Symptoms of Depression and Anxiety as Barriers to Participation in Cardiac Rehabilitation Programs Among Arab and Jewish Patients in Israel. Issue 3 (May 2018)

• Record Type: Journal Article
• Authors: Vilchinsky, Noa; Reges, Orna; Leibowitz, Morton; Khaskia, Abdulrahim; Mosseri, Morris; Kark, Jeremy D.
• Is Part Of: Journal of cardiopulmonary rehabilitation and prevention. Volume 38:Issue 3(2018)
• Publication Date: 2018-05
• Subjects: acute coronary syndrome -- anxiety -- Arab minority -- cardiac rehabilitation -- depression -- Israel; Cardiopulmonary system -- Diseases -- Patients -- Rehabilitation -- Periodicals; Cardiopulmonary system -- Diseases -- Prevention -- Periodicals; 616.103
• DOI: 10.1097/HCR.0000000000000310
• Languages: English
• ISSNs: 1932-7501

Abstract

Abstract : Purpose: Despite its proven efficacy, 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 significant 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. Abstract : Supplemental Digital Content is Available in the Text.Although Israeli Arab patients after acute coronary syndrome reported more frequent symptoms of depression than their Jewish counterparts, this did not explain the profound ethnic difference in cardiac rehabilitation program utilization. Symptoms of anxiety and depression were associated with lower rates of participation in a cardiac rehabilitation program regardless of ethnicity.