J Cardiovasc Nurs. 2025 Sep 3. doi: 10.1097/JCN.0000000000001255. Online ahead of print.
ABSTRACT
BACKGROUND: Older adults with heart disease experience higher rates of depression and insomnia compared with heart disease-free peers. Aside from these psychological disturbances, overall health satisfaction, as a key indicator of subjective health status, may be affected by heart disease status. In spite of these overall associations, symptom-level relationships between depression, insomnia, and health satisfaction remain unclear.
OBJECTIVE: We aimed to compare the prevalence and symptom network differences of these variables between older adults in the United States with and without heart disease.
METHODS: Network analyses were conducted on data from the 2022 wave of the Health and Retirement Study. Propensity score matching identified 2 demographically similar groups: 2861 cohorts with heart disease and 2861 heart disease-free peers. Depression was measured using the 8-item dichotomous version of the Center for Epidemiologic Studies Depression Scale. Insomnia was assessed using the 4-item Jenkins Sleep Scale. Health satisfaction was evaluated with a standardized self-report item querying perceived overall health status on a 5-point Likert scale ranging from “poor” to “excellent.” Central and bridge symptoms were identified using expected influence and bridge expected influence metrics.
RESULTS: Depression prevalence was higher in the heart disease group (19.8%; 95% confidence interval [CI], 18.4%-21.3%) than in the heart disease-free group (11.8%; 95% CI, 10.7%-13.1%; P < .001), with more severe depressive symptoms in the heart disease group (1.8 ± 2.18 vs 1.3 ± 1.83, P < .001). Similarly, the prevalence of having at least 1 insomnia symptom was significantly higher in the heart disease group (48.2%; 95% CI, 46.4%-50.1%) than the heart disease-free group (36.3%; 95% CI, 34.6%-38.1%; P < .001), with more severe insomnia symptoms in the heart disease group (0.9 ± 1.13 vs 0.6 ± 0.92) (P < .001). Network models revealed similar structures between groups. Key central symptoms across these groups included “feeling sad,” “lack of happiness,” and “feeling depressed.” Bridge symptoms were “feeling tired in the morning” and “trouble falling asleep.” “Everything was an effort” was strongly associated with lower health satisfaction across groups.
CONCLUSIONS: Older adults with heart disease exhibited a higher prevalence of depression and more severe overall depressive and insomnia symptoms. Identified central and bridge symptoms may be potential markers of co-occurring conditions and could inform future intervention research aimed at reducing comorbidity. Given the similar symptom structures, interventions developed for heart disease-free adults may also be applicable to those with heart disease, although randomized control trials are needed to establish causal effects.
PMID:40900013 | DOI:10.1097/JCN.0000000000001255
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