Marital Adjustment, Depression and Myocardial Infarction

描述（由申请人提供）：抑郁症和冠心病（CHD）都是常见的疾病，经常同时发生。大约15-23%的人从心脏病发作中恢复过来（例如，心肌梗死（MI）将符合重度抑郁症的标准，高达65%的患者将经历抑郁症状的加重。然而，抑郁症病史和疾病严重程度仅中度预测这种合并症。重要的是，抑郁症是嵌入在社会背景下，特别是，抑郁症与婚姻调整密切相关。目前研究的主要目标是在一项对150名男性和女性进行的6个月、3波前瞻性研究中，检查婚姻适应较差的个体在MI后是否经历了更高水平和更持久的抑郁症状。一些研究表明，婚姻困扰和抑郁症状在女性中的联系比男性更紧密。因此，目前的研究将探讨性别是否会调节婚姻适应与抑郁水平和抑郁过程之间的关联，假设女性的关联比男性更强。先前的研究表明，抑郁症和可能的婚姻调整是MI后不良身体健康结果的危险因素。此外，当心理社会风险因素同时发生时，由于叠加或协同效应，负面结果的可能性可能会大幅增加。因此，本研究的第二个目标是检查抑郁症和婚姻调整对生活质量、功能状态和MI后复发事件的概率的联合和独立影响。女性在MI后可能会经历更糟糕的结局，心理社会因素可能会导致这种趋势。因此，拟议的研究将检查性别是否会缓和抑郁症，婚姻调整和冠心病后的健康结果之间的关系，假设对女性的影响比男性更强。拟议研究的更广泛目标是确定社会功能的各个方面，这些方面可能代表CHD和抑郁症合并症的有效，可改变的风险因素，希望为更有效的预防和干预工作提供信息。

DESCRIPTION (provided by applicant): Depression and Coronary Heart Disease (CHD) are each prevalent disorders, which frequently co-occur. Approximately 15-23% of individuals recovering from a heart attack (e.g., myocardial infarction; MI) will meet criteria for major depression and up to 65% will experience elevations in depressive symptoms. Yet, history of depression and disease severity are only moderately predictive of this co-morbidity. Importantly, depression is embedded within social context and, in particular, depression is strongly associated with marital adjustment. The primary goal of the current research is to examine if individuals with worse marital adjustment experience higher levels and a more persistent course of depressive symptoms following MI, in a 6-mo, 3-wave, prospective study of 150 men and women. Some research suggests that marital distress and depressive symptoms are more closely linked in women than in men. Therefore, the current research will examine if gender moderates the associations between marital adjustment and level and course of depression, with the hypothesis that associations will be stronger for women than for men. Previous research suggests that depression and possibly marital adjustment represent risk factors for negative physical health outcomes following MI. Further, when psychosocial risk factors occur in combination, the probability of negative outcomes is likely to increase substantially due to additive or synergistic effects. A secondary goal of the study will therefore be to examine the joint and independent effects of depression and marital adjustment on quality of life, functional status, and the probability of recurrent events following Ml. Women may experience worse outcomes following MI, and psychosocial factors could contribute to this trend. The proposed research will therefore examine if gender moderates the relationships between depression, marital adjustment, and health outcomes following CHD, with the hypothesis that effects will be stronger for women than for men. The broader goal of the proposed research is to identify aspects of social functioning that could represent potent, modifiable risk factors for CHD and depression co-morbidity, in the hopes of informing more effective prevention and intervention efforts.