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*Corresponding Author: Alisha Jiwani, Fielding Graduate University.
Citation: Alisha Jiwani, (2024), Higher Income Enhances the Association Between Depressive Symptoms and Cardiovascular Disease, Psychology and Mental Health Care, 8(6): DOI:10.31579/2637-8892/289
Copyright: © 2024, Alisha Jiwani. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 24 June 2024 | Accepted: 04 July 2024 | Published: 10 July 2024
Keywords: cardiovascular; depression; income; sibling; acculturation; south asian indian
This research investigated the relationship between cardiovascular disease (CVD) and depressive symptoms, as well as whether income and sibling count moderated this relationship. The database employed included adults between the ages of 40 and 91 (N = 674, Mean= 59) that completed a general survey as new immigrants. Participant data consisted of demographic information pertaining to participant age and participant sibling count, health information regarding CVD history and depressive symptoms, and income information. The study results show that South Asian Indian immigrants who endorsed a history of CVD were associated with reporting more depressive symptoms. As well, South Asian Indian immigrants with higher reported incomes had a stronger association between CVD history and depression symptoms. The number of siblings did not influence the association between depressive symptoms and a history of CVD. It is possible that high stress occupations, often associated with higher incomes, contribute to the onset of CVD and depressive symptoms.
South Asian immigrants are the most prevalent ethnic population that is growing the most rapidly in the United States [10,14]. By 2055, South Asians are estimated to be the largest immigrant group in the United States, (38% of individuals who were born outside of the United States) [18]. South Asian immigrants are more vulnerable to experiencing depression [20], while also being more likely to develop CVD throughout the lifespan [17]. This population is also susceptible to poverty [4,8,23], a social determinant that limits access to healthcare and social support [4,6]. Larger family size is also linked to increased poverty [3,16].
The aim of this research is to identify the relationship between CVD and depression in the South Asian Indian immigrant population. Income and sibling count may influence the relationship between CVD and depression. Poverty has been associated with psychological difficulties [6]. Additionally, increased sibling count has been linked to an increased likelihood of cardiac problems [21] and an increased risk of developing psychopathology in adulthood [22].
Study Overview
The present study used data from ‘The New Immigrant Survey’ (NIS) database. The adult sample of the 2003 NIS is globally representative, cross-sectional in nature, and based on self-report data [24]. The survey was comprised of 8,573 immigrants who were older than 18 years of age. They had all newly obtained permanent residency status in the U.S. [24]. The NIS consisted of a sample of adults who were allowed to obtain legal permanent residence between May and November 2003 [24]. Approximately three months after receiving legal permanent residency status, adults were contacted for either telephone or face to face interviews, which were conducted in their preferred language [24].
Participants
Within the 2003 NIS archival database, inclusion criteria were those who were between the ages of 18 and 95 at the time of survey completion. Additionally, only participant data from Indian immigrants were included [9].
Procedure
The NIS is made available to the public by visiting opr.princeton.edu. The questionnaire included items pertaining to demographics, pre-immigration experiences, employment, health, healthcare and life insurance, daily activities, income, assets, social variables, and migration history [9]. Following access to the NIS database, the Statistical Package for the Social Sciences (SPSS) was used for data analyses. (IRB No. 21-0315)
Measures
Demographic Questions
Sibling Count – Moderator Variable #1
Sibling count was assessed with the following NIS question:
This variable was continuous. ‘Don’t know’ and ‘Refused to answer’ responses were excluded. Missing and/or erroneous values were also removed.
Health Questions
Cardiovascular Disease – Predictor Variable
The presence of CVD was assessed using the following question as illustrated in the NIS health questionnaire:
These variables were dichotomized by excluding ‘Refused to answer’ and ‘Don’t know’ responses. Missing and/or erroneous values were also removed.
Depressive Symptoms – Outcome Variable
The World Health Organization’s Composite International Diagnostic Interview Short Form (CIDI-SF) was used to assess depression on the NIS health questionnaire [19]. The CIDI-SF was modified from the long form of the CIDI, with aims to vet mental health disorders as indicated by criteria outlined in the Diagnostic and Statistical Manual of Mental Health Disorders, fourth edition (DSM-IV) [19]. The CIDI-SF maintains 93% classification accuracy for the presence of major depression, and possesses good reliability and validity [19].
As outlined below, the questions on the CIDI-SF covered a wide range of symptoms that are typically present in a depressive experience and or episode [19].
A depression scale was created based on the sum of the aforementioned depression items. ‘Refused to answer’ and ‘Don’t know’ responses were excluded, as well as missing or erroneous values.
Income Questions
Gross Income – Moderator Variable #2
Gross income was assessed using the following question as illustrated in the NIS income questionnaire [9]:
| Nomenclature | Conceptual Definition | Measure/Operational Def. | Form of Data | Role |
| CV | Cardiovascular Disease | Has a doctor ever told you that you had a heart attack, coronary heart disease, angina, congestive heart failure, or other heart problems? | Categorical Data: Yes-No | IV: Predictor |
| DP | Depressive Symptoms | Adapted items from the CIDI-SF (7 items) | Continuous (Higher value represents greater presence of depressive symptoms) | DV: Outcome |
| IN | Income | What is your gross income? | Continuous (Higher value represents larger income level) | Moderator |
SC
EL
GE
ED | Sibling Count
English Language Proficiency
Gender
Education Level | How many brothers and sisters do you have in total?
How well do you speak English? How well do you write English? How well do you read English? Are you male or female? What is your highest degree, diploma or certificate that you have received? | Continuous
Categorical Data: Yes-No
Continuous | Moderator
Covariate
Covariate
Covariate |
Table 1: Summary of Variables
Preliminary Considerations
To detect small effects (α = 0.02) in a hierarchical regression model with up to 7 predictors (CVD, poverty status, CVD versus income, CVD versus sibling count, English language proficiency, gender, and education level), a sample of N = 395 was required to yield sufficient power (0.80). The sample of 674 Indian immigrants available for analysis was more than adequate for analytic purposes.
Data analysis
To assess the hypothesis that a history of CVD was associated with depression (or depressive symptoms), the bivariate (unadjusted) association was examined with a t-test for independent samples. Overall number of depressive symptoms served as the outcome variable and two groups, varying in whether or not they have a history of CVD served as the predictor variable. Covariates were then added to what became an Analysis of Covariance, testing the same hypothesis, now with an adjusted model. Further, the second and third hypotheses concerned the moderating role of income and sibling count. Moderation analyses were conducted via PROCESS [7]. The regression-based approach to moderation analysis utilized hierarchical regression models where interaction terms (‘predictor by moderator’) were entered in a second step. Significant (‘predictor by moderator’) interaction effects served as evidence of moderation. Regarding the hypothesis on the moderating role of income, a significant interaction between CVD history and income was
examined for its interactive effects on depressive symptoms at three levels of income. A similar analytic approach was used for the hypothesis concerning the moderating role of sibling count. In this case, three levels of sibling count were entered.
The primary predictor in subsequent analysis (CVD history) and the outcome of interest (presence of depressive symptoms) assumed dichotomous form in the investigation. For this reason, they were not screened for standard distributional assumptions. Other variables, however, assumed a scaled, continuous form, including age, total number of siblings, and gross income. These were screened for both normality and outliers. The age distribution was effectively normal in shape, but both number of siblings and gross income were positively skewed, and screening identified 11 outliers at the high end of each scale (9 or more siblings; gross income >/= 213,000). To address the skewness in these distributions, a square root transformation was
performed on each variable rendering them effectively normal, and yielding only a single outlier for each variable. These outliers were removed. Transformed versions of sibling count and gross income (which serve as moderators in analyses pertaining to hypotheses 2 and 3) were used in the analyses that followed.
| N Statistic | Min Statistic | Max Statistic | Mean Statistic | SD Statistic | Skewness Statistic | Skewness Std. Error | Kurtosis Statistic | Kurtosis Std. Error | |
| Sib Total | 653 | 0 | 18 | 2.73 | 2.04 | 1.67 | 0.09 | 5.50 | 0.19 |
| Sqrt (Sib Count) | 653 | 0.00 | 4.24 | 1.53 | 0.62 | 0.08 | 0.09 | 0.79 | 0.19 |
| Gross Income | 674 | 0.00 | 623000.00 | 51667.39 | 58387.81 | 2.29 | 0.09 | 14.09 | 0.18 |
| Sqrt (Gross Income) | 674 | 0.00 | 789.30 | 178.07 | 141.38 | 0.19 | 0.09 | -0.78 | 0.18 |
Table 2: Descriptive Statistics
Basic demographic characteristics of the final sample available for analysis can be found in Table 3. The original sample of South Asian Indian immigrants to the USA included a total of 771 adults. The current sample was smaller than the original because some outlying cases
were removed (e.g. those 92 or older). The sample was disproportionately male (58.6%) and older than a normative sample from the general population. For example, ages ranged from 40 – 91 (Mean = 59.40) and over one third of the sample was 60 or older. While almost one quarter reported no gross income (22.8%), a considerable number reported incomes higher than 100,000 (16.8%). Participants appeared to come from relatively large families insofar as virtually all had siblings (95.6%) and many reported coming from families with five or more siblings (17.9%). Overall, their health status, as disclosed to interviewer, was primarily good to excellent (95.1%).
| n | % | |
| Gender | ||
| Male | 395 | 58.6 |
| Female | 279 | 41.4 |
Age (M = 59.40, SD = 11.07) Range: 40-91(included) | ||
| 40-49 | 122 | 18.1 |
| 50-59 | 315 | 46.7 |
| 60-69 | 122 | 18.1 |
| 70-79 | 66 | 9.8 |
| 80-89 | 45 | 6.7 |
| 90-99 | 4 | 0.6 |
| 100 or older | ||
| Gross Income (M = 51,667.54, SD = 58,387.81) | ||
| No income | 154 | 22.8 |
| 1 – 35k | 180 | 26.7 |
| 36 – 75k | 132 | 19.6 |
| 76 – 100k | 95 | 14.1 |
| > 100k | 113 | 16.8 |
| Sibling Count (M = 2.73, SD = 2.04) | ||
| 0 | 29 | 4.4 |
| 1 | 179 | 27.4 |
| 2 | 167 | 25.6 |
| 3 | 102 | 15.6 |
| 4 | 59 | 9.0 |
| 5 or more | 117 | 17.9 |
| Health Status (M = 4.06, SD = 0.94) | ||
| Poor | 8 | 1.2 |
| Fair | 25 | 3.7 |
| Good | 156 | 23.1 |
| Very good | 214 | 31.8 |
| Excellent | 271 | 40.2 |
Table 3: Sample Characteristics (N = 674)
| n | % | |
| Heart problem | 9 | 1.3 |
| High Blood Pressure | 55 | 8.2 |
| Heart Attack | 2 | 0.2 |
| Angina | 1 | 0.1 |
| Stroke | 0 | 0.0 |
| Any CVD | 59 | 8.8 |
Table 4: Cardiovascular Disease
| n | % | |
| Felt Sad | 32 | 4.7 |
| Lose Interest | 9 | 1.3 |
| More tired | 10 | 1.5 |
| Lose appetite | 8 | 1.2 |
| Trouble falling asleep | 8 | 1.2 |
| Trouble concentrating | 9 | 1.3 |
| Feel down on self | 6 | 0.9 |
| Think about death | 3 | 0.4 |
| Any Depressive Symptom | 32 | 4.7 |
Table 5: Depressive Symptoms
Apart from the moderators in the proposed model (gross income, number of siblings), demographic characteristics including gender, age, and general health status were examined as possible covariates for subsequent analyses. No gender differences were found, and there was no significant association between age and the outcome of interest (depressive symptoms). There was, however, a small negative correlation between general health and depression (r = -.155, p <
.001) indicating that the more favorable one’s health status the less likely they were to report depressive symptoms. General health status was thus included as a covariate in the regression models that follow.
Association between CVD & Depression
To test the hypothesis that a history of CVD and depressive symptoms in the sample would be associated, a series of chi-square analyses were conducted. There was some evidence supporting the hypothesis, but it appeared to be restricted to one of the eight symptoms of depression (felt sad/depressed). Nevertheless, those with a history of CVD were significantly more likely to report at least one depressive symptom (11.9%) than those with no history of CVD (4.1%). As indicated by the Odds ratio of 3.18, this suggests that those with a history of CVD were more than three times as likely to report a depressive symptom than those with no CVD history.
| Any CVD | |||||
| Depressive Symptoms | No (n = 615) | Yes (n = 59) | χ2 (1) | Sig | Odds Ratio (CI) |
| Felt sad/depressed* | 25 (4.1) | 7 (11.9) | 7.24 | .007 | 3.18 (1.31, 7.70) |
| Lose Interest | 9 (1.5) | 0 (0.0) | 0.88 | .350 | NA |
| Felt more tired | 9 (1.5) | 1 (1.7) | 0.02 | .888 | 1.16 (.15, 9.33) |
| Lose appetite | 7 (1.1) | 1 (1.7) | 0.14 | .706 | 1.50 (.18, 12.38) |
| Trouble falling asleep | 7 (1.1) | 1 (1.7) | 0.14 | .706 | 1.50 (.18, 12.38) |
| Trouble concentrating | 8 (1.3) | 1 (1.7) | 0.06 | .801 | 1.31 (.16, 10.64) |
| Feel down on self | 6 (1.0) | 0 (0.0) | 0.58 | .446 | NA |
| Think about death | 3 (0.5) | 0 (0.0) | 0.29 | .591 | NA |
| Any depressive symptom* | 25 (4.1) | 7 (11.9) | 7.24 | .007 | 3.18 (1.31, 7.70) |
Table 6: The Association between CVD and Depressive Symptoms
In an adjusted logistic regression model, however, CVD did not contribute significantly to the model beyond what could be explained by the general health status covariate χ2 (1) = .970, p = .325. Health status was significantly associated with the presence of depressive symptoms in this model Wald (1) = 10.15, p = .001, OR = .551 (.38, .80), indicating that the better a respondent’s health, the less likely they were to report depressive symptoms.
Nevertheless, a history of CVD was itself associated with health status (β = -.305, p < .001), suggesting that the effects of CVD on depressive symptoms might be indirect. To examine this possibility a mediation model was tested with history of CVD serving as the predictor, health status as the mediator, and the presence of depressive symptoms as the outcome.
The link between CVD and health status was significant, and health status had a significant direct effect on the likelihood of depressive symptoms. The indirect effect of CVD on depressive symptoms was significant B = 0.604 (.14, 1.15) as indicated by a bias-corrected bootstrapped confidence interval excluding zero effect. The finding suggests that a history of CVD
in this sample might make one vulnerable to depressive symptoms that undermine their health status.
Income Moderates the Effects of CVD & Depression
The moderating effects of income on the association between CVD and depressive symptoms was examined with a logistic regression-based approach to moderation analysis using the PROCESS software [7]. In a hierarchical model, the predictor (CVD) and the proposed moderator (income), along with the covariate (health status), entered in a first step, and the interaction between them (CVD versus. Income) entered in a second step. Evidence of moderation takes the form of a significant interaction effect that is then probed with simple slopes analysis.
The (CVD versus Income) interaction effect was significant χ2 (1) = 4.02, p = .045 indicating that the effects of CVD on depressive symptoms was different for those with different income levels. More specifically, analysis of the conditional effects of CVD on depressive symptoms at low (-1 SD), mean, and high (+1 SD) income levels indicated that the effect of interest was restricted to those with relatively high income in this adjusted model (i.e. controlled for overall health status).
| Co-efficient | SE | Z | p | LLCI | ULCI | |
| Constant | -.4152 | .7343 | -.5655 | .5718 | -1.8544 | 1.0240 |
| CVD | .6315 | .4893 | 1.2907 | .1968 | -.3274 | 1.5905 |
| Gross Income | -.0002 | .0015 | -.1315 | .8954 | -.0031 | .0027 |
| CVD x Income | .0074 | .0037 | 1.9817 | .0475 | .0001 | .0147 |
| Health Status | -.7072 | .1950 | -3.6259 | .0003 | -1.0894 | -.3249 |
Table 7: Gross Income Moderates the Association Between CVD and Depressive Symptoms
The three lines in Figure 1 represent the association between CVD and depressive symptoms at three levels of the moderator (low income, mean income, high income). The blue line at the top represents the significant (positive) association between CVD and depressive symptoms for those with relatively high income. The middle red line represents the non-significant, small positive association among those with mean level income. The bottom gray line represents the slight, non-significant negative association for those with relatively low income.
Figure 1: Income Moderation Effect
The moderating effects of sibling count on the association between CVD and depressive symptoms was examined with a logistic regression-based approach to moderation analysis using the PROCESS software [7]. In a hierarchical model, the predictor (CVD) and the proposed moderator (sibling count), along with the covariate (health status) were entered in a first step, and the interaction between them (CVD versus. Sibling Count) was entered in a second step. There was no evidence of moderation.
The (CVD versus. Sibling Count) interaction effect was not significant χ2 (1) = 0.244, p = .8760, indicating that the effects of CVD on depressive symptoms was not different for those with different numbers of siblings. More specifically, analysis of the conditional effects of CVD on depressive symptoms at low (-1 SD), mean, and high (+1 SD) sibling count indicated that an effect of interest was not present across degrees of sibling count in this adjusted model (i.e. controlled for overall health status). The absence of moderation is depicted in Figure 2. Precisely, the effects (CVD > dep symptoms) are essentially the same at the three levels of sibling count (low, mean, high).
| Co-efficient | SE | Z | p | LLCI | ULCI | |
| Constant | -.3955 | .7317 | -.5405 | .5889 | -1.8296 | 1.0386 |
| CVD | .3053 | .5385 | .5669 | .5708 | -.7502 | 1.3608 |
| Sqrt Sib | -.0446 | .3256 | -.1368 | .8912 | -.6827 | .5936 |
| Interaction 1 | -.1221 | .7800 | -.1565 | .8756 | -1.6509 | 1.4067 |
| Health Status | -.7038 | .1940 | -3.6272 | .0003 | -1.0840 | -.3235 |
Table 8: Sibling Count Does Not Moderate the Association Between CVD and Depressive Symptoms
Figure 2: Absence of Sibling Count Moderation
This study first aimed to evaluate the association between CVD history and depressive symptoms among South Asian Indian immigrants. The first research hypothesis predicted that there would be a positive correlation between CVD history and depressive symptoms. This hypothesis was supported. South Asian Indian immigrants who endorsed a history of CVD experienced more depressive symptoms. This is consistent with earlier research [11,17]. The second research hypothesis predicted that the association between CVD history and depressive symptoms would be moderated by income, in that the association between depressive symptoms and a history of CVD would be more pronounced for those with a lower income. This hypothesis was not supported. It is possible that participants in this study with lower incomes did not have the means to purchase cigarettes, alcohol, or excess amounts of food to develop risk factors for CVD. On the contrary, South Asian Indian immigrants with higher reported incomes had a stronger association between CVD history and depressive symptoms. It is possible that the participants in this study with high incomes had high stress occupations, which contributed to the onset of CVD and depressive symptoms. This may have occurred by metabolic and/or behavioral pathways. However, this is an unexpected finding given that previous research had identified low income as a risk factor [2,6]. Lastly, the final hypothesis predicted that the association between CVD history and depressive symptoms would be more pronounced for those with more siblings. This hypothesis was not supported as there was no evidence of moderation. Hence, the number of siblings did not influence the association between depressive symptoms and a history of CVD.
It is important to note that the rates of depressive symptoms and CVD histories endorsed are remarkably low relative to prevalence rates in India and the United States. To further illustrate, 48.6% of Americans had some facet of CVD [15]. Regarding past 12-month depression, prevalence among Americans in 2020 was 1 in 10 adults (10%) and 1 in 5 adolescents (20%) [5]. In 2022, the prevalence rate of CVD in India was 29% for 45 years of age and older [13]. In terms of the prevalence of depression in India, approximately 33% of patients seeking medical care may have depressive symptoms [1]. The prevalence of major depressive disorder/depressive episode is estimated to range from 3.2%-4.7% [1]. When comparing these statistics to the rates endorsed in the current study, it is possible that lower reported rates of depressive symptoms (4.7%) and CVD history (8.8%) may be attempts to withhold information. The participants may have feared that disclosing mental and physical health issues would potentially jeopardize their residency/visa status, as well as access to immigration benefits. From a cultural lens, it is common for South Asian Indians to underreport symptoms given that their cultural milieu tends to discourage the expression of vulnerability [12].
Furthermore, the low prevalence rates of CVD and depressive symptoms in this sample may relate to self-selection bias. Specifically, immigrating to the U.S. could increase access to greater resources and higher levels of education as opposed to what is available to those remaining in India. Low reported occurrences of CVD and depressive symptoms in this study may also relate to improved living conditions and greater income opportunities for those immigrating to the U.S. relative to those who remain in India. Taken together, access to more opportunities and resources may enhance one’s quality of life, thereby reducing the rates of depressive symptoms and CVD.
As previously mentioned, the low rates of depressive symptoms and CVD histories make it difficult to statistically detect differences and effects. In essence, these low rates compromise the power available for the analysis. The second limitation of this study is that it utilized an archival database. Hence, there was no way to oversee the data collection process or control for the quality of data that was obtained. A third limitation of this research is that self-report data were provided for all of the variables used in this study. Self-report data may not accurately reflect actual prevalence rates and experiences given that culturally, South Asian Indians are less inclined to report medical and mental health symptoms or conditions. Positive impression management and social desirability effects may influence what the participants disclosed at the time. As previously noted, attaining certain immigration benefits and ensuring the permanence of one’s residency status may have influenced what they chose to share or not share about themselves. Another limitation of this study is that the sample was confined to immigrants who had resided in the United States for at least one year, at which time they received legal permanent residency status. Therefore, other long-term immigrants, as well as undocumented immigrants, would have been excluded, leaving these populations disproportionately represented in the data that were analyzed.
This study provides additional support for the longstanding relationship between CVD and depressive symptoms, and also holds true for South Asian Indian immigrants. It also calls attention to the role of high-income level in the relationship between CVD and depressive symptoms in this population. Future research on noncommunicable diseases among South Asian Indian immigrants should be conducted to decrease the burdens of healthcare costs, inform the medical and psychological communities that work with these individuals, and improve the well-being of South Asian Indian immigrants new to the United States.
Future research should further investigate the unexpected finding of this study; higher income appears to yield a more pronounced relationship between CVD history and depressive symptoms in South Asian Indian Immigrants residing in the United States. Investigating these questions, to a greater extent, may expand the existing knowledge base as it relates to the variables that influence the physical and mental health of South Asian Indian immigrants. Perhaps the underlying mechanisms that contribute to the relationship between CVD and depressive symptoms differ across income, whereby collective pathophysiological factors are more responsible among individuals with higher incomes than behavioral pathways. These are essential questions to address in future research. Collecting data from various sources in future research may enhance reliability and validity, therefore increasing the power and generalizability of the research. These findings may be useful in developing preventative measures for individuals in this demographic to safeguard against the co-occurrence of CVD and depressive symptoms.
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We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
