The Effects of Depression and Sleep Quality on Somatic Symptoms in Middle-Aged Women with Cardiovascular Risk Factors
Abstract
Background: This descriptive study investigated the effects of sleep quality and depression on somatization symptoms in middle-aged women with cardiovascular risk factors.
Methods: Data were collected from outpatients who visited three general hospitals and one private hospital in Korea between May 2017 and December 2018. Questionnaires and anthropometric data were used to analyze 144 middle-aged women (45–65 years) with at least one cardiovascular risk factor. SPSS and WIN 21.0 software were used for statistical analysis. To test the mediating effects, the relationships between independent variables and somatic symptoms were compared using the t-test, analysis of variance, and χ²-test, and correlations were analyzed using Pearson’s correlation coefficient. Finally, multiple linear regression and the Sobel test were used to identify predictors.
Results: Somatic symptoms showed a positive correlation with depression (r=46, P<0.001) and a strong negative correlation with sleep quality (r=-52, P<0.001). Depression and sleep quality explained 37% of somatic symptom variance in a multiple linear regression analysis after correcting for age (R²=0.37, F=41.53, P<0.001). The Sobel test showed a sleep quality Z-value of 3.78, demonstrating that it was a mediating variable. By adding sleep quality to depressive symptoms, the absolute value of β, which shows the effect’s strength, decreased from .49 to .32, confirming a partial mediating effect.
Conclusion: Depression and sleep quality were predictive of somatic symptoms in middle-aged women with cardiovascular risk factors, and sleep quality had a partial mediating effect on somatic symptoms. To reduce somatic symptoms, strategies that alleviate depression by improving sleep quality are required.
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24. Choi HS, Choi JH, Park KH, et al (2007). Standardization of the Korean Version of Patient Health Questionnaire-9 as a screening instrument for major depres-sive disorder. J Korean Acad Fam Med, 28 (2): 114–119.
25. Kim I, Choi H, Kim B (2014). Psychometric properties of Korean Version of Modi-fied Leeds Sleep Evaluation Question-naire (KMLSEQ). Korean J Rehabil Nurs, 17 (1): 10–7.
26. Jun JY, Kim SJ, Lee YJ, et al (2012). Effect of major depressive disorder and insom-nia on somatization. Sleep Med Psychophysiol, 19 (2): 84–8.
27. Derogatis LR (1977). SCL-90R (revised) Man-ual I. Clinical Psychometrics Research Unit, Baltimore, Johns Hopkins Universi-ty School of Medicine.
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29. Baron RM, Kenny DA (1986). The modera-tor–mediator variable distinction in social psychological research: conceptual, strate-gic, and statistical considerations. J Pers Soc Psychol, 51 (6): 1173-82.
30. Keteepe-Arachi T, Sharma S (2017). Cardio-vascular disease in women: understand-ing symptoms and risk factors. Eur Car-diol, 12 (1): 10–13.
31. van Dijk GM, Kavousi M, Troup J, et al (2015). Health issues for menopausal women: the top 11 conditions have common solutions. Maturitas, 80 (1): 24–30.
32. Ham OK, Kim J, Lee BG, et al (2017). Be-havioral characteristics and cardiovascular disease risks associated with insomnia and sleep quality among middle‐aged women in South Korea. Res Nurs Health, 40 (3): 206–217.
33. Bradley SM, Rumsfeld JS (2015). Depression and cardiovascular disease. Trend Cardio-vasc Med, 25 (7): 614–22
34. Win S, Parakh K, Eze-Nliam CM, et al (2011). Depressive symptoms, physical inactivity and risk of cardiovascular mor-tality in older adults: the Cardiovascular Health Study. Heart, 97 (6): 500–5.
35. Chudasama YV, Zaccardi F, Gillies CL, et al (2020). Leisure‐time physical activity and life expectancy in people with cardiomet-abolic multimorbidity and depression. J Intern Med, 287 (1): 87–99.
36. Kim YS (2014). Physical activity and mental health. Hanyang Med Rev, 34: 60–5.
37. Mayo Clinic (2018). Somatic symptom dis-order. Scottsdale, AZ, USA. https://www.mayoclinic.org/diseases-conditions/somatic-symptom-disorder/symptoms-causes/syc-20377776
38. Stojanovska L, Apostolopoulos V, Polman R, et al (2014). To exercise, or, not to ex-ercise, during menopause and beyond. Maturitas, 77 (4): 318–23.
39. Ekelund U, Ward HA, Norat T, et al (2015). Physical activity and all-cause mortality across levels of overall and abdominal adiposity in European men and women: the European Prospective Investigation into Cancer and Nutrition Study (EPIC). Am J Clin Nutr, 101 (3): 613–21.
40. Lee HJ (2019). How has the value of do-mestic labor changed? Daejeon, South Korea. http://www.kostat.go.kr/sri/srikor/srikor_pbl/4/index.board?bmode=read&aSeq=375607&pageNo=1&rowNum=10&amSeq=&sTarget=title&sTxt=
2. Benjamin EJ, Muntner P, Alonso A, et al (2019). Heart disease and stroke statis-tics—2019 update: a report from the American Heart Association. Circulation, 139 (10): e56–e528.
3. Statistics Korea (2018). Cause of death sta-tistics 2018. Daejeon, South Korea. http://kostat.go.kr/portal/korea/kor_nw/1/6/2/index.board?bmode=read&aSeq=377606&pageNo=&rowNum=10&amSeq=&sTarget=&sTxt=
4. Dosi R, Bhatt N, Shah P, et al (2014). Cardi-ovascular disease and menopause. J Clin Diagn Res, 8 (2): 62–64.
5. Galiuto L, Locorotondo G (2015). Gender differences in cardiovascular disease. J In-tegr Cardiol Open Access, 1 (1): 20–2.
6. Gao Z, Chen Z, Sun A, et al (2019). Gender differences in cardiovascular disease. Med Nov Technol Devices, 4: 100025.
7. Beutel ME, Wiltink J, Ghaemi Kerahrodi J, et al (2019). Somatic symptom load in men and women from middle to high age in the Gutenberg Health Study—association with psychosocial and somat-ic factors. Sci Rep, 9 (1): 4610.
8. Crawford SL (2012). Detecting cross-cultural differences in somatization. Menopause, 19 (2): 121–2.
9. O’Neil A, Fisher AJ, Kibbey KJ, et al (2016). Depression is a risk factor for incident coronary heart disease in women: an 18-year longitudinal study. J Affect Disord, 196:117-24.
10. Shifren JL, Gass ML (2014). The North American Menopause Society recom-mendations for clinical care of midlife women. Menopause, 21 (10): 1038–62.
11. Kohlmann S, Gierk B, Hümmelgen M, et al (2013). Somatic symptoms in patients with coronary heart disease: prevalence, risk factors, and quality of life. JAMA In-tern Med, 173 (15): 1469–71.
12. Korea Centers for Disease Control and Prevention (2020). 2019 chronic disease status and issues. Chungcheongbuk-do, Republic of Korea. http://www.cdc.go.kr/gallery.es?mid=a20503020000&bid=0003&b_list=9&act=view&list_no=144581&nPage=1&vlist_no_npage=1&keyField=&keyWord=&orderby=
13. Worrall‐Carter L, Ski C, Scruth E, et al (2011). Systematic review of cardiovascu-lar disease in women: assessment of risk. Nurs Health Sci, 13 (4): 529–35.
14. Kling JM, Miller VM, Mankad R, et al (2013). Go Red for Women cardiovascu-lar health screening evaluation: the di-chotomy between awareness and percep-tion of cardiovascular risk in the com-munity. J Womens Health (Larchmt), 22 (3): 210–8.
15. Bushnell C, McCullough LD, Awad IA, et al (2014). Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the Ameri-can Heart Association/American Stroke Association. Stroke, 45 (5): 1545–88.
16. Haidinger T, Zweimüller M, Stütz L, et al (2012). Effect of gender on awareness of cardiovascular risk factors, preventive ac-tion taken, and barriers to cardiovascular health in a group of Austrian subjects. Gend Med, 9 (2): 94–102.
17. Mosca L, Benjamin EJ, Berra K, et al (2011). Effectiveness-based guidelines for the prevention of cardiovascular disease in women—2011 update: a guideline from the American Heart Association. Circula-tion, 123(11):1243-62.
18. Peng Y, Li W, Wang Y, et al (2015). The cut-off point and boundary values of waist-to-height ratio as an indicator for cardio-vascular risk factors in Chinese adults from the PURE study. PloS One, 10 (12): e0144539.
19. Yoo EG (2016). Waist-to-height ratio as a screening tool for obesity and cardiomet-abolic risk. Korean J Pediatr, 59 (11): 425–431.
20. Gong S, Zhang Y, Jin C, et al (2019). Clini-cal characteristics and related factors of somatization symptoms of outpatients with psychological disorders: a cross-sectional observational study. Research Square. doi: 10.21203/rs.2.14740/v1.
21. World Health Organization (2008). Waist circumference and waist-hip ratio: report of a WHO expert consultation. Geneva, Switzerland. https://www.who.int/nutrition/publications/obesity/WHO_report_waistcircumference_and_waisthip_ratio/en/
22. Lin CH, Chiang SL, Yates P, et al (2015). Moderate physical activity level as a pro-tective factor against metabolic syndrome in middle‐aged and older women. J Clin Nurs, 24 (9–10): 1234–45.
23. Jeon JA (2016). Korean women's mental health indicators. Health and Welfare Fo-rum, 235: 47–60. https://www.kihasa.re.kr/common/filedown.do?seq=35198
24. Choi HS, Choi JH, Park KH, et al (2007). Standardization of the Korean Version of Patient Health Questionnaire-9 as a screening instrument for major depres-sive disorder. J Korean Acad Fam Med, 28 (2): 114–119.
25. Kim I, Choi H, Kim B (2014). Psychometric properties of Korean Version of Modi-fied Leeds Sleep Evaluation Question-naire (KMLSEQ). Korean J Rehabil Nurs, 17 (1): 10–7.
26. Jun JY, Kim SJ, Lee YJ, et al (2012). Effect of major depressive disorder and insom-nia on somatization. Sleep Med Psychophysiol, 19 (2): 84–8.
27. Derogatis LR (1977). SCL-90R (revised) Man-ual I. Clinical Psychometrics Research Unit, Baltimore, Johns Hopkins Universi-ty School of Medicine.
28. Sereda Y, Dembitskyi S (2016). Validity as-sessment of the symptom checklist SCL-90-R and shortened versions for the general population in Ukraine. BMC Psy-chiatry, 16 (1): 300.
29. Baron RM, Kenny DA (1986). The modera-tor–mediator variable distinction in social psychological research: conceptual, strate-gic, and statistical considerations. J Pers Soc Psychol, 51 (6): 1173-82.
30. Keteepe-Arachi T, Sharma S (2017). Cardio-vascular disease in women: understand-ing symptoms and risk factors. Eur Car-diol, 12 (1): 10–13.
31. van Dijk GM, Kavousi M, Troup J, et al (2015). Health issues for menopausal women: the top 11 conditions have common solutions. Maturitas, 80 (1): 24–30.
32. Ham OK, Kim J, Lee BG, et al (2017). Be-havioral characteristics and cardiovascular disease risks associated with insomnia and sleep quality among middle‐aged women in South Korea. Res Nurs Health, 40 (3): 206–217.
33. Bradley SM, Rumsfeld JS (2015). Depression and cardiovascular disease. Trend Cardio-vasc Med, 25 (7): 614–22
34. Win S, Parakh K, Eze-Nliam CM, et al (2011). Depressive symptoms, physical inactivity and risk of cardiovascular mor-tality in older adults: the Cardiovascular Health Study. Heart, 97 (6): 500–5.
35. Chudasama YV, Zaccardi F, Gillies CL, et al (2020). Leisure‐time physical activity and life expectancy in people with cardiomet-abolic multimorbidity and depression. J Intern Med, 287 (1): 87–99.
36. Kim YS (2014). Physical activity and mental health. Hanyang Med Rev, 34: 60–5.
37. Mayo Clinic (2018). Somatic symptom dis-order. Scottsdale, AZ, USA. https://www.mayoclinic.org/diseases-conditions/somatic-symptom-disorder/symptoms-causes/syc-20377776
38. Stojanovska L, Apostolopoulos V, Polman R, et al (2014). To exercise, or, not to ex-ercise, during menopause and beyond. Maturitas, 77 (4): 318–23.
39. Ekelund U, Ward HA, Norat T, et al (2015). Physical activity and all-cause mortality across levels of overall and abdominal adiposity in European men and women: the European Prospective Investigation into Cancer and Nutrition Study (EPIC). Am J Clin Nutr, 101 (3): 613–21.
40. Lee HJ (2019). How has the value of do-mestic labor changed? Daejeon, South Korea. http://www.kostat.go.kr/sri/srikor/srikor_pbl/4/index.board?bmode=read&aSeq=375607&pageNo=1&rowNum=10&amSeq=&sTarget=title&sTxt=
| Files | ||
| Issue | Vol 52 No 3 (2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v52i3.12134 | |
| Keywords | ||
| Somatization Women Cardiovascular Sleep quality Depression | ||
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How to Cite
1.
Kim KA. The Effects of Depression and Sleep Quality on Somatic Symptoms in Middle-Aged Women with Cardiovascular Risk Factors. Iran J Public Health. 2023;52(3):515-524.
