Examining Depressive Symptoms Over Time in Women with Coronary Heart Disease

Coronary heart disease (CHD) is the number one killer of women in the US. Women also experience roughly twice as much depression as men, and depression in CHD is associated with increased morbidity and mortality. Despite these facts, women continue to be under-represented in CHD research, and results by gender are not routinely reported. Screening for depression in this population is problematic due to inconsistent inclusion of somatic symptoms on screening instruments and disagreement about appropriate cutoff scores. This body of work clarifies the concept of depression in women with CHD, presents a systematic review of the longitudinal literature on depressive symptoms in women with CHD examined by instrument, and presents results of a 3-month feasibility study examining women’s depressive symptoms. The purpose of the study was to evaluate participant enrollment, data collection, preliminary quantitative trends, and qualitative surveys for qualitative data collection. Participant recruitment by individuals other than the P.I. was generally poor and attrition was problematic (16.7 – 28%). Prevalence of mean depression screening scores ≥ cutoff values averaged 30% at baseline, 26% at month 2, and 25% at month 3. Trends in symptom severity over the course of the study reflected trends in somatic symptoms and distress but not cognitive symptoms. Current depression was strongly correlated with fatigue and sleep as well as younger age, comorbid diabetes, a history of anxiety, and acute coronary syndrome symptoms. It was less strongly correlated with a history of depression and cardiac rehabilitation attendance. No correlation was found between current depression and employment status. Qualitative survey uptake was poor and the original survey was too restrictive, requiring modification. This dissertation clarifies our understanding of the concept of depression in women with CHD and summarizes the longitudinal descriptive literature on depression in women with CHD. The dissertation study enhances our understanding of depressive symptoms experienced in this population, gives some important preliminary data on use of the PROMIS Depression 8b instrument in this population, highlights the importance of screening for depressive symptoms in this population, and emphasizes the ongoing need for CHD studies which examine and report data by gender

Addressing and Evaluating Health Literacy in mHealth: A Scoping Review

BACKGROUND: Recent surveys have revealed many adults have basic or below basic health literacy, which is linked to medical errors, increased illness, and compromised public health. Health literacy as a concept is multi-faceted extending beyond the individual to include social structures and the context in which health information is being accessed. Delivering health information via mobile devices (mHealth) expands the amount of information available while presenting challenges to ensuring these materials are suitable for a variety of literacy needs. The aims of this study are to discover how health literacy is addressed and evaluated in mHealth app development. METHODS: A scoping review of 5 peer-reviewed databases was conducted. Eligible articles were written in English, addressed general literacy or mHealth/digital/eHealth literacy, and collected literacy information in order to incorporate literacy into the design and/or modification of an app or collected literacy information to describe the population being studied. The Health Literacy Online (HLO) United States (U.S.) government guide was used as a framework. RESULTS: Thirty-two articles were reviewed. Articles included health literacy recommendations for all HLO categories and some recommendations not aligned with these categories. Most articles addressed health literacy using specific HLO categories though none incorporated every HLO category. The most common categories addressed engagement and testing of mHealth content. Though several studies addressed health literacy through a formal assessment tool, most did not. Evaluation of health literacy in mHealth was end-user focused and did not extensively evaluate content for fit to a variety of individuals with limited health literacy. CONCLUSIONS: The recommendations seen consistently in our results in conjunction with formal HLO categories can act as beginning steps towards development of a health literacy evaluation tool for mHealth apps themselves. It is clear efforts are being made to reduce barriers to using mHealth for those with literacy deficits, however, it was also clear that this space has room to be more pragmatic in evaluation of mHealth tools for literacy. End user engagement in design and testing is necessary in future mHealth literacy tool development