Rural setting raises risk for hopelessness in patients with ischemic heart disease

New research suggests that rural patients with ischemic heart disease may be at higher risk for hopelessness compared with their urban counterparts, particularly if they are unmarried.

“Because we know hopelessness is predictive of death in people with heart disease, health care professionals need to recognize the subgroups who are most at risk and provide guidance and treatment,” Susan L. Dunn, PhD, RN, associate professor and head of the department of biobehavioral nursing science at the University of Illinois-Chicago College of Nursing, said in a press release.

For the descriptive, cross-sectional study, Dunn and colleagues culled data from 628 patients hospitalized for ischemic heart disease in the Great Lakes (n = 516) and Great Plains (n = 112). They stratified rurality level using rural-urban commuting area codes. State hopelessness was defined as a temporary response to new events, whereas trait hopelessness was a habitual outlook toward many areas of life.

Demographic and health history profiles were comparable between rural and urban participants. Approximately 25% of the cohort lived in a rural area, whereas roughly one-third of participants were women and two-thirds were married.

Compared with patients living in urban settings, rural patients demonstrated higher levels of state hopelessness (58.8% vs. 48.8%; OR = 1.5; 95% CI, 1.03-2.18) as measured by the State-Trait Hopelessness Scale. This difference remained statistically significant after adjustment for demographics, depression severity and physical functioning (OR = 1.59; 95% CI, 1.06-2.4; P = .026).

After accounting for covariates, researchers reported a link between marital status and rurality on state hopelessness (P = .02). Moreover, compared with married counterparts, nonmarried individuals had elevated risk for state hopelessness in rural areas (72% vs. 52%; P = .03), but not urban areas (nonmarried, 50.6%; married, 47.8%; P = .559).

Trait hopelessness levels did not significantly differ between rural and urban groups.

Study limitations included the small number of different types of nonmarried patients and limited racial/ethnic diversity, as well as the lack of adjusting for multiple testing.

“These results indicate that we need more information, and there is a need to develop effective prevention and treatment methods for people with heart disease who have feelings of hopelessness,” Dunn said in the release.

The researchers concluded that understanding rurality differences is essential in identifying subgroups most at risk for hopelessness. “Knowledge of hopelessness in rural patients with ischemic heart disease is important for health care professionals in both acute care and outpatient settings, so that they can identify and counsel at-risk patients,” they wrote.