Cardiovascular health status and its association with psychological distress and self-care among rural caregivers of patients with chronic disease

Abstract Background Caregivers of patients with chronic disease are at increased risk for developing cardiovascular disease (CVD). Rural caregivers may face additional barriers to engaging in their own self-care often experience psychological distress related to caregiving role. The American Heart Association (AHA) recommends assessing cardiovascular health using Essential 8 components. However, limited information is available on cardiovascular health status (CHS), as defined by AHA’s Life Essential 8, among rural caregivers. Purpose The aim of this study was to evaluate CHS among rural caregivers and to examine association among psychological distress, self-care engagement, and CHS in rural caregivers of patients with chronic illness. Methods This secondary data analysis used baseline data of a randomized controlled trial evaluating a CVD risk-reduction program for rural caregivers. A composite CHS score (range 0 to 100), consistent with AHA Life Essential 8 metrics, was derived from food frequency survey (Health Eating Index 2015 score), physical examination measures, medication and comorbidity history and validated survey measures. Psychological distress was assessed Zarit Burden Interview (caregiving burden), Patient Health Questionnaire-9 (depressive symptoms), Oberst Caregiving Burden Scale (caregiving time and difficulty), Perceived Stress Scale (overall perceived stress). Self-care engagement was assessed using MOS-Specific Adherence Scale. Bivariate associations were examined using t-test, ANOVA, and Pearson correlations. Hierarchical multiple regression analyses were conducted to evaluate the extent to which psychosocial factors and self-care predict CHS while controlled age and sex. Results Among 311 rural caregivers (mean age = 54.8 years; 76% female), only 9% has a CHS score 75 or greater, and 25% scored less than 50. The mean CHS score was 57.4, indicating overall poor cardiovascular health status. The CHS score did not differ by sex, but was associated with age (r = 0.166, P= 0.003). The CHS was significantly associated with caregiving burden (r = 0.142), depressive symptoms (r = -0.407), perceived stress (r = -0.210), and self-care adherence (r= 0.344), but not with caregiving time or difficulty. In multivariable model controlling age and sex, depressive symptoms (β = -.445, P .001) and self-care (β = .265, P .001) were the significant predictors of CHS. Conclusion Rural caregivers’ cardiovascular health status was generally poor based on the AHA’s Life Essential 8 metrics. Depressive symptoms were the strongest predictor of worse cardiovascular health status, whereas greater self-care adherence was associated better cardiovascular health. Screening for and managing depressive symptoms and supporting caregivers’ own self-care may improve cardiovascular health and ultimately reduce CVD risk in rural caregiver populations.