Depressive symptoms in relation to marital and work stress in women with and without coronary heart disease. The Stockholm Female Coronary Risk Study

Abstract

Objective: The aim of this study was to investigate the effect of marital and job stress on depressive symptoms in middle aged women with coronary heart disease (CHD) and healthy women who were cohabiting and currently working. Method: Data were obtained from the Stockholm Female Coronary Risk (FemCorRisk) Study, a population-based case-control study, comprising all women aged 65 years or younger who were admitted for an acute event of CHD between 1991 and 1994. For each patient, an age-matched healthy control was recruited. Marital stress was assessed by a structured interview developed in our research laboratory and work stress by the Karasek demand-control questionnaire. Depressive symptoms were measured by a questionnaire derived from Pearlin et al. [J. Health Soc. Behav. 22 (1981) 337], which was validated by the Beck Depression Inventory. Results: Depressive symptoms were twice as common in women with as in women without coronary disease: Marital stress was statistically significantly associated with depressive symptoms, even after controlling for age, educational level, menopausal status, body mass index (BMI), sedentary lifestyle, cigarette smoking and severity of heart failure symptoms. In both groups, depressive symptoms increased with increasing exposure to marital stress in a graded fashion. Work stress was not associated with depressive symptoms after multivariate adjustment. Conclusions: Marital stress but not work stress is independently related to depressive symptoms in women. Women with coronary disease react similarly to marital stress as healthy women, but depart from a higher level of depression, which may be explained by their poorer health status.