Abstract
The clinical success of the implantable cardioverter defibrillator (ICD) in reducing mortality suggests that more women will be receiving ICDs in the future. The impact of ICD therapy in women is unique in western societies; the ICDs scar and lump in the pectoral area can lead to body image concerns due to the emphasis on women's physical attractiveness. Social support and roles are challenged because women's reaction to stress has been characterized by a “tend and befriend” response, involving cultivating and utilizing social networks, rather than the “fight or flight” response more typical of men. In addition, a woman's identity as a caretaker and caregiver can be threatened by the actual and perceived activity limitations imposed by the ICD or the underlying heart condition. Finally, reproductive and sexual health are important issues, as 25 to 50% of patients with ICDs report concerns in this area, but also report discomfort in discussing these concerns with their health care providers. The purpose of the present paper is to review the relevant literature and to identify the unique impact of the psychosocial issues of body image, social support and roles, and sexual development and reproductive functioning for women with ICDs across the lifespan. In the absence of complete empirical research data on the impact of these concerns, hypotheses to test in future research are offered.
Keywords: implantable cardioverter defibrillator, women, psychosocial issues, review, lifespan
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References
- 1. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, Daubert JP, Higgins SL, Brown MW, Andrews ML: Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002; 346 (12): 877–883 [DOI] [PubMed] [Google Scholar]
- 2. Wolbrette D, Naccarelli G, Curtis A, Lehmann M, Kadish A: Gender differences in arrhythmias. Clin Cardiol 2002; 25 (2): 49–56 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Schron EB, Exner DV, Yao Q, Jenkins LS, Steinberg JS, Cook JR, Kutalek SP, Friedman PL, Bubien RS, Page RL, Powell J: Quality of life in the antiarrhythmics versus implantable defibrillators trial: Impact of therapy and influence of adverse symptoms and defibrillator shocks. Circulation 2002; 105 (5): 589–594 [DOI] [PubMed] [Google Scholar]
- 4. Sears SF, Conti JB: Quality of life and psychological functioning of ICD patients. Heart 2002; 87: 488–493 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. Ziegelstein RC: Depression in patients recovering from a myocardial infarction. J Am Med Assoc 2001; 286 (13): 1621–1627 [DOI] [PubMed] [Google Scholar]
- 6. Research Agenda for Psychosocial and Behavioral Factors in Women's Health. Washington, DC: Women' Programs Office, American Psychological Association; (1996) [Google Scholar]
- 7. Wolszon LR: Women's body image theory and research: A hermeneutic critique. Am Behav Scientist 1998; 41 (4): 542–557 [Google Scholar]
- 8. Guidici MC: Experience with a cosmetic approach to device implantation. PACE 2001; 24: 1679–1680 [DOI] [PubMed] [Google Scholar]
- 9. Bornholt LJ: Social and personal aspects of self‐knowledge: A balance of individuality and belonging. Learning & Instruction 2000; 10 (5): 415–429 [Google Scholar]
- 10. Dubin AM, Batsford WP, Lewis RJ, Rosenfeld LE: Quality of life in patients receiving implantable cardioverter defibrillators at or before age 40. PACE 1996; 19: 1555–1559 [DOI] [PubMed] [Google Scholar]
- 11. Vitale MB, Funk M: Quality of life in younger persons with an implantable cardioverter defibrillator. Dimens Crit Care Nurs 1995; 14 (2): 100–111 [DOI] [PubMed] [Google Scholar]
- 12. Rierdan J, Koff E, Stubbs ML: Gender, depression, and body image in early adolescents. J Early Adolesc 1988; 8 (2): 109–117 [Google Scholar]
- 13. Pycha C, Gulledge AD, Hutzler J, Kadri N, Maloney J: Psychological responses to the implantable defibrillator: Preliminary observations. Psychosomatics 1986; 27 (12): 841–845 [DOI] [PubMed] [Google Scholar]
- 14. Wethington E, Kessler RC: Perceived support, received support, and adjustment to stressful life events. J Health/Social Behav 1986; 27: 78–89 [PubMed] [Google Scholar]
- 15. Walen HR, Lachman ME: Social support and strain from partner, family, and friends: Costs and benefits for men and women in adulthood. J Social/Personal Relationships 2000; 17 (1): 5–30 [Google Scholar]
- 16. Taylor SE, Klein LC, Lewis BP, Gruenewald TL, Gurung RA, Updegraff JA: Biobehavioral responses to stress in females: Tend‐and‐befriend, not fight‐or‐flight. Psychol Rev 2000; 107 (3): 411–429 [DOI] [PubMed] [Google Scholar]
- 17. Hibbard JH, Pope CR: The quality of social roles as predictors of morbidity and mortality. Soc Sci Med 1993; 36 (3): 217–225 [DOI] [PubMed] [Google Scholar]
- 18. Waldron I, Jacobs JA: Effects of multiple roles on women's health: Evidence from a national longitudinal study. Women & Health 1989; 15 (1): 3–19 [DOI] [PubMed] [Google Scholar]
- 19. Thompson RA: The individual child: Temperament, emotion, self, and personality In Developmental Psychology: An Advanced Textbook (Eds. Bornstein MH, Lamb ME.), p. 377–409. Mahwah, N.J.: Erlbaum Associates, 1999. [Google Scholar]
- 20. Rubin KH, Copian RJ, Nelson LJ, Cheah CSL, Lagace‐Seguin DG: Peer relationships in childhood In Developmental Psychology: An Advanced Textbook (Eds. Bomstein MH, Lamb ME.), p. 451–503. Mahwah, N.J.: Erlbaum Associates, 1999. [Google Scholar]
- 21. Orth‐Gomer K, Wamala SP, Horsten M, Schenck‐Gustafsson K, Schneiderman N, Mittleman MA: Marital stress worsens prognosis in women with coronary heart disease: The Stockholm female coronary risk study. J Am Med Assoc 2000; 284 (23): 2008–3014 [DOI] [PubMed] [Google Scholar]
- 22. Litwak E, Messeri P: Organizational theory, social supports, and mortality rates: A theoretical convergence. Am Soc Rev 1989; 54 (1): 49–66 [Google Scholar]
- 23. Sears SF Jr, Burns JL, Handberg E, Sotile WM, Conti JB: Young at heart: Understanding the unique psychosocial adjustment of young implantable cardioverter defibrillator recipients. PACE 2001; 24: 1113–1117 [DOI] [PubMed] [Google Scholar]
- 24. Pavalko EK, Woodbury S: Social roles as processes: Caregiving careers and women's health. J Health/Social Behav 2000; 41 (1): 91–105 [PubMed] [Google Scholar]
- 25. Papadopoulos C, Beaumont C, Shelley S, Larrimore P: Myocardial infarction and sexual activity of the female patient. Arch Intern Med 1983; 143: 1528–1530 [PubMed] [Google Scholar]
- 26. Paikoff RL, McCormick A, Sagrestano LM: Adolescent sexuality In Psychological Perspectives on Human Sexuality (Eds. Szuchman LT, Mascarella F.), p. 416–439. New York: John Wiley & Sons, Inc., 2000. [Google Scholar]
- 27. Cole SS, Cole TM: Sexuality, disability, and reproductive issues through the lifespan. Sexuality and Disability 1993; 11: 189–205 [Google Scholar]
- 28. Sotile WM, Sears SF Jr: You Can Make a Difference: Brief Psychosocial Interventions for ICD Patients and Their Families. Minneapolis, Minn.: Medtronic, Inc., 1999. [Google Scholar]
- 29. Nichols SK, Wolverton CL: Outcome criteria for patients with implantable defibrillators. Dimens Crit Care Nurs 1991; 10: 274–304 [DOI] [PubMed] [Google Scholar]
- 30. James JE, Albarran JW, Tagney J: Going home: The lived experiences of women following ICD implantation. Adv Clin Nurs 1999; 3: 169–178 [Google Scholar]
- 31. Natale A, Davidson T, Geiger MJ, Newby K: Implantable cardioverter defibrillators and pregnancy: A safe combination? Circulation 1997; 96 (9): 2808–2812 [DOI] [PubMed] [Google Scholar]
- 32. Isaacs JD, Mulholland DH, Hess LW, Allbert JR, Martin RW: Pregnancy in a woman with an automatic implantable cardioverter‐defibrillator. J Reprod Med 1993; 38 (6): 487–488 [PubMed] [Google Scholar]