Symptoms of Depression and Anxiety as Barriers to Participation in Cardiac Rehabilitation Programs among Arab and Jewish Patients in Israel

Noa Vilchinsky, Orna Reges, Morton Leibowitz, Abdulrahim Khaskia, Morris Mosseri, Jeremy D. Kark

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Purpose: Despite its proven effi cacy, low participation rates in cardiac prevention and rehabilitation programs (CPRPs) prevail worldwide, especially among ethnic minorities. This is strongly evident in Israel's Arab minority. Since psychological distress has been found to be associated with CPRP participation and minorities are subjected to higher levels of distress, it is plausible that distress may be an important barrier for CPRP participation among minority patients. The current prospective study assessed the contribution of depression and anxiety symptoms to participation in a CPRP after acute coronary syndrome, both in the enrollment phase and when considering adherence over time, among Jewish (majority) and Arab (minority) patients in Israel. Methods: Patients were interviewed during hospitalization about their emotional status and at a 6-mo follow-up concerning participation in a CPRP. Analyses were performed on 397 patients. The Brief Symptom Inventory was used. Logistic regression modeling was applied. Results: Symptoms of depression, but not anxiety, were frequently observed among Arab patients compared with their Jewish counterparts. In analyses adjusted for age, sex, ethnicity, and sociodemographic and clinical characteristics, having symptoms of anxiety was associated with less participation in a CPRP, evident for both Jews and Arabs; this association was less evident for symptoms of depression. Multivariable adjusted models did not show a signifi cant association of symptoms of anxiety or depression with adherence in a CPRP. Accounting for psychological distress did not reduce the sharp difference between Jews and Arabs in CPRP participation. Conclusion: Symptoms of distress may serve as barriers to CPRP participation, regardless of ethnic origin.

Original languageEnglish
Pages (from-to)163-169
Number of pages7
JournalJournal of Cardiopulmonary Rehabilitation and Prevention
Issue number3
StatePublished - 1 May 2018
Externally publishedYes


  • Acute coronary syndrome
  • Arab minority
  • Israel
  • anxiety
  • cardiac rehabilitation
  • depression


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