Identifying illness perception schemata and their association with depression and quality of life in cardiac patients

The purpose of this paper is to identify groups of cardiac patients who share similar perceptions about their illness and to examine the relationships between these schemata and psychosocial outcomes such as quality of life and depression. A total of 190 cardiac patients with diagnoses of myocardial infarction, stable angina pectoris or chronic heart failure, completed a battery of psychosocial questionnaires within four weeks of their admission to hospital. These included the Brief Illness Perceptions Questionnaire (BIPQ), Beck Depression Inventory II (BDI II) and The MacNew Health-related Quality of Life instrument (MacNew). BIPQ items were subjected to latent class analysis (LCA) and the resulting groups were compared according to their BDI II and MacNew scores. LCA identified a five-class model of illness perception which comprised the following: (1) Consequence focused and mild emotional impact, n?=?55, 29%; (2) Low illness perceptions and low emotional impact, n?=?45, 24%; (3) Control focused and mild emotional impact, n?=?10, 5%; (4) Consequence focused and high emotional impact, n?=?60, 32%; and (5) Consequence focused and severe emotional impact, n?=?20, 10%. Gender and diagnosis did not appear to reflect class membership except that class 2 had a significantly higher proportion of AMI patients than did class 5. There were numerous significant differences between classes in regards to depression and health-related quality of life. Notably, classes 4 and 5 are distinguished by relatively high BDI II scores and low MacNew scores. Identifying classes of cardiac patients based on their illness perception schemata, in hospital or shortly afterwards, may identify those at risk of developing depressive symptoms and poor quality of life.     

Components of type A behavior and two-year prognosis of patients with acute coronary syndrome

We investigated prospectively the relationship of Type A behavior and its subcomponents with cardiac mortality and recurrent nonfatal cardiac events in a 2-yr. follow-up of 90 patients [69 men and 21 women, M age=56.4 yr., SD=8.4] after acute coronary syndrome. Type A behavior was assessed via the general Bortner Type A Index. Each patient completed the Bortner's scale before hospital discharge. During the first 2-yr. follow-up, there were 14 cardiac deaths among patients with myocardial infarction. 8 patients had recurrent cardiac events and were hospitalized, and 19 patients had an effort-induced angina pectoris. Patients with acute myocardial infarction who died during follow-up had a significantly lower Bortner score than patients with a secondary cardiac event. Bortner scores of patients with acute myocardial infarction who died indicated Type B behavioral patterns. Mortality was significantly higher in the patients classified as showing Type B (21.8%) behavior than in the patients classified as showing Type A (12.0%) behavior. Patients with a secondary cardiac event had more common Type A behavior patterns and higher Bortner scores than patients without a secondary cardiac event. The items on Bortner's scale "very competitive, ever rushed, tries to do too many things at once, fast in daily activities and expresses feelings" were inversely associated with cardiac deaths. These findings suggest that patients with acute coronary syndrome classified by scores on the Bortner scale as Type B behavior have a greater probability of death, and patients classified on the Bortner scale as Type A behavior have a greater probability of secondary cardiac events during follow-up. This finding may have implications for the treatment of patients with acute coronary syndrome. The inferior survival of patients with Type B personalities argues against attempts to modify Type A behavior in postinfarction patients.     

Effects of a post-hospitalization group health education programme for patients with coronary heart disease

Abstract

Effects of a post-hospitolization group health education programme for patients with coronary heart disease. A health education programme was offered to groups of coronary heart patients and their partners after discharge from hospital. A randomized pre-test post-test control group design was used to evaluate the effects of this experimental intervention. The health education programme was offered to 109 coronary heart patients in groups of between five and eight patients together with their partners in addition to standard medical care and physical training. A control group of 108 patients received only standard medical care and physical training.

The intervention consisted of eight weekly two-hour group health education sessions and one follow-up session. All sessions focused on the promotion of healthy habits and the reduction of adverse psychosocial consequences of the incident.

In the short term (about four months after the incident) the health education programme showed statistically significant intervention effects on knowledge about coronary heart diseases, smoking cessation, healthy eating habits and the number of consultations with the family physician, but no effects on emotional distress. In the long term (one year after the incident) there was only a significant intervention effect on smoking cessation.

These results suggest that the effects of the programme are modest, especially in terms of maintenance of behavioural change. As a consequence, it is suggested that the programme should not be offered to all coronary patients during cardiac rehabilitation, but only to those who can be expected to profit most from it.     

Changes in heart rate during feedback control of respiration

Subjects received one of eight treatments: practice at increasing heart rate with heart-rate feedback, practice at decreasing heart rate with heart-rate feedback, practice at increasing heart rate without heart-rate feedback, practice at decreasing heart rate without heart-rate feedback, practice at increasing respiration rate with respiratory feedback, practice at decreasing respiration rate with respiratory feedback, practice at increasing respiration rate with respiratory instructions only, practice at decreasing respiration rate with respiratory instructions only. Heart rate, Respiration rate, and Respiration depth were measured. Analysis indicated that subjects who controlled respiration with respiratory feedback reliably increased and decreased heart rate; subjects who controlled respiration with respiratory instructions only reliably increased but not decreased heart rate; subjects in the respiratory-feedback conditions showed higher heart-rate increase and decrease than heart-rate increase and decrease of subjects in the other six conditions.     

Health Related Quality of Life After Percutaneous Coronary Revascularisation in Patients with Previous Coronary Artery Bypass Grafts: A Two-Year Follow Up Study

Percutaneous coronary revascularisation [PCR] improves angina and health related quality of life [HRQOL] compared to standard medical therapy. It is unknown whether PCR has the same benefits for patients with a history of CABG. Over a period of 5 years, we assessed HRQOL of patients undergoing PCR using Part 1 of the Nottingham Health Profile [NHP] at baseline 3, 12 and 24 months. We compared HRQOL after PCR in 255 patients with CABG to 2680 without. There were more males [81.1% v 69.6% p = 0.002] and older patients [mean age 60.1 years v. 58.0 p = 0.03] in CABG group. Perceived HRQOL improved at 24 months for pain, energy and emotional reaction but the improvement was less in the CABG group. However, mean NHP scores at 24 months for those with CABG had returned to baseline levels for sleep [34.9] and for physical function was worse than at baseline [22.0 vs 30.7]. This relationship persisted after adjustment for male sex, history of previous MI and coronary stent usage. Patients with previous CABG had less improvement in HRQOL after PCR. Further work is needed to assess the benefits and cost effectiveness of PCR in these patients.     

Depression Screening,Assessment, and Treatment for Patients with Coronary Heart Disease: A Review for Psychologists

Depression prevalence is between 15% and 20% in coronary heart disease patients, such as those with angina, or after a myocardial infarction or coronary artery bypass graft surgery. The presence of depression places a coronary heart disease patient at twofold higher risk for further major cardiac events and death, as well as poor quality of life and early exit from the labour force. As a consequence, several learned societies, including the National Heart Foundation of Australia, have published guidelines that recommend questionnaire screening to improve identification and management strategies for depression in coronary heart disease patients. Psychologists in hospitals, community settings, and private practice can have a key role in the realisation of the National Heart Foundation of Australia's aims. We review the recent guidelines and outline implications for psychologists to identify and manage depression in coronary heart disease patients. The evidence reviewed suggests that cognitive‐behavioural therapy and problem‐solving therapy are frontline non‐pharmacological interventions for depression in CHD patients.     

Lifestyle effects of group health education for patients with coronary heart disease

Abstract

In the present study, effects of a health education (INFO) and a PsychoEducational Prevention (INFO + PEP) Programme were Investigated in three hospitals. These programmes were offered to groups of coronary heart disease (CHD) patients and their partners alter discharge from hospital. The INFO was offered to 127 CHD patients in addition to FIT (i.e. standard medical care and physical training). The PEP was offered to 90 Patients in, addition to the INFO and FIT. A control group of 122 patients received only FIT. The INFO and the PEP consisted of four weekly two-hour group sessions each. In addition, the PEP was followed by seven telephone follow-up contacts.

On average, patients improved their lifestyles during the first three months. Between three and twelve months an extra improvement was found for eating habits, whereas there was a relapse for smoking and a sedentary lifestyle. In the short term, angina pectoris and a longer period of heart complaints were parallelled with a decrease in the risk of maintaining unhealthy eating habits, whereas in the long term a longer period of heart complaints a younger age and unemployment predicted a lower risk of maintaining unhealthy eating habits In the short term living with a partner and in the long term female gender were predictive of continued smoking behaviour In the short term, older age, a first CABG and a specific hospital setting decreased the risk of a continued sedentary lifestyle.

The FIT + INFO + PEP had a favourable short-term effect on eating habits. For smoking and a sedentary lifestyle, however, there were negative effects. In the short term patients in the FIT +INFO and those in the FIT +INFO+PEP had significantly more problems in quitting a sedentary lifestyle than those in the FIT intervention in the long term, patients in the FIT + INFO had significantly more problems in stopping smoking compared to these in the FIT.     

Relationship of M.S. Belief Scale scores to depression and anxiety in hospitalized psychiatric patients

The M.S. Belief Scale (MSB) was administered to 61 psychiatric hospital patients on admission and just prior to discharge. Measures of depression and anxiety were also taken before and after hospital treatment. MSB prescores were positively correlated with presenting levels of depression and anxiety. Furthermore, declines in irrational thinking after a treatment program of cognitive-behavioral therapy were associated with declines in levels of depression. Initial levels of irrational thinking did not accurately predict length of hospital stay. The MSB scores for these patients at admission were considerably higher than for other populations previously reported. However, their discharge levels were comparable to normal levels reported by others. The results suggest a relationship between irrational thinking and depression for hospitalized psychiatric patients.Dr. Templeman is a licensed psychologist in private practice in Pendleton, Oregon.     

Personality, type A behavior, and coronary heart disease: the role of emotional expression

The nature of the relation between personality factors and coronary heart disease (CHD, the nation's greatest killer) is one of the most important if controversial issues in the field of psychology and health. Although there is still a great deal of conceptual confusion, progress is being made in refining the key components of a predisposition to heart disease. In this article we examine the construct of a coronary-prone personality in the context of the relations among personality, emotional expression, and disease. Special consideration is given to mode of measurement of the Type A behavior pattern--Structural Interview (SI) versus Jenkins Activity Survey (JAS)--and to components and non-Type A correlates of the general coronary-prone construct. Fifty middle-aged men who had had a myocardial infarction were compared with 50 healthy controls in terms of relevant aspects of their psychological functioning. Results indicate that the SI is better than the JAS as a predictor of coronary heart disease (CHD) because of its attention to emotional expressive style. Traditional emphases on hurry sickness in coronary proneness are deemed wholly inadequate. Furthermore, the results indicate that depression, anxiety, or both may relate to CHD independently of and in addition to Type A behavior. Other aspects of personality and social support are also discussed in the context of improving the construct of coronary proneness.     

A meta-analysis of psychoeduational programs for coronary heart disease patients.

In a meta-analysis of 37 studies, the effects of psychoeducational (health education and stress management) programs for coronary heart disease patients were examined. The results suggest that these programs yielded a 34% reduction in cardiac mortality; a 29% reduction in recurrence of myocardial infarction (MI); and significant (p < .025) positive effects on blood pressure, cholesterol, body weight, smoking behavior, physical exercise, and eating habits. No effects of psychoeducational programs were found in regard to coronary bypass surgery, anxiety, or depression. The results also suggest that cardiac rehabilitation programs that were successful on proximal targets (systolic blood pressure, smoking behavior, physical exercise, emotional distress) were more effective on distal targets (cardiac mortality and MI recurrences) than programs without success on proximal targets.     

The role of masculinity in a prognostic predictor of heart attack severity

Coronary heart disease (CHD) is the leading cause of mortality and morbidity in the United States for both men and women. Men, however, are more likely that women to suffer from CHD at all ages. While previous research has linked Type A behavior to CHD, investigators have failed to note the role traditional masculinity plays in the development of that behavior pattern and in the development of other psychosocial risk factors for CHD. In the present study, 90 postmyocardial infarction patients were interviewed shortly before hospital discharge. The masculinity-CHD relationship was hypothesized to be mediated by masculinity's link to Type A behavior, poor health practices, and impaired social networks. Masculinity, along with these mediating variables, was then expected to be related to the Peel prognostic indicator of heart attack severity. Results indicated that negative or extreme masculinity was related to each of the mediating variables and to heart attack severity, but the effect of masculinity on heart attack severity was not mediated by Type A behavior, poor health practices, or impaired social networks.     

Prevalence and severity of anxiety, depression and Type A behaviors in angina pectoris

The role of psychological factors in coronary heart disease was examined by administering the Bech Rating Scale (BRS) of mood disorders and the Jenkins Activity Survey (JAS) for Type A behavior patterns (TABP) to a consecutive sample of angina patients ( N = 94), to a consecutive sample of noncardiac patients ( N = 47), and to a random sample of adults from the general population ( N = 217). Anxiety and depression were both more frequent and more severe in angina patients than in noncardiac patients or in the general population. There was a tendency for certain components of TABP (i. e. speed, impatience, hard-driving and competitive disposition) to be elevated in angina patients, but a similar trend was noted in noncardiac patients. Although no consistent relations were observed between negative emotions and TABP scores in angina patients, their anxiety and depression scores were reliably related to their use of nitroglycerin. The findings concur with previous studies concerning the presence of anxiety and depression in patients with angina pectoris and indicate that such negative emotions are not closely related to Type A personality traits.     

变异性心绞痛患者心率变异性与冠状动脉病变关系的研究

研究变异性心绞痛患者 ST 段抬高对心率变异性的影响。回顾性分析122例变异性心绞痛患者 ST 段抬高幅度及持续时间对心率变异性的影响;心率变异性与冠状动脉病变及病变支数、狭窄程度有相关性。结果心率变异性在 ST 段抬高≥0．4mv 患者中较 ST 段抬高＜0．4mv 患者中明显降低（P＜0．05）;其在 ST 段抬高持续时间≥3min 患者中较 ST 段抬高持续时间＜3min 患者中明显降低（P＜0．05）;其在冠状动脉狭窄≥50％患者中较冠状动脉狭窄＜50％患者中明显降低（P＜0．05）;心率变异性在多支较单支病变明显降低（P ＜0．05）,单支病变狭窄程度≥75％较50％～75％者明显降低（P＜0．05）。提示变异性心绞痛患者自主神经系统受损程度与冠状动脉缺血严重程度,缺血持续时间密切相关,心率变异性能一定程度反映变异性心绞痛患者冠状动脉病变严重程度。     

Unidimensionality of the Brief Symptom Inventory (BSI) in Adult and Adolescent Inpatients

This study investigated the factor structure of the Brief Symptom Inventory (BSI; Derogatis, 1992) for adult and adolescent psychiatric inpatients. The BSI was administered to 217 adults and 188 adolescents at admission, and discharge from a private psychiatric hospital. Principal components factor analyses revealed that most variance among dimension scores was accounted for by one unrotated factor. Factorial invariance was evident across adult and adolescent samples for admission and discharge scores. Our findings are consistent with previous research on the BSI and Symptom Checklist-90-R (Derogatis, 1977), suggesting that both instruments measure primarily a unidimensional construct of general psychological distress.     

急性冠脉综合征患者血液Rho激酶活性分析

探讨 Rho 激酶（ROCK）活性与急性冠脉综合征（ACS）患者冠状动脉狭窄程度及预后的关系。选取2012年6月至2013年3月住院的129例患者,其中急性心肌梗死（AMI）组68例、不稳定型心绞痛（UA）组30例、对照（CON ）组31例。Western Blot 检测血液白细胞中 ROCK 、ROCK1、ROCK2活性,同时根据冠状动脉的狭窄程度及是否发生心血管意外分组再次比较。 AMI 组和 UA 组 ROCK 、ROCK1、ROCK2活性均增高;且 AMI 组高于 UA 组;三支、双支、单支病变组活性依次减低,Gensini 评分≥20分组及发生心血管意外组均高于 Gensini 评分＜20分组及未发生心血管意外组,差异均有统计学意义（P＜0．05）。 ROCK 活性可能对 ACS 患者预后观察、评估有重要意义。     

Social networks and partner stress as predictors of adherence to medication, rehabilitation attendance, and quality of life following acute coronary syndrome.

OBJECTIVE: This study examined whether social network size and partner stress predicted medication adherence, cardiac rehabilitation attendance, and quality of life 12 months following hospitalization for an acute coronary syndrome (ACS). DESIGN: ACS patients (N = 193, M age = 60.6 years, SD = 11.4 years, 23% female) were recruited shortly following admission to 4 local hospitals. A prospective design was employed with follow-up data collected 12 months following hospital admission. MAIN OUTCOME MEASURES: Data were gathered on social network size and partner stress. The main outcomes assessed at 12 months were medication adherence, cardiac rehabilitation attendance, and quality of life (Short Form 36). RESULTS: Partner stress predicted medication nonadherence, odds ratio: 2.89, (95% CI = 1.21, 6.95). ACS patients with large social networks were more likely to attend rehabilitation, odds ratio: 3.42, (95% CI = 1.42, 8.25). Analyses were adjusted for age, gender, clinical risk scores, readmission/recurrence, and negative affectivity. Both partner stress and smaller social network size were associated with poorer quality of life. CONCLUSION: Social network size and partner stress may partly exert their influence on coronary heart disease morbidity and mortality through recovery behaviors and maintenance of quality of life.     

Cortisol changes interact with the effects of a cognitive behavioural psychological preparation for surgery on 12-month outcomes for surgical heart patients

Previous studies offer contradictory evidence regarding the effects of cortisol changes on health outcomes for surgical heart patients. Increased cortisol and inflammation have been related to psychological stress while separate studies have found an inverse relation between cortisol and inflammation. Psychological preparations for surgery can reduce stress and improve outcomes and may interact with cortisol changes. Following from these relationships, we hypothesised that a preparation for surgery will interact with changes in cortisol to affect outcomes. Measures were the SF 36 General Health and Activities, medical visits and satisfaction. Eighty-five patients were randomly assigned to standard care plus a psychological preparation or standard care alone using a single-blind methodology. Data on psychological and biological functioning were collected at admission, 1 day prior and 5 days post-surgery, and 12-months after hospital discharge. General health and activities, and medical visits were related to the interaction of cortisol change and psychological preparation in support of the hypothesis. Patients were more satisfied in the preparation group than controls. Based on these findings, some outcomes from psychological preparations may be affected by changes in levels of cortisol. These results caution against a one-size-fits-all approach to psychological preparations.     

Satisfaction profile (SAT-P) in 732 patients: Focus on subjectivity in hrqol assessment

Abstract

A 32-item questionnaire aimed at assessing patient's satisfaction about every day life is presented. In the Satisfaction Profile (SAT-P) patients are asked to evaluate their own satisfaction level on 32 daily life aspects concerning the last month. 732 participants were enrolled into the study: 490 in-patients suffering from different types of chronic diseases (e.g., chronic heart failure, severe respiratory failure, coronary heart disease) and 242 healthy persons of working age. SAT-P validity was confirmed by comparing its scores with the NHP, EPQ and STAI-X2 scores. The factor analysis extracted 5 factors which corresponded to the hypothesised areas (54% of variance explained). Test-retest reliability and internal consistency were confirmed: Pearson's coefficients were ranging from 0.45 to 0.93 and Cronbach's alpha coefficient was 0.92. SAT-P responsiveness, evaluated by comparing baseline and 6 months follow up scores from 45 chronic heart failure patients, resulted to be satisfatory, although further studies are needed. These results, together with the “user-friendly” structure, the brief administration and scoring time, the simple graphic representation, suggest to consider the SAT-P a useful complementary tool in HRQoL assessment. The Italian, English and French versions are available.     

Reinforcement strength in classical conditioning of leg flexion,freezing, and heart rate in cats

Stable leg-flexion CRs were successfully elaborated in cats receiving tone-strong shock pairings, but not in cats receiving tone-weak shock pairings. Both shock USs elicited reliable flexion URs in the presence of the CS, thus satisfying the contiguity requirement basic to the Pavlovian paradigm. Elaboration of the flexion CRs required a large number of trials relative to the conditioned freezing and decelerative heart rate responses which appeared after only a very few trials in the strong-US cats. As with flexion CRs, freezing and heart-rate responses never developed with the weak-shock US. When the weak-US cats were later switched to the strong US, freezing and heart-rate CRs quickly appeared and flexion CRs appeared after fewer strong-US trials than in cats receiving the strong shock originally. The results were interpreted as supporting a reinforcement conception of classical defense conditioning and as indicating the importance of using a US capable of eliciting emotional responses.     

The Novacco Anger Scale and Jenkins Activity Survey as predictors of cardiovascular reactivity

This study investigated the relationship among anger, the Type A construct, and cardiovascular reactivity. The Novacco Anger Scale and the Jenkins Activity Survey (JAS) were used to measure anger proneness and Type A characteristics, respectively. Twenty-four college males were selected from the upper and lower quintiles of the JAS distribution. During the study, the subjects were exposed to varying levels of experimentally induced challenge, while measurements were taken of heart-rate and blood-pressure changes. The results showed a modest but significant correlation between scores on the Novacco Anger Scale and the JAS. More importantly, scores on the Novacco Anger Scale correlated significantly with heart rate and systolic blood pressure under all challenge conditions, while those on the JAS were unrelated to cardiovascular excitability. These results raise questions about the usefulness of the JAS as a predictor of CHD risk. They are also consistent with the beliefs of other investigators that anger and hostility are the most important Type A behaviors in predisposing patients to coronary heart disease. Additional implications of the study are discussed.