. lowca@upmc.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptPsychosom Med. Author manuscrip...

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