Character-strength hope/optimism may protect mental health in patients undergoing stressful open-heart surgery: Gender differences?

Depression and anxiety are mental health indicators associated with mortality risks in cardiac diseases. As part of character strength hope/optimism, optimism is evident for its survival benefits in cardiac disease patients but has rarely been examined in those undergoing open-heart surgery (OHS)—a stressful lifesaving procedure. Women with cardiac diseases have disadvantages compared to men. This interdisciplinary study evaluated a hypothetical model on the effect of pre-OHS optimism on post-OHS mental health and gender differences. A three-wave clinical study was conducted before and 1 month following OHS in a cohort of U.S. patients (N = 312). Structural equation modeling was performed to estimate final solutions. Optimism was indicated by two subconstructs, optimism and optimism-R. Whole-group paired t-tests showed reduced scores of anxiety but increased scores of depression, postoperatively compared to preoperatively. However, the increase in depression was only significant for women. The final structural equation modeling solution supported the mediation of pre-OHS hope/optimism between levels of pre- and post-OHS depression and anxiety, but no mediation for gender effects. Women reported poorer mental health both pre- and post-operatively compared to men, while post hoc analysis found no gender—optimism interaction. The findings suggest that character strength hope/optimism may be protective for the mental health of both men and women undergoing OHS. Reduction in post-OHS anxiety suggests the stressful nature of OHS. Women’s poor mental health reinforces the literature on their biopsychosocial disparities. However, their rising levels of post-OHS depression must be explained beyond psychological phenomena and OHS-related physical trauma. Pre-OHS stress management should consider these facts for patient-centered care.